Finally, additional potential outcome-relevant lifestyle-factors such as nutrition and sports activity as well as social factors such as social networks and social support were not taken into account of this study. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. Cerebrovasc Dis. CADISS Trial Investigators. Article 2011;134(Pt 12):367286. 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). 1). Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Spontaneous dissections have been reported. (2001) [34]. 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. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. Thomas LC, Rivett DA, Attia JR, Levi CR. 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). The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. 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. bright spots on my Strauss E, Sherman EMS, Spreen O. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Stroke. 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. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. 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. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. They finally hypothesized that the rate of incidence must be equal throughout life. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Procedures for vertebral artery dissection include: Most people make a full recovery. Neuropsychologia. 2004;251(10):12428. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. 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). Arch Phys Med Rehabil. These are typically among the first tests people receive. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. Data about pathological results of neuropsychological test battery assessment. 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. 2013;94(12):253541. 2009;256(3):4439. 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. communication). Knecht et al. 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. Google Scholar. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. 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. CAS The first data collection in each patient was performed at baseline (time point t1) in the acute phase in hospital after clinical stabilization: neuro-status at admission by National Institute of Health Stroke Scale (NIH-SS) score [18] according to patients records, neurostatus (mRS) and clinical data at baseline according to examination and interview, cognitive screening as well as extensive neuropsychological testing by battery at baseline, and administering self-rating protocols for symptoms of anxiety and depression pre-baseline as well as stroke-related QOL pre-baseline. By using this website, you agree to our 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. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. The vertebral arteries have many small branches. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Speck et al. VAD leads to impaired QOL at 6months follow-up due to multiple factors. 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]. Grond-Ginsbach et al. Likewise, mean values of pre-baseline total QOL were not significantly different. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. (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. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. Psychosom Med. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. 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. 1997;9:44551. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study, https://doi.org/10.1186/s12883-019-1541-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. Anasthesiol Intensivmed Notfallmed Schmerzther. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. At first I just had a very bad neck pain, couldn't move it much. 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). At least 90 percent of adults with FMD are women. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. 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. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Classification of subtype of acute ischemic stroke. The cerebellar cognitive profile. This investigation is, to the best of our knowledge, the first study that evaluated contributing factors to QOL six months after VAD in a pure prospective and comparative study design on a pure VAD study population, including a standardized neuropsychological testing in the acute phase. Neurorehabil Neural Repair. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. Otherwise, antithrombotic therapy was 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. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Acta Anaesthesiol Scand. 2008;28(6):171128. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. 2018;265(8):18919. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. (2014) [46], mean age 44.8years. 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/ 2023 BioMed Central Ltd unless otherwise stated. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. Their series comprised physically less affected patients, two-third after ICAD and one-third after VAD, with ischemic stroke in form of mainly small lesions in about one-third of cases only. Neurological outcome and quality of life after stroke due to vertebral artery dissection. 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). Magnetic resonance angiography is a sophisticated test thats not widely available. These include vertebral and carotid arteries. Horn W. L-P-S Leistungsprfsystem. FMD is usually a life-long condition. Auflage. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. Czechowsky D, Hill MD. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. This difference was not statistically significant (p<0.05). (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. 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]. 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. Gttingen: Beltz Test GmbH; 2001. 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. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. 2006;37(10):2499503. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. Blood in the separated layers of the vessel wall can lead to blood clot formation. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. Neurology. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. 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. 2005;76(9):122933. Neurology. 2011;77(12):117481. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Vertebral artery dissection is a rare cause of stroke in older adults. 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. 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