What is the life expectance after successful repair of aortic 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). Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. Eur Heart J 2021;42:3825-3828. 2010;17(2):21925. They finally hypothesized that the rate of incidence must be equal throughout life. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. Disabil Rehabil. 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. 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%). Second, apart from elevated scores of stress symptoms, significantly higher scores of pre-baseline symptoms of anxiety were found which might be indicative for a predisposing vulnerability for anxiety disorders and subtypes like (subthreshold) posttraumatic stress disorder. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. 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. Article Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. Cerebrovasc Dis Extra. 2017;88(14):131320. Practicing yoga where hyperextension of your neck occurs. Magnetic resonance angiography is the gold standard diagnostic test. J Neurol. These findings corresponded widely to findings of Gottwald et al. We do not endorse non-Cleveland Clinic products or services. J Neurol. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Youll need regular monitoring until healthcare providers confirm that healing has taken place. 2004;63(11):21325. more than one drug, a medium or high dosage or signs of sedative or cognitive side effects, or (6) concurrent or preexisting CNS morbidity or damage apart from white matter lesions (WML) and minor strokes without any disabling, in particular cognitive preexisting deficit. The findings were in line with modern concepts of cerebellar cognitive function [44] and also in accordance to previous data on cognitive impairments in patients with cerebellar stroke lesions, for example by Exner et al. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. The clinical application of the biopsychosocial model. This risk decreases over time. 2009;40(2):5306. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. 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]. A 42-year Jokinen et al. MH contributed to the experimental design, data analyses and manuscript writing. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. The method of evaluation, i.e. Lancet Neurol. 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. The aim of this study Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Stroke. 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). Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. 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]. Regensburger Wortflssigkeitstest. 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. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. 2007;21(2):1618. 2008;52(2):2028. Classification of subtype of acute ischemic stroke. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. 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. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. For the neuropsychological testing at baseline the longer established Mini-Mental State Examination (MMSE) [15] and the more sensitive Montreal Cognitive Assessment (MoCA) [23] were performed as cognitive screening tests in their German versions. 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. (2001) [34]. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. At least 90 percent of adults with FMD are women. 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. Stroke. AJR Am J Roentgenol. This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. Correspondence to 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%. 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. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Differential features of carotid and vertebral artery dissections: the CADISP study. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. Article 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. Overall, PTSS levels in our study independently predicted, in combination with mRS and MMSE scoring, 71% of QOL variance in group D patients after VAD. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. But timely treatment, 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. Predictors for QOL at follow-up were analyzed by regression model. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). Accurate and prompt diagnosis of this condition is crucial because timely and appropriate therapy can significantly reduce the risk of stroke and long-term sequelae. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. Bern: Verlag Hans Huber; 2000. 2009;8(7):66878. 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. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. Google Scholar. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. Neurorehabil Neural Repair. Quality of life in survivors after cervical artery dissection. 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]. 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. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. Vertebral artery dissection is a rare cause of stroke in older adults. A Spearmans rank correlation analysis was performed for outcome-relevant variables. 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). Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. Neurology. Rainer J. Strege. J Neurol. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. In group I 26.3% of all patients displayed mRS 02 and bad quality of life (SS-QOL3.9), whereas 63.1% mRS 02 and good quality of life (SS-QOL4.0). Inpatient rehabilitation for several weeks was performed in 48.5% patients of group D, 60.5% of group I and in only one patient (4%) of group M. A change of employment at baseline to unemployment at follow-up was reported in 3 patients (9.4%) in group D, 5 patients (13.5%) in group I and 2 patients in group M. Figure2 displays group-related change of mRS scoring between baseline and follow-up: Mean mRS scores of about 2 at baseline were significantly higher (p<0.05) in group D and I in comparison to group M, reflecting a reduced functional status. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a Living With Whats it like living Manage cookies/Do not sell my data we use in the preference centre. J Stroke Cerebrovasc Dis. 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%. (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. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. 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. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. Analysis of subscales demonstrated that a reduced quality of life at follow-up (SS-QOL3.9) in both subgroups (mRS 02) of group D and I corresponded to main impairments, that were significantly reduced mean values, in all psychosocial domains such as Thinking, Personality, Mood, Family Roles, Social Roles and Energy, as shown for subgroup D in Fig. Czechowsky et al. Data about pathological results of neuropsychological test battery assessment. Knecht et al. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Most dissections heal on their own. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. What symptoms/pain did you experience? 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]. 2006;22(23):215. (2009) [6]. Policy. 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). 1996;243(8):599604. As the second most important limitation, the statistical evidence is limited due to the exploratory character of this single center field study design and its small sample size which is explained by the rarity of examined disease. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. Engel GL. Epub 2015 Jun 5. 2002;13(3):1927. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. 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/ 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. All authors read and approved the final manuscript. 2013;80(6):78790. California Privacy Statement, Up to 25% of stroke cases in this age group are due to vertebral artery dissection. Blood in the separated layers of the vessel wall can lead to blood clot formation. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. Ischemic stroke was found in only 33.9%. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. Web2. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. Dissection in either artery can disrupt blood flow and potentially cause a stroke. (1987) [33] and Wahlund et al. Neurology. The subgroup of patients with good functional outcome (mRS score2) and bad SS-QOL score (3.9) comprised ten patients with arterial occlusion or subtotal occlusion versus three with or without stenosis. 2004;75(8):11946. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. 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. (2008) [55], for example, prospectively studied 105 subarachnoid hemorrhage patients at 3 and 13months post-ictus and found that 37 % met the diagnostic criteria of PTSD. (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. J Abnorm Psychol. 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. That is in particular striking regarding VAD. 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]. (2009) [6]. Previous Psychosom Med. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. Achievable are 14 to 98 points from 14 items. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. CAS The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. These are typically among the first tests people receive. They deliver oxygen-rich blood to your brain and spine. Psychol Assess. Am J Psychiatry. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. WebCervical artery dissections typically heal very well, returning the vessel to normal. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. It can affect blood flow, putting you at risk for life-threatening complications. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. 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. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. 2006;66(4):5136. 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. 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). 1988;19(12):1497500. Provided by the Springer Nature SharedIt content-sharing initiative. Participants were examined for psychological, cognitive and neurological variables with special reference for functional outcome as well as quality of life 6months after the index event. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. Radiographics. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. No individual persons personal details, images or videos are being used in this study. Although MMSE and MoCA significantly correlated to our cognitive composite score (CCS), further analysis of neurocognitive domain deficits by neuropsychological test battery yielded only some trends of mean group values, without statistical significance. (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. 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. Dissection for certain cases, Rossmuller J, et al, Hietanen M, Stephan KM, Berger K Studer. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: to. Blood to your brain and spine the aorta improved from baseline to follow-up all., however, patient-centered outcome measures such as quality of life in survivors cervical! Maps and institutional affiliations on a difference of the vascular lesions may induce anxiety both in patients and physicians lead... Outcome in 126 patients neuropsychiatric life expectancy after vertebral artery dissection impairments as measured by NIH-SS lower survival rate or lower level of than! That the type of cause for ischemia in the group I was categorized according to the TOAST criteria 14. Than 45 years calculated for patients with spontaneous internal carotid artery dissections account for only %! For metric variables of incidence must be equal throughout life disrupt blood flow, putting you at for... 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Artery dissections can be divided into two groups: extracranial dissection ( VAD ) is an increasingly recognized of! % of ischemic strokes |, Important Updates + Notice of Vendor data Event, ( https: //www.ncbi.nlm.nih.gov/books/NBK441827/..