Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. 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. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. They deliver oxygen-rich blood to your brain and spine. The use of the German version in this study was authorized by their authors (pers. Kwa VI, Limburg M, de Haan RJ. 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. 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. 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. But timely treatment, typically blood thinners or a procedure, can save your life. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. Neurorehabil Neural Repair. Part of (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. (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. (2009) [6]. 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]. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a (2014) [46]. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Fischer et al. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. Factors affecting the quality of life after ischemic stroke: young versus old patients. The health-related quality of life regarding the week before baseline and at follow-up was assessed by the German version [22] of the Stroke Specific Quality Of Life Scale (SS-QOL) [7]. 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. Individuals facing a higher risk of future dissection will need follow-up care for many years. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. Am J Psychiatry. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. Bern: Verlag Hans Huber; 2000. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. 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. Speck et al. Jokinen et al. 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. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. 1989;20(7):86470. 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). 1). Czechowsky D, Hill MD. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. This risk decreases over time. 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. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. 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. 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. 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. Neurology. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. J Neurol. As the key finding, our subgroup analysis of these VAD patients showed significantly higher levels of posttraumatic stress symptoms (p=0.002) and of pre-baseline anxiety symptoms (p=0.006) being associated with patients with good functional outcome (mRS02) and bad QOL compared to those with good functional outcome (mRS 02) and good QOL. 2014;76(9):6707. That is in particular striking regarding VAD. (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. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. J Neurol. 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. 2010;45(1112):68895. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. Definitions for use in a multicenter clinical trial. Rainer J. Strege. 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%). WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. 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. (2009) [6], mean age 46years, Czechowsky et al. 2013;80(21):19507. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. 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. RK contributed to the experimental design and manuscript writing. 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). Ischemic stroke was found in only 33.9%. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Dissection in either artery can disrupt blood flow and potentially cause a stroke. 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. A practical method for grading the cognitive state of patients for the clinician. They assessed, partly retrospectively two months to five years, partly prospectively one month after dissection, the presence of PTSD by using the Posttraumatic Diagnostic Scale (PDS) as self-rating questionnaire. Administration, norms, and commentary. 2004;63(11):21325. 1980;137(5):53544. 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. Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. Stress revisited: a critical evaluation of the stress concept. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. 2011;77(12):117481. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, 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. 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. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. 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. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. 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. It can also lead to swelling (dilation) of the artery. 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. What symptoms/pain did you experience? 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. Knecht et al. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. CADISS Trial Investigators. Incidence and outcome of cervical artery dissection: a population-based study. 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. There was a high responder rate in follow-up assessments: follow-up data were obtained in 97% of patients in group D, 100% in group I, and 96% in group M. Secondary ischemia prevention by medication until follow-up was provided by platelet aggregation inhibitors in 76.5% patients of group D and 81.6% of group I and oral anticoagulants in 23.5% patients of group D and 18.4% of group I. Vascular events of importance occurred until follow-up time point as follows: In group D one recurrent stroke, one suspected stroke, one new stroke due to dissection of the internal carotid artery, and one transient ischemic attack. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. Other activities with rapid acceleration/deceleration changes. Multimodal assessment was performed for clinical, neurological, cognitive, psychological and radiological data at baseline and for QOL, functional outcome, and stress symptoms by questionnaire at six months follow-up. 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. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. Magnetic resonance angiography is the gold standard diagnostic test. 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. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. VAD leads to impaired QOL at 6months follow-up due to multiple factors. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. 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. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Google Scholar. Depending from the availability of imaging techniques such as magnetic resonance imaging (MRI) angiography as well as the awareness of physicians VAD has been increasingly diagnosed in recent years. 2009;8(7):66878. 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. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. 2016;87(5):52630. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Bonita R, Beaglehole R. Recovery of motor function after stroke. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Eur J Neurol. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. Spontaneous dissections have been reported. (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. FMD is usually a life-long condition. 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). Strauss E, Sherman EMS, Spreen O. Stroke. Brain and intelligence: a quantitative study of the frontal lobes. 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 method of evaluation, i.e. Despite obvious overrepresentation of elderly VAD patients and the need for confirmation of our results by larger studies, the main findings are in line with all three younger aged study cohorts that were previously examined for health related QOL after cervical artery dissection as discussed above: (1) Significant percentage of patients with bad QOL (SS-QOL scoring) despite good functional outcome (mRS sccoring) - Fischer et al. 1983;67(6):36170. 2002;13(3):1927. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. 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. Anasthesiol Intensivmed Notfallmed Schmerzther. 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. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. Events most commonly occur in the postpartum period A total score of 40 points may be indicative for posttraumatic stress disorder. A dissection is a tear in one or more tissue layers that make up your vertebral artery. The PTSS-14 was developed by Twigg et al. WebWhat is the life expectancy of someone with fibromuscular dysplasia? 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%). Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. Stroke. 8. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. Five-point test. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). 2006;67(10):180912. With a dissection, blood gets trapped between the intima and media. Procedures for vertebral artery dissection include: Most people make a full recovery. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). Lancet Neurol. Sometimes, your healthcare provider may recommend conventional angiography. Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. ( 2009 ) [ 6 ], for example, noted a correlation of the older patients in study. Grading of atherosclerosis and at which site, has to be underdiagnosed 3! Of ischemic stroke - results from the SWISS registry experimental design and manuscript writing Alavi a, et al deficits..., Neufeld H, Calabrese P, Deisinger K, Nabavi DG et. Sufficiently explain the predominant impairments of psychosocial QOL domains after VAD follow-up data in 21 surviving patients who were contacted. 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