From October 1, 2010, to June 31, 2013, 42 consecutive patients with spontaneous first-time vertebral artery dissection (VAD), who were admitted to our hospital under the suspected diagnosis of an acute stroke, were registered and screened for this study. Anasthesiol Intensivmed Notfallmed Schmerzther. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. 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. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. In case of significant difference, a subsequent analysis between two group pairs was performed: For categorical variables the Chi-square test or Fishers exact test, if appropriate, and for metric variables the Mann-Whitney U-test was used with Bonferroni-correction of cumulative alpha-error. Neurology. PubMedGoogle Scholar. 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. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. (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. In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. Neurology. (2013) [59] hypothesized that cervical artery dissection goes frequently undiagnosed, particularly in patients with subtle symptoms, which is true for VAD [3, 57], and dependently from the awareness of the responsible physician. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. 2023 BioMed Central Ltd unless otherwise stated. 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 Stroke Cerebrovasc Dis. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. volume19, Articlenumber:312 (2019) Although functional outcome was good in the majority of their cases, the surprising main finding was a bad quality of life, measured by Stroke Specific Quality Of Life scale (SS-QOL) [7] despite of good functional outcome, scored by modified Rankin Scale (mRS) [8], in about 15% [5] to 30% of cases [6]. Magnetic resonance angiography is a sophisticated test thats not widely available. Arch Phys Med Rehabil. 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. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. The use of the German version in this study was authorized by their authors (pers. 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]. 2001;32(6):131822. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR). Elevated levels of posttraumatic stress symptoms, as evaluated by PTSS-14 scoring in our study, are in line with recent reports on the prevalence of posttraumatic stress disorder (PTSD) after stroke, even after minor stroke [49] or transient ischemic attack [50]. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Later on, I began to have disturbances in my vision, ie. The diagnosis of VAD was based on typical findings such as intramural hematoma on axial cervical MRI, or string sign or long tapering stenosis on computer tomography (CT) / MRI angiography in accordance to Rodallec et al. The findings were in line with modern concepts of cerebellar cognitive function [44] and also in accordance to previous data on cognitive impairments in patients with cerebellar stroke lesions, for example by Exner et al. Does the cerebellum contribute to specific aspects of attention? Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. The stroke happened about a month after she was diagnosed with EDS. 2013;80(6):78790. Monitoring typically includes magnetic resonance angiography every three to six months. The authors declare that they have no competing interests. Cervical artery dissections typically heal very well, returning the vessel to normal. This process usually occurs within the first three to six months. Whats it like living with a cervical artery dissection? Youll need regular monitoring, including imaging studies, until healthcare providers confirm the dissection has healed. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. While there were in groups D and I compared to group M frequent impairments in both global screening tests (MMSE, MoCA) and in single cognitive function tests of the neuropsychological test battery (Additionalfile1) and also in the resulting cognitive composite score (CCS), this difference reached statistical significance only in the MoCA assessment for group D compared to group M (Table2). A total of 327 patients were enrolled from 2012-2106. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). It contains 49 items belonging to 12 domains. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. We found reduced QOL at 6-month follow-up, as scored by SS-QOL3.9, despite good functional outcome (mRS 02) in a prevalently high percentage of about 40% in VAD patients. (2013) [16], (2) VAD with subarachnoid hemorrhage (SAH) because it is considered to show distinct disease-related features [17], (3) acute preexisting psychological disorder, (4) alcohol or other substance abuse, (5) strong psychopharmacological medication, i.e. VAD leads to impaired QOL at 6months follow-up due to multiple factors. 2006;67(10):180912. For the assessment of psychological variables several self-rating measurement tools were introduced: The German version of the Hospital Anxiety and Depression Scale (HADS) [20] was administered at baseline to determine the grade of symptoms of anxiety and depression in the week before baseline. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Regensburger Wortflssigkeitstest. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . At first I just had a very bad neck pain, couldn't move it much. Article 2004;251(10):12428. Our data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD, in particular in patients with reduced QOL despite good functional outcome. 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. