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. Chronic posttraumatic stress symptoms after nonsevere stroke. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. 2008;63(6):1095104 discussion 04-5. However, you may be at risk for future dissections. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. 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. Neuropsychologia. 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). Measuring quality of life in a way that is meaningful to stroke patients. Fischer et al. 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. Fourth, maladaptive coping strategies were significant predictors for and associated with posttraumatic stress disorder in patients with cervical artery dissection in the study of Speck et al. 3rd ed. Other activities with rapid acceleration/deceleration changes. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Your healthcare provider may recommend alternative treatments. The study protocol was approved by the Local Ethics Committee of the University of Bremen. 2. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. Google Scholar. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. These findings corresponded widely to findings of Gottwald et al. (2009) [6], mean age 46years, Czechowsky et al. Web2. Although functional outcome was good in the majority of their cases, the surprising main finding was a bad quality of life, measured by Stroke Specific Quality Of Life scale (SS-QOL) [7] despite of good functional outcome, scored by modified Rankin Scale (mRS) [8], in about 15% [5] to 30% of cases [6]. 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. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. Stroke. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. CAS 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). Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. Blood in the separated layers of the vessel wall can lead to blood clot formation. Advertising on our site helps support our mission. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. 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]. 2007;21(2):1618. 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. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. 2004;75(8):11946. Otherwise, antithrombotic therapy was 2016;87(5):52630. 2009;256(3):4439. (2014) [46], mean age 44.8years. 2011;35(5):1291301. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. Article The study protocol was approved by the Local Ethics Committee of the University of Bremen. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. The clinical application of the biopsychosocial model. Aortic dissection is life-threatening. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. 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. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. The PTSS-14 was developed by Twigg et al. It may also occur with sudden neck movements and trauma. Factors affecting the quality of life after ischemic stroke: young versus old 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. Despite obvious overrepresentation of elderly VAD patients and the need for confirmation of our results by larger studies, the main findings are in line with all three younger aged study cohorts that were previously examined for health related QOL after cervical artery dissection as discussed above: (1) Significant percentage of patients with bad QOL (SS-QOL scoring) despite good functional outcome (mRS sccoring) - Fischer et al. This difference was not statistically significant (p<0.05). Spontaneous dissection of the carotid and vertebral arteries. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. 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. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. Stroke. (2009) [6]. No individual persons personal details, images or videos are being used in this study. Painting a ceiling with your neck in an extended position for a long time. 2008;52(2):2028. Its more common in people younger than 45. 2001;32(6):131822. 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. Horn W. L-P-S Leistungsprfsystem. 2002;13(3):1927. 1999;53(8):183943. 2006;66(4):5136. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. (2004) [45]. 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. Aschenbrenner S, Tucha O, Lange KW. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 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). In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. All participants were informed about the procedure and gave written informed consent to participate in the study. Article WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. They deliver oxygen-rich blood to your brain and spine. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. Google Scholar. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). 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. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. 2014;76(9):6707. The method of evaluation, i.e. Importantly, our study cohort of VAD patients appeared to be not significantly biased by exclusion of eight patients, whose features and mean age of 64.5years widely resembled those of the study group. TOAST. Eur Heart J 2021;42:3825-3828. 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. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. The cerebellar cognitive profile. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. PubMed Vertebral artery dissection: presenting findings and predictors of outcome. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Epub 2015 Jun 5. 2013;80(6):78790. This risk decreases over time. Privacy Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. Auflage. 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/ National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. 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. Get useful, helpful and relevant health + wellness information. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. Cervical artery dissection: trauma and other potential mechanical trigger events. Stroke. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. 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. By using this website, you agree to our Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. Engel GL. Neurosurgery. 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. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. Turm von London Deutsche Version. This option is also for people with hemorrhagic stroke. 2018;3(1):4756. Bonita R, Beaglehole R. Recovery of motor function after stroke. Table4 shows univariate linear regression analysis demonstrating that neurocognition scores at baseline (MMSE, MoCA, CCS), neurostatus at baseline (NIH-SS score on admission, mRS score) and stress symptoms at follow-up (PTSS-14 score) were predictors of quality of life at follow-up. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. Gttingen: Hogrefe Verlag; 2004. Neurology. 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. In our study, five patients (15%) of group D displayed scoring for posttraumatic stress symptoms (PTSS-14) above cut-off scores indicating PTSD compared to one patient each in group I as well as group M. Previous data [52], however, have already stressed that even subsyndromal scores may be of relevance, as can be assumed for our thirteen subgroup D patients with elevated PTSS-14 levels and bad QOL despite good functional outcome. Folstein MF, Folstein SE, McHugh PR. Procedures for vertebral artery dissection include: Most people make a full recovery. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. statement and Kissela et al. Grond-Ginsbach et al. 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. (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. 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. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. However, incidental minor trauma Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. 2005;53(4):6959. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. In case of significant difference, a subsequent analysis between two group pairs was performed: For categorical variables the Chi-square test or Fishers exact test, if appropriate, and for metric variables the Mann-Whitney U-test was used with Bonferroni-correction of cumulative alpha-error. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. bright spots on my We do not endorse non-Cleveland Clinic products or services. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. Article 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]. Correspondence to CADISS Trial Investigators. 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. 2009;8(7):66878. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. 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. 1983;67(6):36170. 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). Czechowsky D, Hill MD. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a 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. Not applicable. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. 2017;88(14):131320. Stroke. 2008;28(6):171128. 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. Bern: Verlag Hans Huber; 2000. 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). Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. 2017;7(3):16572. 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. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. 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. 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]. Intergroup analysis of change of mean total scores of QOL, as measured by SS-QOL, from pre-baseline to follow-up displayed a significant deterioration (p<0.001; Wilcoxon signed-rank test) in groups D and I but not in group M. Further analysis of changing scores in the twelve SS-QOL domains yielded developing impairments from baseline to follow-up in all three groups D, I, and M. Impairments evolved mainly in psychosocial domains such as family roles, social roles and energy and less in physical domains. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). Eur J Radiol. Eur J Neurol. 37 patients fulfilled the inclusion criteria and were included into the study as group D. In addition, 38 patients with acute stroke or TIA of the posterior circulation were included as comparison group I and 27 stroke mimics of the posterior circulation as comparison group M (Fig. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. Kwa VI, Limburg M, de Haan RJ. Strauss E, Sherman EMS, Spreen O. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. 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. typical type and onset of symptoms. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. 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. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. [13] and in the context of a fitting medical history, i.e. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. Cerebrovasc Dis. The stroke happened about a month after she was diagnosed with EDS. (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. Am J Psychiatry. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Noble AJ, Baisch S, Mendelow AD, Allen L, Kane P, Schenk T. Posttraumatic stress disorder explains reduced quality of life in subarachnoid hemorrhage patients in both the short and long term. 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%. Six patients died within 3 months, the remaining 108 were contacted after 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. , cervical artery dissections account for only 2 % of patients die immediately from rupture. 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