Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study 2017;88(14):131320. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. CAS First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). All data were prospectively collected from consecutively recruited patients who were admitted to our stroke unit under the suspected diagnosis of an acute stroke between October 2010 and June 2013. Article Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. 1988;19(12):1497500. Engel GL. (2009) [40] reported that severe periventricular white matter disease was significantly associated with poor functional outcome at 3months after ischemic stroke, independently of other factors. At follow-up assessment, group M showed the best distribution of mRS scores in direction to better ones and group D the worst with a significant higher mean score of mRS. Group-related changing in mRS scoring between time points t1 (baseline) and t2 (6months follow-up), group D patients with dissection; group I patients with ischemia without dissection; group M stroke mimics; mRS modified Rankin Scale; n. s. not significant, * significant difference. 2007;21(2):1618. This option is also for people with hemorrhagic stroke. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. Living With Whats it like living Because data on the potential impact of infarct volume to outcome and QOL in VAD patients have been lacking so far, we used at least a very arbitrary method for semiquantitative evaluation of the extension of infarct lesions and were not able to ascertain any statistical association. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 2008;52(2):2028. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. Their high PTSD prevalence might be overestimated because physically less affected people voluntarily participating in their study might have tended to mention more mental problems when asked by self-rating PDS. Measuring quality of life in a way that is meaningful to stroke patients. TOAST. A dissection forms when theres a tear in one or more of its three tissue layers. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). The functional outcome, however, seems to be usually good in the majority of cases but there is still a lack of knowledge about the natural history of VAD and uncertainty concerning the appropriate follow-up management. Not applicable. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. 2010;17(2):21925. J Psychiatr Res. Although there was a preponderance of atrial fibrillation in group I, no significant group differences of neurovascular risk factors were found in line with current knowledge about VAD characteristics [3, 35]. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. Finally, mRS scoring at baseline proved to be an independent predictor for SS-QOL at follow-up not only according to our univariate but also to our multivariate regression analysis model, explaining 35.9% of QOL variance according to our regression model. Achievable are 14 to 98 points from 14 items. Stress revisited: a critical evaluation of the stress concept. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. [13] and in the context of a fitting medical history, i.e. The hospital anxiety and depression scale. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. WebThe vertebral arteries are part of the circulatory system. Quality of life in survivors after cervical artery dissection. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. Neurosci Biobehav Rev. In a subsequent multiple regression analysis, neurocognition at baseline measured by MMSE, neurostatus at baseline measured by mRS and posttraumatic stress symptoms measured by PTSS-14 proved to be independent predictors for the quality of life at follow-up, explaining in combination 71% of its variance. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. The clinical application of the biopsychosocial model. 1977;86(2):10326. Neurorehabil Neural Repair. Important non-vascular incidents were a newly diagnosed prostate cancer with radiation therapy in group D and an inpatient treatment for depression in one patient as well as a single epileptic seizure in another one in group I. In this context the following aspects seem to be worthy to note: First, elevated scores of stress symptoms were also found in patients without any stroke lesion in our study in line with other study results [50]. In contrast to younger people who are supported by their also young family as well as the health system to achieve occupational reintegration as fast as possible, elderly people may be limited by less easy access to rehabilitation facilities, less support by potentially also disabled caregivers and, probably most important, by potential comorbidities and/or neurovascular risk factors. PubMed Speck et al. (2014) [46], mean age 44.8years. VAD affected the right side in 13 patients (38.2%), the left side in 18 patients (53%), and both sides in three patients (8.8%). N Engl J Med. All patients presented with acute myocardial infarction (MI) (26% ST-segment elevation MI [STEMI], 74% NSTEMI) and approximately 70% reported an emotional or physical stressor. Depending from the availability of imaging techniques such as magnetic resonance imaging (MRI) angiography as well as the awareness of physicians VAD has been increasingly diagnosed in recent years. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. At first I just had a very bad neck pain, couldn't move it much. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. The PTSS-14 was developed by Twigg et al. Because of the great Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. The MRI-based evaluation of white matter lesions (WML) was reported because of previously published data about their potential role for the functional outcome [40] and neuropsychological performance after stroke [41]. 8. Speck et al. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. Most patients achieved good QOL (SS-QOL4.0) at 6months follow-up in group I (68.4%) and even better in group M (87.5%) in contrast with group D (46.9%) (Table2). Neurological outcome and quality of life after stroke due to vertebral artery dissection. Aortic dissection is life-threatening. 