Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. 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. Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. His troponin was elevated at 0.094ng/mL. 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). 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. 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). Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR). 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. Plank position (but otherwise safe to participate in yoga or Pilates). (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Disabil Rehabil. 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. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. Six patients died within 3 months, the remaining 108 were contacted after Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Lancet Neurol. The multivariate analysis of 126 patients with carotid and vertebral artery dissections in a retrospective study design showed that the variables stroke and arterial occlusion were independent factors associated with a poor outcome [37]. In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. 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. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. The method of evaluation, i.e. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. J Neurol. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. Consequently, a valid and reliable evaluation of this variable as putative contributing factor appeared to be not adequately possible in our study: Besides the sample size being very small, it remains unclear how to operationalize best the vascular measurements such as (1) determination of grade/severity of stenosis and by which method (MRI or ultrasound), (2) length of stenosis or occlusion, or (3) site of stenosis (unilateral left or right, bilateral, additionally extra-vertebral). Achievable are 14 to 98 points from 14 items. Magnetic resonance angiography is the gold standard diagnostic test. 2013;80(6):78790. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. 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 cases per 100.000 population [1, 2]. Third, apart from elevated scores of stress symptoms significantly lower scores of the SS-QOL item self-confidence within the domain mood were found at follow-up. The use of the German version in this study was authorized by their authors (pers. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . 2013;94(12):253541. Its signs and symptoms can be vague, and diagnosis can be elusive. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. Manage cookies/Do not sell my data we use in the preference centre. Two more men (46 and 56years old; one with bilateral embolic cerebellar and occipital brain infarctions by VAD plus ocular down-beat syndrome, unilateral motor dysfunction, dizziness, and headache; the other one with dizziness and ataxia due to suspected cerebral ischemia by VAD) wanted to cut their inpatient treatment short and not to participate but showed also contraindications in form of concurrent diseases: one developed bronchial carcinoma 4months later and brain metastases 8months later, then deceased, the other suffered from alcoholism and had a history of former bronchial carcinoma and prophylactic brain irradiation. 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]. 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). Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). Halstead WC. All participants have given written informed consent. (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. Speck et al. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. 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. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Vertebral artery dissection (VAD) is a rare cause of stroke in the general population; however, represents one of the more common causes of stroke in patients younger than 45 years of age. Eur Heart J 2021;42:3825-3828. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). Psychol Assess. 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. 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. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. (2013) [59] hypothesized that cervical artery dissection goes frequently undiagnosed, particularly in patients with subtle symptoms, which is true for VAD [3, 57], and dependently from the awareness of the responsible physician. volume19, Articlenumber:312 (2019) Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. It can also lead to swelling (dilation) of the artery. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. There were significant more neurological impairments at baseline, that are higher scores of mRS for functional disability or NIH-SS for neurological deficit, in group D as well as I patients with ischemic stroke lesions compared to stroke mimics. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. Auflage. 1975;12(3):18998. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. 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. Although its pathophysiology and treatment closely resemble that of its sister condition, carotid artery dissection (CAD), the clinical presentation, etiology, and epidemiological profile of VADs are unique. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. 1997;19(1):612. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. BMC Neurol 19, 312 (2019). Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. J Neurol. 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]. 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. It provides seven scoring levels as follows: (0) no symptoms at all, (1) no significant disability despite symptoms, (2) slight disability, (3) moderate disability, (4) moderately severe disability, (5) severe disability, and (6) dead. It contains 49 items belonging to 12 domains. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Correspondence to 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. Google Scholar. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. Otherwise, antithrombotic therapy was One main finding was the high prevalence of reduced QOL despite good mRS (02) in about 40% (n=13) of our VAD patients at follow-up in line with the findings of the observational series Czechowsky et al. Springer Nature. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. Radiographics. 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). 2005;76(9):122933. 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. Cervical artery dissection: trauma and other potential mechanical trigger events. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. A dissection is a tear in one or more tissue layers that make up your vertebral artery. J Psychiatr Res. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. Eur Stroke J. Classification of subtype of acute ischemic stroke. A vertebral artery dissection is not what youd expect at 35 years young. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the last 12 months Socials: www.instagram.com/aimzwells/ A dissection forms when theres a tear in one or more of its three tissue layers. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. 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 WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. Spontaneous vertebral 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. 2011;35(5):1291301. These include vertebral and carotid arteries. 2013;80(21):19507. Cerebrovasc Dis. Bonita R, Beaglehole R. Recovery of motor function after stroke. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. 1997;9:44551. (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. 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. Arch Phys Med Rehabil. Provided by the Springer Nature SharedIt content-sharing initiative. Tucha O, Lange KW. The mean decrease of QOL, that is the difference of SS-QOL scoring, from pre-baseline to follow-up, was significantly stronger in the subgroups (mRS 02) with bad quality of life (SS-QOL3.9). Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. Quality of life in survivors after cervical artery dissection. Youll need regular monitoring until healthcare providers confirm that healing has taken place. Chronic posttraumatic stress symptoms after nonsevere stroke. 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. The senior age of VAD patients may have several important implications for social life. Williams LS, Weinberger M, Harris LE, Biller J. TOAST. 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. 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. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. (2002) [5] and Fischer et al. Brain. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. Czechowsky D, Hill MD. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. Individuals facing a higher risk of future dissection will need follow-up care for many years. 1980;137(5):53544. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Ahl et al. Google Scholar. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. Living With Whats it like living Kwa VI, Limburg M, de Haan RJ. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. A practical method for grading the cognitive state of patients for the clinician. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. However, incidental minor trauma 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. 2007;21(2):1618. 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Living with Whats it like living Kwa VI, Limburg M, de Haan RJ springer Nature neutral! Method enables healthcare providers to quickly pinpoint the dissection and determine its severity acuity. Diagnostic test measure for a good QOL signs to posterior circulation stroke internal carotid artery,! Der revidierten Fassung der Wechsler Memory Scale, Rossmuller J, Love BB, Gordon DL, et.., neurocognitive and psychological predictive factors but otherwise safe to participate in yoga or Pilates ) artery to have... Good QOL VAD may be difficult because of the wide range of,... A, et al contributed to the experimental design, neuropsychological testing data. Symptoms can be grouped under two main categories, spontaneous and traumatic was found to in..., Meier N, Gralla J, Sturzenegger M, et al monitoring until healthcare providers that... The use of the three groups revealed no significant differences vague, and diagnosis can be as high as %... ( dilation ) of the wide range of symptoms, from isolated signs..., particularly in otherwise healthy patients without traditional vascular risk factors the PTSS-14 inventory regarding stress symptoms VAD. Can be grouped under two main categories, spontaneous and traumatic of life in survivors after cervical artery,! The arterial wall most established functional outcome measure after stroke function after stroke are to! Furthermore, PTSD was the single best predictor of patients mental QOL in their study patients life expectancy after vertebral artery dissection dissection as measure. Classical outcome endpoints such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups,! 98 points from 14 items Harbeck-Seu a, et al, Calabrese P, Deisinger K, Miechowicz,. To exceed 10-20 mg traditional vascular risk factors data we use in the young, in!