Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. Cerebrovasc Dis. 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. Cite this article. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. 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. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. 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. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. More importantly, however, our study showed also several limitations. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. Gttingen: Hogrefe Verlag; 2004. All authors read and approved the final manuscript. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. "mini-mental state". Vulnerability--a new view of schizophrenia. BMC Neurology Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. 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. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Auflage. 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. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. It provides seven scoring levels as follows: (0) no symptoms at all, (1) no significant disability despite symptoms, (2) slight disability, (3) moderate disability, (4) moderately severe disability, (5) severe disability, and (6) dead. Neurology. Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. Third, psychological condition was not examined at baseline. Strauss E, Sherman EMS, Spreen O. Cerebrovasc Dis. Events most commonly occur in the postpartum period 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. Czechowsky D, Hill MD. Theyll use contrast dye and X-ray-guided imaging to look at blood flow through the artery itself along with the extent of the dissection or vessel injury in real-time. In earlier stages, you might not notice symptoms. 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. 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. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. Neurology. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. 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]. 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]. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. 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. New York: Oxford University Press; 2006. Web2. 1997;9:44551. 1975;12(3):18998. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. 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. Cerebrovasc Dis Extra. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Fourth, maladaptive coping strategies were significant predictors for and associated with posttraumatic stress disorder in patients with cervical artery dissection in the study of Speck et al. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Because data on the potential impact of infarct volume to outcome and QOL in VAD patients have been lacking so far, we used at least a very arbitrary method for semiquantitative evaluation of the extension of infarct lesions and were not able to ascertain any statistical association. You may also need to continue taking a blood thinner during this time. 2013;80(21):19507. BMC Neurol 19, 312 (2019). 8. A total of 327 patients were enrolled from 2012-2106. 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). MoCA, to our best knowledge, was used in our study for the first time in VAD patients. Neurology. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. The cerebellar cognitive profile. 2005;53(4):6959. Noble et al. The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Zigmond AS, Snaith RP. 2001;32(6):131822. Plank position (but otherwise safe to participate in yoga or Pilates). (1987) [33] and Wahlund et al. Stress revisited: a critical evaluation of the stress concept. Article Cleveland Clinic is a non-profit academic medical center. Aortic dissection is life-threatening. Article Evaluation for neurological status at baseline was done by the responsible physician at patients admission to hospital, using the National Institute of Health Stroke Scale (NIH-SS) [18], and by an experienced neurologist (RJS) at the time of neuropsychological testing, administering the modified Rankin Scale (mRS) [8]. 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. At least 90 percent of adults with FMD are women. Article We do not endorse non-Cleveland Clinic products or services. 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. Does the cerebellum contribute to specific aspects of attention? Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). 2011;134(Pt 12):367286. Gttingen: Hogrefe Verlag; 2000. Google Scholar. 1). This six months follow-up period was chosen based on recent scientific data supporting the idea that the major part of functional recovery does usually take place during the first six months after stroke [19]. This difference was not statistically significant (p<0.05). Differential features of carotid and vertebral artery dissections: the CADISP study. 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. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. 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. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. typical type and onset of symptoms. 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 24 stroke mimics only two patients (8.3%) with mRS 02 reported a bad quality of life in contrast to 20 patients (83.3%) with mRS 02. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. Disabil Rehabil. 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). Five-point test. Rainer J. Strege. J Neurol. Tucson: Neuropsychological Press; 1985. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. 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. MH contributed to the experimental design, data analyses and manuscript writing. Article Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. It may also occur with sudden neck movements and trauma. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, 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]. 2001;344(12):898906. PubMed 2008;52(2):2028. Brain and intelligence: a quantitative study of the frontal lobes. 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]. 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. 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. In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. 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. (2004) [45]. 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]. J Clin Neurol. Anasthesiol Intensivmed Notfallmed Schmerzther. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. 2011;92(5):7928. Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. (2009) [6]. The vertebral arteries have many small branches. All participants have given written informed consent. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Nearly all other potential contributing factors were not significantly different. They finally hypothesized that the rate of incidence must be equal throughout life. 2006;22(23):215. Halstead WC. Spontaneous dissection of the carotid and vertebral arteries. Spontaneous vertebral 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. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. Eur Heart J 2021;42:3825-3828. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. By using this website, you agree to our Classification of subtype of acute ischemic stroke. A dissection forms when theres a tear in one or more of its three tissue layers. In group I 26.3% of all patients displayed mRS 02 and bad quality of life (SS-QOL3.9), whereas 63.1% mRS 02 and good quality of life (SS-QOL4.0). This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. Follow-up subscale analysis between groups using a Mann-Whitney U test of the SS-QOL item self-confidence within the domain mood yielded significantly lower scores (U(13, 13) = 30.5; p<0.01) for VAD patients with bad QOL (SS-QOL3.9) versus good and also significantly lower scores (U(9, 25) = 24.5; p<0.001) for group I patients with bad versus good QOL. (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. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. A Spearmans rank correlation analysis was performed for outcome-relevant variables. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. The cut off in the German version is defined as a score of 40 points with a sensitivity of 82% and a good specificity of 92%. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. Epub 2015 Jun 5. Psychosom Med. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Quality of life in survivors after cervical artery dissection. 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]. Privacy Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Stroke. Its more common in people younger than 45. Table4 shows univariate linear regression analysis demonstrating that neurocognition scores at baseline (MMSE, MoCA, CCS), neurostatus at baseline (NIH-SS score on admission, mRS score) and stress symptoms at follow-up (PTSS-14 score) were predictors of quality of life at follow-up. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Neuropsychologia. Sometimes, your healthcare provider may recommend conventional angiography. 1988;19(12):1497500. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. 2010;17(2):21925. Although there was a preponderance of atrial fibrillation in group I, no significant group differences of neurovascular risk factors were found in line with current knowledge about VAD characteristics [3, 35]. A vertebral artery dissection is not what youd expect at 35 years young. 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