(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Speck et al. 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). Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. 2012;13:164. (2009) [6], mean age 46years, Czechowsky et al. Neurology. The vertebral arteries have many small branches. It may also occur with sudden neck movements and trauma. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. 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. SS-QOL scores at follow-up varied among subgroups as demonstrated in a subgroup analysis stratified for good functional outcome (mRS 02) plus good quality of life (SS-QOL4.0) versus good functional outcome (mRS 02) plus bad quality of life (SS-QOL3.9). In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 1993;24(1):3541. (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. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Does the cerebellum contribute to specific aspects of attention? Group D only displayed a significant lower mean value than groups I and M in the domain social roles. Gttingen: Hogrefe Verlag; 1983. Your chances of experiencing a stroke are low. 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]. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. Magnetic resonance angiography is a sophisticated test thats not widely available. VAD leads to impaired QOL at 6months follow-up due to multiple factors. Cervical artery dissection goes frequently undiagnosed. Tucha O, Lange KW. 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. 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). Events most commonly occur in the postpartum period 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. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. 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. MH contributed to the experimental design, data analyses and manuscript writing. 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. communication). A total score of 40 points may be indicative for posttraumatic stress disorder. All participants have given written informed consent. 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. 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). Get useful, helpful and relevant health + wellness information. Lancet Neurol. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. PubMedGoogle Scholar. 2010;45(1112):68895. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Practicing yoga where hyperextension of your neck occurs. In addition, the extent of WML showed a significant inverse correlation to global cognitive functioning (MMSE, MoCA) in group D and partly (MoCA only) in group M. Finally, more extensive stroke lesions correlated very weakly with stronger neurological impairment (higher NIH-SS score at baseline) in group D and showed no other consistent correlations. Measurements of acute cerebral infarction: a clinical examination scale. (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. 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 may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. PubMed 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%). Dissection in either artery can disrupt blood flow and potentially cause a stroke. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Neurology. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. 2013;80(6):78790. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. 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. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. Third, psychological condition was not examined at baseline. 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. 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. 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. However, you may be at risk for future dissections. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. 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]. Stroke. Tucson: Neuropsychological Press; 1985. Acta Psychiatr Scand. (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. Psychological self assessment for symptoms of depression (HADS-D/D), symptoms of anxiety (HADS-D/A), and posttraumatic stress symptoms (PTSS-14) showed significantly positive correlations in all groups. 2. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. Regensburger Wortflssigkeitstest. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. On rare occasions, this can lead to stroke. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. 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]. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Acta Anaesthesiol Scand. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. Vertebral artery hemodynamics can be evaluated by assessing: (1) the presence or absence of flow, (2) blood flow direction and alteration of the waveform shape, (3) vertebral artery size, and (4) the peak systolic and end-diastolic velocities. 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. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. 1999;53(8):183943. 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. 2011;35(5):1291301. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. 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. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. 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). 2004;75(8):11946. 2011;77(12):117481. 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 Magnetic resonance angiography is the gold standard diagnostic test. Otherwise, antithrombotic therapy was Analysis of subscales demonstrated that a reduced quality of life at follow-up (SS-QOL3.9) in both subgroups (mRS 02) of group D and I corresponded to main impairments, that were significantly reduced mean values, in all psychosocial domains such as Thinking, Personality, Mood, Family Roles, Social Roles and Energy, as shown for subgroup D in Fig. Ischemic stroke was found in only 33.9%. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. 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]. PubMed Central 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 role of cognitive impairment in the quality of life after ischaemic stroke. Article There were significant more neurological impairments at baseline, that are higher scores of mRS for functional disability or NIH-SS for neurological deficit, in group D as well as I patients with ischemic stroke lesions compared to stroke mimics. GA compendium of neuropsychological tests. Chicago: University of Chicago Press; 1947. Eur Heart J 2021;42:3825-3828. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. 1988;19(12):1497500. Furthermore, some recently published data suggested for the first time a role of VAD-accompanied atherosclerosis as additional putative contributing factor to functional outcome at three months in posterior circulation stroke (PCS) patients [39]. 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. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. Previous Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. 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. Later on, I began to have disturbances in my vision, ie. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. 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. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. 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. 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. A dissection is a tear in one or more tissue layers that make up your vertebral artery. Data about pathological results of neuropsychological test battery assessment. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. You may need a procedure. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. 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. Spontaneous vertebral Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. (1987) [33] and Wahlund et al. 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. California Privacy Statement, 1983;67(6):36170. Neurology. "mini-mental state". Painting a ceiling with your neck in an extended position for a long time. J Neurol. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. At least 90 percent of adults with FMD are women. Stroke. 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. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. Blood in the separated layers of the vessel wall can lead to blood clot formation. Aschenbrenner S, Tucha O, Lange KW. J Neurol. Thirteen of 32 VAD patients (40.6%) rated QOL at follow-up as bad (SS-QOL score3.9) despite of good functional outcome (mRS score 02). Your two carotid arteries run along either side of your neck in the front. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. 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. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. Neuropsychologia. Folstein MF, Folstein SE, McHugh PR. Quality of life in survivors after cervical artery dissection. Google Scholar. A dissection forms when theres a tear in one or more of its three tissue layers. Plank position (but otherwise safe to participate in yoga or Pilates). In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. You can still exercise but should avoid the following: Vertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. J Abnorm Psychol. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Sometimes, your healthcare provider may recommend conventional angiography. 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. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. 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]. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. CAS These include vertebral and carotid arteries. Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. RK contributed to the experimental design and manuscript writing. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). Disabil Rehabil. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. CAS In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. 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. On rare occasions, this can lead to stroke. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. It contains 49 items belonging to 12 domains. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. Stroke. Eur Stroke J. Neurology. 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. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. 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. Differential features of carotid and vertebral artery dissections: the CADISP study. J Am Geriatr Soc. The use of the German version in this study was authorized by their authors (pers. 2008;63(6):1095104 discussion 04-5. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. 3rd ed. The method of evaluation, i.e. BMC Neurology 2005;76(9):122933. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). By using this website, you agree to our Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. 1989;20(7):86470. 1997;9:44551. Trial of org 10172 in acute stroke treatment. Czechowsky et al. Moreover, our data demonstrated no role of WML as independent predictor of QOL. No individual persons personal details, images or videos are being used in this study. (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. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. 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. The authors declare that they have no competing interests. Neurosurgery. Because of the great Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. 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. statement and Another 66years old patient with medulla oblongata infarction deceased due to nonspecific heart failure and was lost for follow-up; in group I one stroke and two myocardial infarcts occured; group M remained without any vascular event. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. Provided by the Springer Nature SharedIt content-sharing initiative. 2005;53(4):6959. Spontaneous dissection of the carotid and vertebral arteries. 2004;251(10):12428. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. These findings corresponded widely to findings of Gottwald et al. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. A practical method for grading the cognitive state of patients for the clinician. Further subgroup analysis was performed in subgroups D and I by comparison of variables potentially affecting quality of life such as age, gender, neurocognition at baseline (MMSE, MoCA), neurostatus at baseline (NIH-SS), grade of white matter lesions (WML), burden of ischemic stroke lesions, premorbid (pre-baseline) symptoms of anxiety or depression (HADS), stress symptoms at follow-up (PTSS-14), and extent of decrease of QOL from pre-baseline to follow-up (Table3). 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.
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