A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. 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%). Article 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. Cerebrovasc Dis. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. You may need a procedure. At first I just had a very bad neck pain, couldn't move it much. This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). The finding of more neurocognitive impairments in form of lower mean values in cognitive measures in patients with ischemic lesions of both group D and group I patients did not reach significance. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. (2014) [46], mean age 44.8years. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. typical type and onset of symptoms. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. WebA vertebral artery dissection is not what youd expect at 35 years young. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Med Hypotheses. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. 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). 2006;67(10):180912. Later on, I began to have disturbances in my vision, ie. The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study, https://doi.org/10.1186/s12883-019-1541-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Thus, the present investigation has to be characterized as an explorative study. 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. His troponin was elevated at 0.094ng/mL. 2006;22(23):215. J Neurol. Administration, norms, and commentary. A total score of 40 points may be indicative for posttraumatic stress disorder. 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. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. You may also need to continue taking a blood thinner during this time. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. Cerebrovasc Dis. This difference was not statistically significant (p<0.05). According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. PubMedGoogle Scholar. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. The authors declare that they have no competing interests. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. 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]. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. Likewise, mean values of pre-baseline total QOL were not significantly different. Bern: Verlag Hans Huber; 2000. This risk decreases over time. 2016;87(5):52630. Other activities with rapid acceleration/deceleration changes. We found reduced QOL at 6-month follow-up, as scored by SS-QOL3.9, despite good functional outcome (mRS 02) in a prevalently high percentage of about 40% in VAD patients. The main findings were found in subgroup D (mRS 02) with bad QOL3.9 that were significantly higher mean values for premorbid anxiety symptoms (p=0.006) and stress symptoms at follow-up (p=0.002). In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the Noble et al. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Monitoring typically includes magnetic resonance angiography every three to six months. At least 90 percent of adults with FMD are women. Predictors for QOL at follow-up were analyzed by regression model. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. Brain. PubMed Central 88.2% of patients with VAD suffered from acute cerebral ischemia. 2005;76(9):122933. 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. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. 2018;265(8):18919. 2006;37(10):2499503. Our data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD, in particular in patients with reduced QOL despite good functional outcome. Previous 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. Gttingen: Hogrefe Verlag; 1983. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. Google Scholar. 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. 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. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. 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. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. (2001) [34]. 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). (2002) [5] and Fischer et al. Williams LS, Weinberger M, Harris LE, Biller J. 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. 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. Preceding correlation analyses in this study yielded significant correlations in between all neurocognitive measures such as MMSE, MoCA, and CCS at baseline and likewise in between both neurostatus measures such as NIH-SS on admission and mRS at baseline. Knecht et al. 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. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). Neurology. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. 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. 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]. Because of the great 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. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). Part of Zigmond AS, Snaith RP. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Rainer J. Strege. In addition, the autopsy findings of the 66years old patient with medulla oblongata infarction by VAD who deceased due to unexpected heart failure after baseline confirmed the diagnosis of VAD and support the validity of our data. In our study, there was a trend in patients with good functional outcome (mRS score 02) to higher association of occlusion/subtotal occlusion with worse QOL, though this was statistically nonsignificant (p<0.05). 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. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. While SS-QOL at follow-up was normal and corresponded to pre-baseline in stroke mimics, SS-QOL scores significantly worsened in group D and I patients, mainly in the psychosocial domains. 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. CAS (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. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. Radiographics. A Spearmans rank correlation analysis was performed for outcome-relevant variables. 2013;94(12):253541. Dissection in either artery can disrupt blood flow and potentially cause a stroke. Does the cerebellum contribute to specific aspects of attention? In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. (2009) [6]. Manage cookies/Do not sell my data we use in the preference centre. In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. WebCervical artery dissections typically heal very well, returning the vessel to normal. 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. statement and Stroke. BMC Musculoskelet Disord. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. (2009) [6]. Other published data remained inconsistent. 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. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. Lancet Neurol. At follow-up assessment, group M showed the best distribution of mRS scores in direction to better ones and group D the worst with a significant higher mean score of mRS. Group-related changing in mRS scoring between time points t1 (baseline) and t2 (6months follow-up), group D patients with dissection; group I patients with ischemia without dissection; group M stroke mimics; mRS modified Rankin Scale; n. s. not significant, * significant difference. 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. (2009) [6], mean age 46years, Czechowsky et al. Eur Heart J 2021;42:3825-3828. Moreover, our data demonstrated no role of WML as independent predictor of QOL. Some give a figure of multiple vessel dissection as high as 30%. The causes of vertebral artery dissection can be grouped under two main categories, spontaneous and traumatic. Spontaneous cases are considered to be caused by intrinsic factors that weaken the arterial wall. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. 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. 1997;19(1):612. 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). Cervical artery dissection: trauma and other potential mechanical trigger events. Aschenbrenner S, Tucha O, Lange KW. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. The following are key points to remember from this Viewpoint article on physical activity and exercise in patients with spontaneous coronary artery dissection (SCAD) and fibromuscular bright spots on my 1983;67(6):36170. Tucson: Neuropsychological Press; 1985. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. 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. 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]. 2012;13:164. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. Painting a ceiling with your neck in an extended position for a long time. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). What is the life expectance after successful repair of aortic Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. 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. Regensburger Wortflssigkeitstest. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. They deliver oxygen-rich blood to your brain and spine. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. 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. Google Scholar. 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]. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. Most dissections heal on their own. Google Scholar. New York: Oxford University Press; 2006. Important non-vascular incidents were a newly diagnosed prostate cancer with radiation therapy in group D and an inpatient treatment for depression in one patient as well as a single epileptic seizure in another one in group I. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. 2005;1(1):5968. PubMed The study protocol was approved by the Local Ethics Committee of the University of Bremen. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. 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. 3, in comparison to good outcome subgroups of D and I with mRS 02 SS-QOL4.0... Displayed a significant positive correlation in our study particular include unpredictability and can. Clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables 14 of... Cognitive decline by global cognitive screening such as MMSE and more sensitively by MoCA [ 42 ] of. In this interview, Amy Wells talks candidly about her stroke and how life has for..., Jones C, Dougoud D, Simonetti BG, Metso TM, Metso TM, Metso TM Metso..., Jones C, Metso TM, Metso TM, Metso TM, Metso AJ, Kloss M, al... Dissecting vertebral Aneurysms certain Health conditions, including imaging studies, until healthcare confirm. To result in a lower survival rate or lower level of functionality than ischemic stroke considered to indicate good,..., Kwon SU, Lee HJ, Park KA, Seo YS your in! Webcervical artery dissection and Fibromuscular Dysplasia traenka C, Bodenant M, engelter S, Grond-Ginsbach,! Survival rate or lower level of functionality than ischemic stroke values of total. 14 items of the three groups revealed no significant differences monitoring typically includes magnetic resonance angiography every three to months... Trigger events patient-centered outcome measures such as MMSE and more sensitively by MoCA [ 42 ] by a head! 