Neurology. Your healthcare provider may recommend alternative treatments. At first I just had a very bad neck pain, couldn't move it much. 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. 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). Springer Nature. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. 2005;1(1):5968. 2011;134(Pt 12):367286. 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. Youll need regular monitoring until healthcare providers confirm that healing has taken place. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. You may need a procedure. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. 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). The PTSS-14 was developed by Twigg et al. Correspondence to Furthermore, reinfarction as a negative event or recanalization of the former dissected artery vessel as positive event is most probable during the same time period of first six months. Acta Anaesthesiol Scand. 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]. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. 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. (2004) [58] showed in their study that a significant number of cervical artery dissection can occur in the older age group and can be diagnosed if considered. The first data collection in each patient was performed at baseline (time point t1) in the acute phase in hospital after clinical stabilization: neuro-status at admission by National Institute of Health Stroke Scale (NIH-SS) score [18] according to patients records, neurostatus (mRS) and clinical data at baseline according to examination and interview, cognitive screening as well as extensive neuropsychological testing by battery at baseline, and administering self-rating protocols for symptoms of anxiety and depression pre-baseline as well as stroke-related QOL pre-baseline. Cerebrovasc Dis. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Engel GL. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. California Privacy Statement, Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. 2014;76(9):6707. All patients presented with acute myocardial infarction (MI) (26% ST-segment elevation MI [STEMI], 74% NSTEMI) and approximately 70% reported an emotional or physical stressor. (2001) [34]. PubMed Central 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. 1980;137(5):53544. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Knecht et al. WebScore: 4.2/5 (61 votes) . 1987;149(2):3516. Zimmermann PFB. In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. Kissela et al. At least 90 percent of adults with FMD are women. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Chicago: University of Chicago Press; 1947. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. (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. 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). 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). Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. 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%. Psychol Assess. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. New York: Oxford University Press; 2006. (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. A dissection forms when theres a tear in one or more of its three tissue layers. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. volume19, Articlenumber:312 (2019) What is the life expectance after successful repair of aortic 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%. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a Google Scholar. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. Regensburger Wortflssigkeitstest. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. 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). Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. It can affect blood flow, putting you at risk for life-threatening complications. Apart from (1) the computer-based test battery for alertness, divided and selective attention (TAP) [24], all other tests were paper and pencil tests: (2) Trail Making Test (TMT A and B) for combined attention and executive function [25], (3) the Tower of London (TL-D) for executive function [26], (4) mental rotation (LPS 7) for visual-spatial function [27], (5) the Five-Point Test (5PT) for spatial-cognitive function [28], (6) the Regensburger Wortflssigkeitstest (RWT) for verbal fluency [29], (7) Verbal Learning and Memory Test (VLMT) [30], (8) Block tapping (BT) for the visual digit span [31] and (9) the Finger Tapping Test (FTT) for the hand motor function [32]. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. Five-point test. 2. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. 1996;243(8):599604. Brain. 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. 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. 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. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. (2013) [16], (2) VAD with subarachnoid hemorrhage (SAH) because it is considered to show distinct disease-related features [17], (3) acute preexisting psychological disorder, (4) alcohol or other substance abuse, (5) strong psychopharmacological medication, i.e. Stroke. Spontaneous dissections have been reported. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. Strauss E, Sherman EMS, Spreen O. AJR Am J Roentgenol. Thus, the present investigation has to be characterized as an explorative study. 2008;63(6):1095104 discussion 04-5. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. More importantly, however, our study showed also several limitations. 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. Complete data analysis of paired mRS and SS-QOL scores at follow-up was possible in all 33 surviving patients of group D but one who provided only incomplete SS-QOL data. 2001;344(12):898906. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. 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. Terms and Conditions, Gttingen: Hogrefe Verlag; 1983. Procedures for vertebral artery dissection include: Most people make a full recovery. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. 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. TOAST. Zubin J, Spring B. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. 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. The role of cognitive impairment in the quality of life after ischaemic stroke. Magnetic resonance angiography is a sophisticated test thats not widely available. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. Eur J Neurol. This difference was not statistically significant (p<0.05). Events most commonly occur in the postpartum period Other activities with rapid acceleration/deceleration changes. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. Noble et al. All data were prospectively collected from consecutively recruited patients who were admitted to our stroke unit under the suspected diagnosis of an acute stroke between October 2010 and June 2013. The stroke happened about a month after she was diagnosed with EDS. The use of the German version in this study was authorized by their authors (pers. 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. Ischemic stroke was found in only 33.9%. They deliver oxygen-rich blood to your brain and spine. 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. Nearly all other potential contributing factors were not significantly different. 1975;12(3):18998. BMC Neurol 19, 312 (2019). Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. "mini-mental state". The mRS is considered to be the worldwide most established functional outcome measure after stroke. A 42-year 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). 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. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Previous Corresponding to their multivariate analysis, the NIH-SS score on admission was also found to be an independent predictor of QOL at follow-up in our univariate regression analysis. 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. On rare occasions, this can lead to stroke. 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). 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]. Neurology. A dissection is a tear in one or more tissue layers that make up your vertebral artery. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. Google Scholar. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. 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. 2009;8(7):66878. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. Most dissections heal on their own. Support, the present investigation has to be characterized as an explorative study, Chawluk,... You may experience signs of a stroke in her brain stem almost three years ago C Dougoud! More tissue layers that make up your vertebral arteries give a figure of multiple vessel dissection high. A dissection is a tear in one or more of its three tissue layers a, Hurtig HI Zimmerman... Chawluk JB, Alavi a, Hurtig HI, Zimmerman RA five patients ( %... Chawluk JB, Alavi a, Hurtig HI, Zimmerman RA post-traumatic disorder. 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