At least 90 percent of adults with FMD are women. The cerebellar cognitive profile. 2006;37(10):2499503. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. 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. [13] and in the context of a fitting medical history, i.e. 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. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. 2010;45(1112):68895. 2006;22(23):215. 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 more than one drug, a medium or high dosage or signs of sedative or cognitive side effects, or (6) concurrent or preexisting CNS morbidity or damage apart from white matter lesions (WML) and minor strokes without any disabling, in particular cognitive preexisting deficit. 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%). Thomas LC, Rivett DA, Attia JR, Levi CR. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. Clinical assessment of data on hypertension (history or systolic arterial blood pressure>140mmHg or diastolic arterial blood pressure>90mmHg), diabetes mellitus, dyslipidemia (LDL>155mg/dl and/or HDL<35mmHg), and atrial fibrillation was performed at baseline. 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. https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. WebScore: 4.2/5 (61 votes) . Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. Neurology. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. Another woman (47years old; locked in-syndrome due to pontine infarction by basilar artery occlusion due to vertebral artery dissection) and a man (77years old; dizziness, nausea, vomiting, headache, ataxia, facial weakness, dysarthria, dysphagia; combined medulla oblongata and cerebellar infarction) without a sufficient ability to speak for participating in neuropsychological testing. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the When starting the present study, however, the knowledge about the putative contributing role of cognitive as well as psycho-affective factors to QOL in VAD patients was lacking. 2003;250(10):117984. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. 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. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. This difference was not statistically significant (p<0.05). Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Trial of org 10172 in acute stroke treatment. (2014) [46]. Noble et al. In earlier stages, you might not notice symptoms. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. 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. 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. 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. 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. 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. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. 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]. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. Arch Phys Med Rehabil. PubMedGoogle Scholar. 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. Ischemic stroke was found in only 33.9%. 2003;41(11):145260. Article J Psychiatr Res. (2014) [46], mean age 44.8years. MMSE and MoCA inversely cross-correlated with NIH-SS scores in group D with weak significance, MoCA scoring with NIH-SS also significantly in group I, and MMSE scoring with NIH-SS only non-significantly in group I. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. PubMed Not applicable. 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. As a key result, higher levels of posttraumatic stress symptoms appeared to be a prominent contributing factor to bad QOL in VAD patients with otherwise good functional outcome. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. Thus, somewhat unspecific symptoms in this age group and context of VAD history, if not critically reflected, may usually prompt otherwise evitable inpatient diagnostics for stroke and/or recurrence of dissection. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. Google Scholar. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. 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. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. A dissection is a tear in one or more tissue layers that make up your vertebral artery. (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. Neurosurgery. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. Its signs and symptoms can be vague, and diagnosis can be elusive. 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). Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. But timely treatment, typically blood thinners or a procedure, can save your life. Magnetic resonance angiography is the gold standard diagnostic test. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. It may also occur with sudden neck movements and trauma. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. No individual persons personal details, images or videos are being used in this study. Neurology. (2009) [6]. J Neurol Neurosurg Psychiatry. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. 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. Stroke. 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). Cerebrovasc Dis. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). 2006;67(10):180912. What is the life expectance after successful repair of aortic Stroke. J Abnorm Psychol. 2017;88(14):131320. Brain. A 42-year 88.2% of patients with VAD suffered from acute cerebral ischemia. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Knecht et al. Regensburger Wortflssigkeitstest. N Engl J Med. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. Painting a ceiling with your neck in an extended position for a long time. 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. J Neurol. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. Correspondence to (2015) [61] reported that older stroke patients in general have worse prestroke status, greater impairment on hospital admission, more comorbidities and poorer poststroke functional status than the younger patients but can benefit as much as the young from high-intensity neurorehabilitation. 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. 2006;66(4):5136. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. (2018) [38] reported more recently in their observational cohort study on patients with cervical, mainly carotid artery dissection, that numerically, but not statistically significant more patients with combined endovascular therapy (EVT)/intravenous thrombolysis (IVT) had excellent outcome and arterial recanalization than patients treated with EVT only. When tics cause Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. Folstein MF, Folstein SE, McHugh PR. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. statement and 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. To reduce the risk of blood clots, you may receive blood-thinning medications as a first-line therapy such as aspirin or aspirin-like medications (Plavix), heparin infusion or warfarin tablets. 2012;13:164. 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. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. CTA, MRI, and Provided by the Springer Nature SharedIt content-sharing initiative. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Neurology. 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. The health-related quality of life after VAD was examined in a standardized manner for the first time in only two published studies [5, 6] in the last decade. Med Hypotheses. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. This investigation is, to the best of our knowledge, the first study that evaluated contributing factors to QOL six months after VAD in a pure prospective and comparative study design on a pure VAD study population, including a standardized neuropsychological testing in the acute phase. Ahl et al. Your two carotid arteries run along either side of your neck in the front. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. FMD is usually a life-long condition. CAS In the SSQOL-subgroup analysis of patients with good functional outcome (mRS score2) and good SS-QOL score (4.0) at follow-up were eight patients with arterial occlusion or subtotal occlusion versus five with or without stenosis. NIH-SS and mRS scoring at baseline of groups D and I yielded scores significantly worse compared with group M, indicating a reduced neurological status of affected patients (Table2). 2013;94(12):253541. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. 2009;256(3):4439. J Neurol. 2001;32(6):131822. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Corresponding to their multivariate analysis, the NIH-SS score on admission was also found to be an independent predictor of QOL at follow-up in our univariate regression analysis. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. Spontaneous vertebral artery dissection (VAD) represents a rare but significant disease, accounting for an average annual incidence rate of about 0.97 to 1.5 cases per 100.000 population [1, 2]. Moreover, our data demonstrated no role of WML as independent predictor of QOL. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. Vertebral artery dissection is a rare cause of stroke in older adults. 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]. (3) The upper inclusion limit of age range for our study was quite high with 85years. All participants were informed about the procedure and gave written informed consent to participate in the study. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. 1989;20(7):86470. Thus, the present investigation has to be characterized as an explorative study. Third, psychological condition was not examined at baseline. 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. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. 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]. 1975;12(3):18998. The vertebral arteries have many small branches. 2013;80(6):78790. Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. 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. They showed ischemic stroke lesions in the majority of cases (73.6%) like the patients of group I (86.8%), larger than 10mm in maximal diameter in 67.6% versus 76.3%, respectively, as shown in Table2. 3rd ed. (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. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. 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. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. I was unable to return to work for three months. Gttingen: Hogrefe Verlag; 1983. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). 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. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Living With Whats it like living PubMed Central 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. bright spots on my BMC Neurol 19, 312 (2019). Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. (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. Afterwards we developed a multivariate regression model using variables that have proven statistically significant at the univariate analysis at a significant level of 5% (p<0.05). 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/. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. 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. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. Quality of life in survivors after cervical artery dissection. Arch Phys Med Rehabil. 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). Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. Five patients were excluded from the dissection study group after screening according to the inclusion/exclusion study criteria: One woman (70years old; ataxia, dizziness, facial weakness; medulla oblongata infarction by vertebral artery occlusion suspicious for but not yet proven dissection) deceased due to unexpected cardiopulmonary failure not otherwise specified in the acute phase. 2010;17(2):21925. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. The higher the score the more probable is a posttraumatic disorder. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). Vertebral and carotid artery dissections account for only 2% of ischemic strokes. It comprised standardized self-rating protocols for neurostatus (mRS), stroke specific QOL and posttraumatic stress symptoms, and in addition open questions for the clinical course.