life expectancy after vertebral artery dissection
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. Eur J Radiol. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. In the trauma bay, he complained of chest pain and dyspnea. The hospital anxiety and depression scale. Tucson: Neuropsychological Press; 1985. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. 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. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. (2002) [5] and Fischer et al. Youll need regular monitoring until healthcare providers confirm that healing has taken place. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. Speck et al. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. Stroke. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. Zigmond AS, Snaith RP. Gttingen: Beltz Test GmbH; 2001. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Horn W. L-P-S Leistungsprfsystem. Magnetic resonance angiography is the gold standard diagnostic test. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. Brain and intelligence: a quantitative study of the frontal lobes. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. TOAST. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. 2. Regarding premorbid psychological profiles, no significant group differences of the mean values of scoring systems (HADS-A/D) for symptoms of anxiety or depression in the week before baseline were found. 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. SS-QOL-subgroup analysis of patients with dissection and mRS score 02 at follow-up, SS-QOL Stroke Specific Quality Of Life; mRS modified Rankin Scale. Google Scholar. Neurosurgery. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. The vertebral arteries have many small branches. Cleveland Clinic is a non-profit academic medical center. 2005;76(9):122933. 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]. Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. Events most commonly occur in the postpartum period If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. Factors affecting the quality of life after ischemic stroke: young versus old patients. 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. Neurology. Web2. Chronic posttraumatic stress symptoms after nonsevere stroke. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. Auflage. (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. Elevated levels of posttraumatic stress symptoms, as evaluated by PTSS-14 scoring in our study, are in line with recent reports on the prevalence of posttraumatic stress disorder (PTSD) after stroke, even after minor stroke [49] or transient ischemic attack [50]. You may need a procedure. Halstead WC. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. It generates 12 domain-related scores and a total score. 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. Article 2001;32(6):131822. Adding one additional base point in all individuals our self-constructed cognitive composite score (CCS) showed a range from score 1=normal to 10=completely pathological. 2004;251(10):12428. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. PubMed Central California Privacy Statement, 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. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. 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). Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. 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. Google Scholar. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. 2005;1(1):5968. Spontaneous dissections have been reported. 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]. 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. Czechowsky et al. Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. N Engl J Med. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. 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. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. Other published data remained inconsistent. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Neurology. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. 2006;67(10):180912. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. Blood in the separated layers of the vessel wall can lead to blood clot formation. Trial of org 10172 in acute stroke treatment. 2009;256(3):4439. Most dissections heal on their own. The use of the German version in this study was authorized by their authors (pers. Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. Arch Phys Med Rehabil. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. PubMed 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. (2014) [46], mean age 44.8years. Cervical artery dissection goes frequently undiagnosed. 2023 BioMed Central Ltd unless otherwise stated. J Clin Neurol. All participants have given written informed consent. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. (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. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. It can affect blood flow, putting you at risk for life-threatening complications. In line with previously published and reviewed data [36], the rate of ischemic recurrence of 9% in our VAD patients (literature estimates between 0 and 13.3%) and rate of recurrent dissection of 3% (literature estimates between 0 and 25.0%) were low. 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. The aim of this study For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. PubMedGoogle Scholar. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Am J Psychiatry. The cerebellar cognitive profile. You may also need to continue taking a blood thinner during this time. What symptoms/pain did you experience? Rainer J. Strege. 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. The role of cognitive impairment in the quality of life after ischaemic stroke. (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. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. From October 1, 2010, to June 31, 2013, 42 consecutive patients with spontaneous first-time vertebral artery dissection (VAD), who were admitted to our hospital under the suspected diagnosis of an acute stroke, were registered and screened for this study. 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. 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. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. Six patients died within 3 months, the remaining 108 were contacted after Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. 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. 2018;3(1):4756. Otherwise, antithrombotic therapy was Spontaneous vertebral Up to 25% of stroke cases in this age group are due to vertebral artery dissection. 2001;344(12):898906. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the Dissection in either artery can disrupt blood flow and potentially cause a stroke. The functional outcome, however, seems to be usually good in the majority of cases but there is still a lack of knowledge about the natural history of VAD and uncertainty concerning the appropriate follow-up management. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. (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. 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. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. bright spots on my 2011;77(12):117481. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. (2009) [6], mean age 46years, Czechowsky et al. Other activities with rapid acceleration/deceleration changes. 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. This option is also for people with hemorrhagic stroke. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. A practical method for grading the cognitive state of patients for the clinician. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. Afterwards we developed a multivariate regression model using variables that have proven statistically significant at the univariate analysis at a significant level of 5% (p<0.05). statement and Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. PubMed 88.2% of patients with VAD suffered from acute cerebral ischemia. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. 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 Schievink WI. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. 1997;9:44551. 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. 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