(2014) [46]. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. Google Scholar. But timely treatment, Cervical artery dissection goes frequently undiagnosed. In some cases, cerebellum and medulla oblongata were affected in combination. CTA, MRI, and Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. (2004) [45]. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. Zimmermann PFB. A dissection is a tear in one or more tissue layers that make up your vertebral artery. It has been already earlier demonstrated in both patients with stroke and patients with Parkinsons disease that the type of psychosocial alterations, psychosocial adaptation and coping strategies seem to be of much greater impact than the degree of physical impairment [56]. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 2003;41(11):145260. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. CADISS Trial Investigators. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. communication). 2001;32(6):131822. You may also need to continue taking a blood thinner during this time. Speck et al. Zubin J, Spring B. Article Kissela et al. (2009) [6]. 2014;76(9):6707. 1975;12(3):18998. Other sites of ischemia were occipital lobe in 17.6% of group D and 34.2% of group I, furthermore thalamus in 5.3% of group I. In addition, the autopsy findings of the 66years old patient with medulla oblongata infarction by VAD who deceased due to unexpected heart failure after baseline confirmed the diagnosis of VAD and support the validity of our data. Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. 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. That is in particular striking regarding VAD. BMC Neurology Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Neurology. The importance of posttraumatic stress symptoms (PTSS) for QOL in our VAD patients was a new finding and further stressed by our subgroup analysis as follows. Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. Psychosom Med. While post-stroke anxiety [9] and depression [10] have been described already earlier, even depression in stroke patients treated and non-treated with intravenous thrombolytic therapy [51], posttraumatic stress disorder has been coming to attention more recently. J Neurol. No further differences were found in the other domains. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Subgroup analysis stratified for QOL by Stroke Specific Quality of Life Scale (SS-QOL) were done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 02). Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. 1997;19(1):612. They carry blood to the brain and spinal cord, which are part of the nervous system. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. J Neurol Neurosurg Psychiatry. 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. These findings corresponded widely to findings of Gottwald et al. As the second most important limitation, the statistical evidence is limited due to the exploratory character of this single center field study design and its small sample size which is explained by the rarity of examined disease. The role of cognitive impairment in the quality of life after ischaemic stroke. Exclusion criteria were as follows: (1) VAD due to severe trauma - in contrast to conventionally as spontaneous labeled dissection due to minor prior cervical trauma which should be better termed mechanical trigger event according to Engelter et al. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. Likewise, functional impairment measured by mRS at follow-up significantly correlated with reduced SS-QOL at follow-up in concordance with the results of the mixed cervical artery dissection series of Fischer et al. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. Neurology. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Apart from the limits of our measurement method, we assumed that the neuroanatomical function of the affected stroke area was much more important than the extension. 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). Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Clinical monitoring should address this topic to make timely treatment possible. Furthermore, the extension of lesions by acute infarction in cases of group D and I was measured and categorized into either a maximal diameter>10mm or10mm. A total of 327 patients were enrolled from 2012-2106. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). J Am Geriatr Soc. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. Chicago: University of Chicago Press; 1947. 37 patients fulfilled the inclusion criteria and were included into the study as group D. In addition, 38 patients with acute stroke or TIA of the posterior circulation were included as comparison group I and 27 stroke mimics of the posterior circulation as comparison group M (Fig. Other important findings were found in subgroup I (mRS02) with bad QOL that were significantly higher mean values for premorbid anxiety symptoms (p=0.002) and depression symptoms (p<0.001). Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. (2001) [34]. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. 2014;45(11):33606. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. 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 profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. Vertebral artery dissection (VAD) is a rare cause of stroke in the general population; however, represents one of the more common causes of stroke in patients younger than 45 years of age. J Abnorm Psychol. No individual persons personal details, images or videos are being used in this study. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. Most of the time, ischemic stroke is due to atherosclerosis (thickening of the artery from other risk factors, such as smoking, high blood pressure, high cholesterol, diabetes). First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). Turm von London Deutsche Version. (2) Broad neuroimaging of cervical arteries including cervical MRA was regularly applied to patients of all age groups and risk profiles whenever differential diagnosis of VAD appeared to be possible. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. 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%). Article Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. Plank position (but otherwise safe to participate in yoga or Pilates). The cut off in the German version is defined as a score of 40 points with a sensitivity of 82% and a good specificity of 92%. CAS They finally hypothesized that the rate of incidence must be equal throughout life. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. Three cohorts of consecutive patients were included in the study for the purpose of comparison: group D (dissection) as the main group comprised patients with first-time spontaneous vertebral artery dissection (VAD) of at least one vertebral artery, group I (ischemia) as a positive control group consisted of patients with acute cerebral ischemia such as stroke or transient ischemic attack (TIA) of the posterior circulation due to any other cause than dissection, and group M (mimics) was chosen as a negative control group of stroke mimics of the posterior circulation. Gttingen: Hogrefe Verlag; 2000. We do not endorse non-Cleveland Clinic products or services. Article Radiographics. CAS Vulnerability--a new view of schizophrenia. With a dissection, blood gets trapped between the intima and media. Second, apart from elevated scores of stress symptoms, significantly higher scores of pre-baseline symptoms of anxiety were found which might be indicative for a predisposing vulnerability for anxiety disorders and subtypes like (subthreshold) posttraumatic stress disorder. They assessed, partly retrospectively two months to five years, partly prospectively one month after dissection, the presence of PTSD by using the Posttraumatic Diagnostic Scale (PDS) as self-rating questionnaire. 2010;17(2):21925. 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. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. 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. The prevalence of 73.6% VAD patients with ischemic stroke and 14.7% with TIA in our study corresponded well to 67% (114 patients) and 10% (17 patients), respectively, in a large European multicenter prospective study on patients with first-ever spontaneous VAD [3]. These are typically among the first tests people receive. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. 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. Participants were examined for psychological, cognitive and neurological variables with special reference for functional outcome as well as quality of life 6months after the index event. 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. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. It contains 49 items belonging to 12 domains. Group-related mean values were below this cut-off level and not significantly different between groups: group D 27.1513.10, group I 23.848.74, and group M 26.129.55. 2006;22(23):215. Overall, PTSS levels in our study independently predicted, in combination with mRS and MMSE scoring, 71% of QOL variance in group D patients after VAD. PubMed Because of the great 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. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. 2003;250(10):117984. The other variables showed no significant differences. Lancet Neurol. Fischer et al. The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. Traenka et al. A better understanding of clinical courses and their affecting variables with special respect to the biopsychosocial model [12] seemed to be of great importance for the neurorehabilitation of such VAD patients in the future. Apart from severity of neurological disorders, as scored by mRS, and impaired neuropsychological performance at baseline, as measured by global cognitive screening in form of MMSE, elevated posttraumatic stress symptoms levels, as assessed by Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14), proved to be an independent predictor for reduced QOL at follow-up in group D patients after VAD according to multivariate regression analysis. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. (2009) [6] prospectively found 3793455days after event 30% patients with impaired SS-QOL scoring among 66% with favorable functional outcome (mRS01) in a mixed series including patients with VAD and patients with ICAD. Because recurrence of stroke or dissection is very low despite a mostly lacking morphological artery recanalization and it is nearly limited to the first weeks after dissection, it was questioned by Leys and Debette (2006) [4] what are the appropriate clinical monitoring parameters for follow-up. Eur Stroke J. 2016;87(5):52630. 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. We think increased PTSS levels were neither decisively stroke unit-related, as they were less frequent in comparison group I and M patients who were also treated on the stroke unit, nor disease-specific, as they were also present in group I and M. PTSS levels have been still prevalent in group D which might be explained by the stress-vulnerability model [53]. 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.

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