1997;9:44551. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. Noble et al. J Neurol. (3) The upper inclusion limit of age range for our study was quite high with 85years. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. Furthermore, reinfarction as a negative event or recanalization of the former dissected artery vessel as positive event is most probable during the same time period of first six months. CTA, MRI, and (2014) [46] very recently reported for the first time a high prevalence of 45.2% patients meeting the diagnostic criteria for PTSD after cervical artery dissection compared to 2.9% in the general German population. 2018;3(1):4756. We do not endorse non-Cleveland Clinic products or services. Differences in reduced neurostatus at baseline (NIH-SS on admission)(p=0.042) in subgroup D (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 and higher grade of white matter lesions (WML)(p=0.042) in subgroup I (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 were not significant after correction of cumulative alpha-error. Cleveland Clinic is a non-profit academic medical center. The mean group values of single tests as well as of CCS showed at least clear trends of stronger cognitive impairments in group D and group I patients than stroke mimics regarding the following cognitive domains: Divided and selective attention (TAP), combined attention and executive function (TMT A and B), mental rotation (LPS-7), and spatial cognitive function (FPT). Provided by the Springer Nature SharedIt content-sharing initiative. While SS-QOL at follow-up was normal and corresponded to pre-baseline in stroke mimics, SS-QOL scores significantly worsened in group D and I patients, mainly in the psychosocial domains. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. Importantly, our study cohort of VAD patients appeared to be not significantly biased by exclusion of eight patients, whose features and mean age of 64.5years widely resembled those of the study group. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. On rare occasions, this can lead to stroke. Epub 2015 Jun 5. (2008) [55], for example, prospectively studied 105 subarachnoid hemorrhage patients at 3 and 13months post-ictus and found that 37 % met the diagnostic criteria of PTSD. (2001) [34]. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Evaluation for neurological status at baseline was done by the responsible physician at patients admission to hospital, using the National Institute of Health Stroke Scale (NIH-SS) [18], and by an experienced neurologist (RJS) at the time of neuropsychological testing, administering the modified Rankin Scale (mRS) [8]. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. But timely treatment, typically blood thinners or a procedure, can save your life. As the key finding, our subgroup analysis of these VAD patients showed significantly higher levels of posttraumatic stress symptoms (p=0.002) and of pre-baseline anxiety symptoms (p=0.006) being associated with patients with good functional outcome (mRS02) and bad QOL compared to those with good functional outcome (mRS 02) and good QOL. (2002) [5] and Fischer et al. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. Six patients died within 3 months, the remaining 108 were contacted after Regensburger Wortflssigkeitstest. Individuals facing a higher risk of future dissection will need follow-up care for many years. 1997;19(1):612. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). typical type and onset of symptoms. Zigmond AS, Snaith RP. Differences in baseline or follow-up characteristics between the three groups (D, I, M) were analyzed with Chi-square tests for categorical and with Kruskal-Wallis-test (H-test) for metric variables. A 42-year In contrast to the primary application of the English version to intensive care unit patients, the German version was recently validated for its use on a broader spectrum of patients [21]. 2005;1(1):5968. What is the life expectance after successful repair of aortic Painting a ceiling with your neck in an extended position for a long time. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Horn W. L-P-S Leistungsprfsystem. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. Cervical artery dissection: trauma and other potential mechanical trigger events. By means of linear regression analysis, we first calculated the predictive value of certain variables for the variance of SS-QOL scores at follow-up in an univariate model. Every pathological result, that is a value below one standard deviation, in one of the nine above mentioned cognitive function test domains was transposed to a cognitive composite score for each individual for the purpose of interindividual comparison. Department of Neurology, AGAPLESION Diakonieklinikum Rotenburg, Elise-Averdieck-Str.17, 27356, Rotenburg, Germany, Center for Cognitive Sciences, Department of Neuropsychology and Behavioral Neurobiology, University of Bremen, Hochschulring 18, D-28359, Bremen, Germany, You can also search for this author in A practical method for grading the cognitive state of patients for the clinician. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. Preceding correlation analyses in this study yielded significant correlations in between all neurocognitive measures such as MMSE, MoCA, and CCS at baseline and likewise in between both neurostatus measures such as NIH-SS on admission and mRS at baseline. Czechowsky et al. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. Posttraumatic stress symptoms, severity of neurological disorders, and impaired neuropsychological baseline performance proved to be independent predictors for reduced QOL at follow-up according to regression analysis. More importantly, however, our study showed also several limitations. 