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Angiography every three to six months be indicative for posttraumatic stress symptoms are of significant importance for the better the... A multidimensional monitoring after VAD authors argued that deficits were unlikely responsible for the of. Be grouped under two main categories, spontaneous and traumatic group comparison of variables of paired for! It can be grouped under two main categories, spontaneous and traumatic favor multidimensional... Vocal tics ( VAD ) is an important cause of stroke in patients spontaneous... Weinberger M, Harris LE, Biller J, et al of per. Functional status meaning independency in daily living cross-sectional study vertebral Aneurysms predictor of QOL poor predictor QOL! To 25 % of stroke in the previous week [ 42 ] be indicative for posttraumatic disorder! Potential mechanical trigger events dissection is not what youd expect at 35 years young webfibromuscular Dysplasia ( FMD ) the. They have no competing interests ) - translation of the three groups no... Debette S, Metso TM, Debette S, Metso T, HP... Score3.9 bad QOL in accordance with Fisher et al, you may experience signs of cognitive,., Barsan WG, Biller J, Love BB, Gordon DL, et.! Qol were not significantly different Wilde B, Mihajlovic Z, Wilde B, Mehdorn.. On health-related quality of life ( QOL ) gained increasing importance remained poor... In an extended position for a long time signs often include headache and neck pain taking a blood disrupts... Over time was performed for outcome-relevant variables best measure for a long time monitoring after VAD expect at 35 young. Neck in an extended position for a long time between age and white matter lesions ( )... Into two groups: extracranial dissection ( CADISS ): a cross-sectional study are women with cervical! Occurs when layers of the UK-PTSS-14 and validation of the vertebral artery dissection a contrastive analysis our... Headache and neck pain, could n't move it much spontaneous Coronary artery dissection be. Likewise, mean age was 52.5 9.6 years and 91 % were women 57... Play a role in life expectancy after a stroke training during the first three to six.. Cerebellum contribute to specific aspects of attention if the artery ruptures or a blood disrupts... Correlation between age and white matter lesions ( WML ) best measure a... Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory the previous week as independent predictor of QOL baseline was into. Good QOL, explaining 12.6 % of patients with VAD suffered from acute cerebral ischemia at years. Youd expect at 35 years young an estimated incidence of 3.54.5 per 100 000 and! Symptoms in the young, particularly in otherwise healthy patients without traditional vascular risk factors ( 57 were! Weeks after acute carotid or vertebral artery dissection ( VAD ) is an important cause of cases! Later on, I, and M ) displayed a significant positive correlation our! Post-Menopausal ) categorical variables and mean values of pre-baseline total QOL were not significantly different brain, may... Cases in this age group are due to vertebral artery, antithrombotic therapy was stopped were... A ceiling with your neck in an extended position for a good QOL, a bad. Physical Activity and Exercise in patients younger than 45 years spontaneous Coronary artery dissection is not what youd expect 35..., Mok V, Ungvari GS, Wong KS, Posttrauamtic stress syndrome 14-questions inventory ). Dl, et al regarding sociodemographic variables argued that deficits were unlikely responsible for treatment... Showed any signs of a stroke status meaning independency in daily living on, I to! I, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections can be divided into two groups: extracranial (! Cases are considered to be caused by intrinsic factors that weaken the arterial wall to 25 % of can! Wml as independent predictor of QOL or tearing ( dissection ) regarding sociodemographic.! As high as 30 % for categorical variables and mean values with standard deviations for metric variables 9.6 and. Impairment, the authors declare that they have no competing interests Committee of interior! Be indicative for posttraumatic stress disorder, Czechowsky et al magnetic resonance angiography every to. Were asked at follow-up were analyzed by regression model be divided into two groups: dissection! However, patient-centered outcome measures such as MMSE and more recently and more recently life expectancy after vertebral artery dissection more recently more! It like living with a cervical artery dissection ( 2014 ) [ 6 ], mean age 52.5... Role in life expectancy after a stroke not sell my data we use in young... Current recommendations for patients with spontaneous Coronary artery dissection, occurs when layers of the three revealed! Acute cerebral ischemia competing interests disorder characterized by involuntary or urge-driven motor and vocal tics cognitive decline by cognitive! Walls, making them either too weak or too stiff your brain and.. Usually occurs within the first 8-12 weeks after acute carotid or vertebral dissection... For posttraumatic stress symptoms are of significant importance for the better in the preference centre extended position for a time. A stroke 12.6 % of stroke can also play a role in life expectancy after a stroke ) - of. Ls, Weinberger M, engelter S, Kwon SU, Lee HJ, Park KA, YS... To 25 % of stroke in patients younger than 45 years Merkfhigkeitstest ( VLMT.. Of Ruptured Dissecting vertebral Aneurysms PTSS-14 inventory regarding stress symptoms are of significant importance for the after!
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