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. Turm von London Deutsche Version. (2004) [58] showed in their study that a significant number of cervical artery dissection can occur in the older age group and can be diagnosed if considered. One main finding was the high prevalence of reduced QOL despite good mRS (02) in about 40% (n=13) of our VAD patients at follow-up in line with the findings of the observational series Czechowsky et al. Three initially included woman of ages 70, 71, and 77years had to be excluded secondarily because of concurrent diseases in form of preexisting idiopathic cerebellar syndrome, acute symptomatic anterior circulation brain infarction, and predominant arteriitis temporalis (first with ocular disorder, paresis of arm, ataxia, and dysarthria plus suspected brainstem infarction due to VAD; second with VAD and arm paresis; third with VAD and visual field disorder). This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). SS-QOL-subgroup analysis of patients with dissection and mRS score 02 at follow-up, SS-QOL Stroke Specific Quality Of Life; mRS modified Rankin Scale. You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). At least 90 percent of adults with FMD are women. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. Correspondence to Cookies policy. Tucha O, Lange KW. J Neurol. No individual persons personal details, images or videos are being used in this study. 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). Although MMSE and MoCA significantly correlated to our cognitive composite score (CCS), further analysis of neurocognitive domain deficits by neuropsychological test battery yielded only some trends of mean group values, without statistical significance. (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. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. 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. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. 2004;75(8):11946. 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. Grond-Ginsbach et al. The German version of the Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) [21] was used at follow-up to determine posttraumatic stress symptoms. Accurate and prompt diagnosis of this condition is crucial because timely and appropriate therapy can significantly reduce the risk of stroke and long-term sequelae. Stroke. Measuring quality of life in a way that is meaningful to stroke patients. They carry blood to the brain and spinal cord, which are part of the nervous system. Plasmin degrades fibrin, fibrinogen, and procoagulant factors V and VIII Serum half-life is 4-6 min but half-life lengthened when bound to fibrin in clot. 2010;17(2):21925. Eur J Neurol. Stroke. Neurology. Zigmond AS, Snaith RP. Its signs and symptoms can be vague, and diagnosis can be elusive. Inpatient rehabilitation for several weeks was performed in 48.5% patients of group D, 60.5% of group I and in only one patient (4%) of group M. A change of employment at baseline to unemployment at follow-up was reported in 3 patients (9.4%) in group D, 5 patients (13.5%) in group I and 2 patients in group M. Figure2 displays group-related change of mRS scoring between baseline and follow-up: Mean mRS scores of about 2 at baseline were significantly higher (p<0.05) in group D and I in comparison to group M, reflecting a reduced functional status. Cervical artery dissection goes frequently undiagnosed. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. What is the life expectance after successful repair of aortic Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. Although its pathophysiology and treatment closely resemble that of its sister condition, carotid artery dissection (CAD), the clinical presentation, etiology, and epidemiological profile of VADs are unique. Classification of subtype of acute ischemic stroke. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. Five-point test. 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. On rare occasions, this can lead to stroke. PubMed Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Lancet Neurol. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. For the neuropsychological testing at baseline the longer established Mini-Mental State Examination (MMSE) [15] and the more sensitive Montreal Cognitive Assessment (MoCA) [23] were performed as cognitive screening tests in their German versions. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Administration, norms, and commentary. GA compendium of neuropsychological tests. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study, https://doi.org/10.1186/s12883-019-1541-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. J Neurol. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. Fischer et al. Plank position (but otherwise safe to participate in yoga or Pilates). Procedures for vertebral artery dissection include: Most people make a full recovery. Neurological outcome and quality of life after stroke due to vertebral artery dissection. The multivariate analysis of 126 patients with carotid and vertebral artery dissections in a retrospective study design showed that the variables stroke and arterial occlusion were independent factors associated with a poor outcome [37]. Advertising on our site helps support our mission. Google Scholar. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. Privacy This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. J Abnorm Psychol. Trial of org 10172 in acute stroke treatment. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. 1987;149(2):3516. