In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. Tucha O, Lange KW. Data about pathological results of neuropsychological test battery assessment. CTA, MRI, and Stroke. J Stroke Cerebrovasc Dis. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. Previous The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. This risk decreases over time. This difference was not statistically significant (p<0.05). Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. 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. 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. 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. BMC Neurology Spontaneous dissections have been reported. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. Administration, norms, and commentary. 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. (2014) [46] very recently reported for the first time a high prevalence of 45.2% patients meeting the diagnostic criteria for PTSD after cervical artery dissection compared to 2.9% in the general German population. 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. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. In the SSQOL-subgroup analysis of patients with good functional outcome (mRS score2) and good SS-QOL score (4.0) at follow-up were eight patients with arterial occlusion or subtotal occlusion versus five with or without stenosis. Psychol Assess. Stress revisited: a critical evaluation of the stress concept. Get useful, helpful and relevant health + wellness information. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. 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 2011;92(5):7928. Vertebral artery hemodynamics can be evaluated by assessing: (1) the presence or absence of flow, (2) blood flow direction and alteration of the waveform shape, (3) vertebral artery size, and (4) the peak systolic and end-diastolic velocities. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. 1987;149(2):3516. 1999;53(8):183943. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. RK contributed to the experimental design and manuscript writing. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. Subgroup analysis stratified for QOL by Stroke Specific Quality of Life Scale (SS-QOL) were done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 02). It has been already earlier demonstrated in both patients with stroke and patients with Parkinsons disease that the type of psychosocial alterations, psychosocial adaptation and coping strategies seem to be of much greater impact than the degree of physical impairment [56]. Because previous studies have shown no crucial role of neurovascular risk factors or sociodemographic factors for QOL of VAD patients, we focused our analysis of potential contributing factors for QOL on previously less investigated neurological, neurocognitive and psychological variables with special respect to the biopsychosocial model [12]. (3) The upper inclusion limit of age range for our study was quite high with 85years. 1996;243(8):599604. Vulnerability--a new view of schizophrenia. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. 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. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. Cervical artery dissection: trauma and other potential mechanical trigger events. In earlier stages, you might not notice symptoms. (2002) [5] and Fischer et al. 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. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. Zigmond AS, Snaith RP. A better understanding of clinical courses and their affecting variables with special respect to the biopsychosocial model [12] seemed to be of great importance for the neurorehabilitation of such VAD patients in the future. 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). Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. BMC Musculoskelet Disord. Kwa VI, Limburg M, de Haan RJ. TOAST. 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%. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). 1975;12(3):18998. The PTSS-14 was developed by Twigg et al. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. 2010;45(1112):68895. 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. Spontaneous vertebral artery dissection (VAD) represents a rare but significant disease, accounting for an average annual incidence rate of about 0.97 to 1.5 Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. 1997;9:44551. 1980;137(5):53544. 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%). However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. 3rd ed. Disabil Rehabil. Living With Whats it like living (2009) [6], mean age 46years, Czechowsky et al. Predictors for QOL at follow-up were analyzed by regression model. 2001;344(12):898906. 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%). Department of Neurology, AGAPLESION Diakonieklinikum Rotenburg, Elise-Averdieck-Str.17, 27356, Rotenburg, Germany, Center for Cognitive Sciences, Department of Neuropsychology and Behavioral Neurobiology, University of Bremen, Hochschulring 18, D-28359, Bremen, Germany, You can also search for this author in It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. 2017;7(3):16572. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. 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. 2013;80(6):78790. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. California Privacy Statement, Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. 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. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. 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. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. J Neurol Neurosurg Psychiatry. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. 2010;17(2):21925. 2009;8(7):66878. But timely treatment, typically blood thinners or a procedure, can save your life. The aim of this study Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. The senior age of VAD patients may have several important implications for social life. 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). Individuals facing a higher risk of future dissection will need follow-up care for many years. 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. All participants have given written informed consent. Eur Stroke J. Neurological outcome and quality of life after stroke due to vertebral artery dissection. They finally hypothesized that the rate of incidence must be equal throughout life. 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). Thirteen of 32 VAD patients (40.6%) rated QOL at follow-up as bad (SS-QOL score3.9) despite of good functional outcome (mRS score 02). 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. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. PubMed Cleveland Clinic is a non-profit academic medical center. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Auflage. Classification of subtype of acute ischemic stroke. 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). 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. While the mean group values of MMSE around 28 out of 30 were within normal range, only the group of stroke mimics showed a normal mean value of 26.96 if scored by MoCA. Apart from severity of neurological disorders, as scored by mRS, and impaired neuropsychological performance at baseline, as measured by global cognitive screening in form of MMSE, elevated posttraumatic stress symptoms levels, as assessed by Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14), proved to be an independent predictor for reduced QOL at follow-up in group D patients after VAD according to multivariate regression analysis. 2008;28(6):171128. 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. 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. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. Three cohorts of consecutive patients were included in the study for the purpose of comparison: group D (dissection) as the main group comprised patients with first-time spontaneous vertebral artery dissection (VAD) of at least one vertebral artery, group I (ischemia) as a positive control group consisted of patients with acute cerebral ischemia such as stroke or transient ischemic attack (TIA) of the posterior circulation due to any other cause than dissection, and group M (mimics) was chosen as a negative control group of stroke mimics of the posterior circulation. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. 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. No individual persons personal details, images or videos are being used in this study. J Clin Neurol. J Neurol. As a key result, higher levels of posttraumatic stress symptoms appeared to be a prominent contributing factor to bad QOL in VAD patients with otherwise good functional outcome. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a 2004;63(11):21325. Among physical domains only the domain work showed also deterioration in groups D and I. The cerebellar cognitive profile. Google Scholar. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. Neurorehabil Neural Repair. Nearly all other potential contributing factors were not significantly different. Chronic posttraumatic stress symptoms after nonsevere stroke. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. The German version of the Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) [21] was used at follow-up to determine posttraumatic stress symptoms. At first I just had a very bad neck pain, couldn't move it much. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). Stroke. 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. Article Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. Brain. These findings corresponded widely to findings of Gottwald et al. 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