Neurological outcome and quality of life after stroke due to vertebral artery dissection. However, incidental minor trauma Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. His troponin was elevated at 0.094ng/mL. 2013;80(21):19507. Vertebral artery dissection: presenting findings and predictors of outcome. 88.2% of patients with VAD suffered from acute cerebral ischemia. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. 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. They carry blood to the brain and spinal cord, which are part of the nervous system. 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]. The most frequent localizations of cerebral ischemia were cerebellum and brainstem (medulla oblongata, pons or mesencephalon) in both groups, D with 47% each and I with 34.2 and 42.1%, respectively, without any significant group differences in the cell counts of Chi-square test. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. I was unable to return to work for three months. Your chances of experiencing a stroke are low. 2010;17(2):21925. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. 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. The role of cognitive impairment in the quality of life after ischaemic stroke. 3rd ed. They deliver oxygen-rich blood to your brain and spine. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. 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. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. PubMed (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. 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. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. J Abnorm Psychol. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. The stroke happened about a month after she was diagnosed with EDS. 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]. 2013;80(6):78790. Grond-Ginsbach et al. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. 2006;22(23):215. 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%. Fischer et al. 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. Factors affecting the quality of life after ischemic stroke: young versus old patients. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. 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. 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. Third, psychological condition was not examined at baseline. The aim of this study Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. Traenka et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. 2004;251(10):12428. Czechowsky D, Hill MD. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. 8. Definitions for use in a multicenter clinical trial. 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). 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). This risk decreases over time. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Neurosci Biobehav Rev. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. 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. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. 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. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. But timely treatment, typically blood thinners or a procedure, can save your life. (1987) [33] and Wahlund et al. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. However, you may be at risk for future dissections. Ischemic stroke was found in only 33.9%. Dissection in either artery can disrupt blood flow and potentially cause a stroke. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. While there were in groups D and I compared to group M frequent impairments in both global screening tests (MMSE, MoCA) and in single cognitive function tests of the neuropsychological test battery (Additionalfile1) and also in the resulting cognitive composite score (CCS), this difference reached statistical significance only in the MoCA assessment for group D compared to group M (Table2). Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. The aim of this study was therefore as follows: (1) to evaluate the characteristics of patients after VAD with special focus on those with bad quality of life despite good functional outcome in comparison with positive and negative control patients in a prospective comparative study design (2); to identify contributing factors to quality of life after VAD, considering neurological, cognitive, and psychological variables (3); to identify the predictive factors for quality of life after VAD. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. 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). Neuropsychologia. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. At first I just had a very bad neck pain, couldn't move it much. The prevalence of 73.6% VAD patients with ischemic stroke and 14.7% with TIA in our study corresponded well to 67% (114 patients) and 10% (17 patients), respectively, in a large European multicenter prospective study on patients with first-ever spontaneous VAD [3]. 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. Five-point test. 2016;87(5):52630. J Neurol. Vertebral artery dissection is a rare cause of stroke in older adults. Neurology. 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. Not applicable. 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. 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. By using this website, you agree to our Cerebrovasc Dis. Disabil Rehabil. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. Its more common in people younger than 45. Spontaneous dissections have been reported. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. FMD is usually a life-long condition. Measurements of acute cerebral infarction: a clinical examination scale. 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. 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]. CAS (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. No individual persons personal details, images or videos are being used in this study. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). Furthermore, PTSD was the single best predictor of patients mental QOL in their study. Article The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. (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. 2003;250(10):117984. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . Gttingen: Hogrefe Verlag; 1983. Stroke. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Halstead WC. 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