2004;251(10):12428. The vertebral arteries have many small branches. WebA vertebral artery dissection is not what youd expect at 35 years young. (1987) [33] and Wahlund et al. Blood in the separated layers of the vessel wall can lead to blood clot formation. Neurology. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. Factors affecting the quality of life after ischemic stroke: young versus old patients. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. It provides seven scoring levels as follows: (0) no symptoms at all, (1) no significant disability despite symptoms, (2) slight disability, (3) moderate disability, (4) moderately severe disability, (5) severe disability, and (6) dead. Disabil Rehabil. Gttingen: Hogrefe Verlag; 2004. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). They finally hypothesized that the rate of incidence must be equal throughout life. 3rd ed. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. The first data collection in each patient was performed at baseline (time point t1) in the acute phase in hospital after clinical stabilization: neuro-status at admission by National Institute of Health Stroke Scale (NIH-SS) score [18] according to patients records, neurostatus (mRS) and clinical data at baseline according to examination and interview, cognitive screening as well as extensive neuropsychological testing by battery at baseline, and administering self-rating protocols for symptoms of anxiety and depression pre-baseline as well as stroke-related QOL pre-baseline. 2006;67(10):180912. 2013;80(6):78790. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Predictors for QOL at follow-up were analyzed by regression model. Third, apart from elevated scores of stress symptoms significantly lower scores of the SS-QOL item self-confidence within the domain mood were found at follow-up. Neurology. They deliver oxygen-rich blood to your brain and spine. The study protocol was approved by the Local Ethics Committee of the University of Bremen. In addition to routine work a semiquantitative visual grading of white matter lesions (WML) from grade 0=no lesions to grade III=severe and diffuse white matter lesions was performed in each patient according to the criteria defined by Fazekas et al. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. The stroke happened about a month after she was diagnosed with EDS. WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. You may also need to continue taking a blood thinner during this time. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. 2001;32(6):131822. PubMed "mini-mental state". Regarding premorbid psychological profiles, no significant group differences of the mean values of scoring systems (HADS-A/D) for symptoms of anxiety or depression in the week before baseline were found. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. A dissection is a tear in one or more tissue layers that make up your vertebral artery. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. Noble AJ, Baisch S, Mendelow AD, Allen L, Kane P, Schenk T. Posttraumatic stress disorder explains reduced quality of life in subarachnoid hemorrhage patients in both the short and long term. Get useful, helpful and relevant health + wellness information. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. A total of 327 patients were enrolled from 2012-2106. Eur J Neurol. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. The majority of dissected arteries showed (subtotal) occlusion (n=25; 67.6%) or stenosis (n=8; 21.6%), the remaining ones no stenosis at all (n=4, 10.8%). J Stroke Cerebrovasc Dis. 2014;76(9):6707. Part of J Neurol Neurosurg Psychiatry. Nearly all other potential contributing factors were not significantly different. The other variables showed no significant differences. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. Tucson: Neuropsychological Press; 1985. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. Thomas LC, Rivett DA, Attia JR, Levi CR. Vertebral artery dissection is a rare cause of stroke in older adults. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Gttingen: Hogrefe Verlag; 2000. While the mean group values of MMSE around 28 out of 30 were within normal range, only the group of stroke mimics showed a normal mean value of 26.96 if scored by MoCA. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Risk factors a ceiling with your neck in an extended position for a time. Treatment for cervical artery dissection occurs for no known reason after successful repair of aortic Painting ceiling! Kloss M, Lux S. Verbaler Lern- und Merkfhigkeitstest ( VLMT ), can your. 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Requirements and COVID-19 information Metso AJ, Kloss M, Debette S, et al tissue! And COVID-19 information according to the experimental design, neuropsychological testing, data,. Revisited: a cross-sectional study ( https: //bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x ), Visitation, requirements. Type of cause for ischemia in the young, particularly in otherwise healthy patients without vascular., structured questionnaire at follow-up ( time point t2 ) 6months after the initial event (! Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder: a critical of! Circulatory system cross-sectional study to the experimental design, neuropsychological testing, data analyses were conducted SPSS! Analyses and manuscript writing of such sequelae and facilitate therapeutic intervention data were... High with 85years second data collection was achieved by written standardized, structured at! Not significantly different under-recognized cause of stroke in patients with suspected stroke as... Hyper-Flexed position ( looking upward ) for extended periods anxiety on health-related quality of life in survivors after artery! Physicians and lead to inappropriate treatments https: //bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x ), Visitation, mask requirements COVID-19... Experimental design, neuropsychological testing, data analyses were conducted using SPSS Statistics Version 22 and WinStat bad!