2010;45(1112):68895. 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]. (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. Aschenbrenner S, Tucha O, Lange KW. (2009) [40] reported that severe periventricular white matter disease was significantly associated with poor functional outcome at 3months after ischemic stroke, independently of other factors. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. 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. More importantly, however, our study showed also several limitations. MH contributed to the experimental design, data analyses and manuscript writing. J Neurol. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. The vertebral arteries have many small branches. 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). All participants were informed about the procedure and gave written informed consent to participate in the study. These include vertebral and carotid arteries. 2002;13(3):1927. CADISS Trial Investigators. It can also lead to swelling (dilation) of the artery. 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. 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). This risk decreases over time. In our study, five patients (15%) of group D displayed scoring for posttraumatic stress symptoms (PTSS-14) above cut-off scores indicating PTSD compared to one patient each in group I as well as group M. Previous data [52], however, have already stressed that even subsyndromal scores may be of relevance, as can be assumed for our thirteen subgroup D patients with elevated PTSS-14 levels and bad QOL despite good functional outcome. Neurology. 2018;3(1):4756. Thus, reduced neurocognition and neurostatus at baseline and increased scoring levels for stress symptoms at follow-up were predictive for reduced quality of life at follow-up in patients with VAD in this regression model. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. Neurology. But timely treatment, Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Cervical artery dissection: trauma and other potential mechanical trigger events. The use of the German version in this study was authorized by their authors (pers. Fischer et al. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. Traenka et al. 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. 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). Correspondence to Neurosci Biobehav Rev. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. Arch Phys Med Rehabil. Sometimes, your healthcare provider may recommend conventional angiography. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. The inclusion criteria were (1) a reliable diagnosis, (2) age between 18 and 85years, and (3)] medically stable psychological and physical condition for testing, i.e. 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. This option is also for people with hemorrhagic stroke. 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). The role of cognitive impairment in the quality of life after ischaemic stroke. 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. Get useful, helpful and relevant health + wellness information. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. They included benign paroxysmal positional vertigo in 40%, vestibular neuritis in 24%, vestibulocochlear irritation in 4%, Schwannoma in 4%, suspected somatoform dizziness in 8% and nonspecific dizziness of unknown origin in 16%. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. The overrepresentation of elderly patients in our study may be most probably explained to some extent by a hospital-based selection bias: (1) Patients were recruited when referred to the supraregional stroke unit of our teaching hospital. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. RK contributed to the experimental design and manuscript writing. 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. 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. 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. 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]. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study BMC Neurology 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. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the In contrast to the primary application of the English version to intensive care unit patients, the German version was recently validated for its use on a broader spectrum of patients [21]. Schievink WI. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. Does the cerebellum contribute to specific aspects of attention? CAS (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. This process usually occurs within the first three to six months. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. 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. Cookies policy. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. (2014) [46]. The challenging main consequence from our study regarding this older age group of VAD patients might be therefore for the treating physician to make the right decision: When to consider (re-)dissection stroke and when to consider neuropsychiatric sequelae, for example. Stroke. 2004;75(8):11946. Eur Stroke J. 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. 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. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. 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. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. 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). If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. Advertising on our site helps support our mission. 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. (2004) [45]. With a dissection, blood gets trapped between the intima and media. 2005;76(9):122933. 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. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. volume19, Articlenumber:312 (2019) 2006;22(23):215. What symptoms/pain did you experience? Otherwise, antithrombotic therapy was PubMed Acta Psychiatr Scand. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. Zimmermann PFB. Both conditions fit if someone is suffering from a spontaneous artery dissection as well as subarachnoid hemorrhage in contrast to ischemic stroke caused by vascular risk factors which can be treated. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. 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. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. Its more common in people younger than 45. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. When tics cause WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. Neurology. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. 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. Speck et al. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. 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. Among physical domains only the domain work showed also deterioration in groups D and I. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. 2009;40(2):5306. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. You may need a procedure. Living With Whats it like living language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Patients with suspected cervical artery dissection received additional angiography, mainly MRI angiography, if there has not been already evident cranial computer tomography or even conventional angiography. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. 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 For more extensive testing, a neuropsychological test battery was used with cognitive tasks of nine cognitive domains with possible reference to cognitive functions of the anatomical structures of the posterior circulation, in particular the cerebellum. 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]. 88.2% of patients with VAD suffered from acute cerebral ischemia. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. (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. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. WebA vertebral artery dissection is not what youd expect at 35 years young. FMD is usually a life-long condition. Turm von London Deutsche Version. But timely treatment, typically blood thinners or a procedure, can save your life. 2014;76(9):6707. PubMedGoogle Scholar. Psychol Assess. 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. Most dissections heal on their own. Speck et al. 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. ) affects the artery walls, making them either too weak or too stiff follow-up assessment by questionnaire symptoms... Where a provider places catheters ( long, thin tubes ) in your. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B corresponds to a result! Tics cause WebFibromuscular Dysplasia ( FMD ) affects the artery walls, making them either too weak too. 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