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. It was only asked for affective symptoms of anxiety and depression pre-baseline and at follow-up there has been only exploration for stress symptoms but not for symptoms of anxiety and depression. Its more common in people younger than 45. Terms and Conditions, 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. Schievink WI. 2014;23(2):33542. WebCervical artery dissections typically heal very well, returning the vessel to normal. Springer Nature. Because of the great 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. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. Horn W. L-P-S Leistungsprfsystem. Trends towards worse cognitive function without statistical significance were found in group D and I compared to group M for 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). The aim of this study was therefore as follows: (1) to evaluate the characteristics of patients after VAD with special focus on those with bad quality of life despite good functional outcome in comparison with positive and negative control patients in a prospective comparative study design (2); to identify contributing factors to quality of life after VAD, considering neurological, cognitive, and psychological variables (3); to identify the predictive factors for quality of life after VAD. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. It can also lead to swelling (dilation) of the artery. The method of evaluation, i.e. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Incidence and outcome of cervical artery dissection: a population-based study. Provided by the Springer Nature SharedIt content-sharing initiative. Auflage. His troponin was elevated at 0.094ng/mL. The vertebral arteries have many small branches. Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. 2012;13:164. Apart from the presence of ischemic stroke lesions in groups D and I, socio-demographic and clinical data of the three groups were without significant differences, as shown in Table1. Although specific information about overall life expectancy after aortic dissection repair is not available, a recent study from the International Registry of Acute Aortic Dissection reported that about 85% of patients who have undergone successful repair of acute dissection involving the ascending aorta remain alive at 5 years. 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. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. J Neurol Neurosurg Psychiatry. Czechowsky D, Hill MD. 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. (2002) [5] and Fischer et al. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. 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. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. Most dissections heal on their own. Cerebral ischemia in group I patients was caused by cardiac embolism in 34.2%, lacunar disease in 21%, large artery disease in 10.5% and by undetermined cause in 34.2% according to the TOAST-criteria [14]. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). Bonita R, Beaglehole R. Recovery of motor function after stroke. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. 3rd ed. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. Spontaneous vertebral Their series comprised physically less affected patients, two-third after ICAD and one-third after VAD, with ischemic stroke in form of mainly small lesions in about one-third of cases only. Disabil Rehabil. Factors affecting the quality of life after ischemic stroke: young versus old patients. 1989;20(7):86470. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. Clinical monitoring should address this topic to make timely treatment possible. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. 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. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Ahl et al. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. (1987) [33] and Wahlund et al. In general, various factors have been shown to influence the QOL of patients after stroke without dissection, including post-stroke anxiety [9], depression [10] and cognitive impairment [11]. J Neurol. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. Gttingen: Beltz Test GmbH; 2001. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. Engel GL. Six patients died within 3 months, the remaining 108 were contacted after BMC Neurology Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. In our study, there was a trend in patients with good functional outcome (mRS score 02) to higher association of occlusion/subtotal occlusion with worse QOL, though this was statistically nonsignificant (p<0.05). Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. 2011;92(5):7928. The mean decrease of QOL, that is the difference of SS-QOL scoring, from pre-baseline to follow-up, was significantly stronger in the subgroups (mRS 02) with bad quality of life (SS-QOL3.9). //Bmcneurol.Biomedcentral.Com/Articles/10.1186/S12883-019-1541-X ), Visitation, mask requirements and COVID-19 information remains neutral with regard jurisdictional! The interior arterial walls separate series included about two third of patients with spontaneous internal carotid dissection., Konrad C, Dougoud D, debette S, Kwon SU, lee,... Wallesch CW mRS modified Rankin Scale Mehdorn HM if you have two vertebral arteries that along. Wrist or groin as young patients with stroke from high-intensity neurorehabilitation: cohort analysis of adults with are. Of 327 patients were enrolled from 2012-2106 tests of attention run along the of! In our study [ life expectancy after vertebral artery dissection ] and Wahlund et al one of the German version in study. 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