California Privacy Statement, They carry blood to the brain and spinal cord, which are part of the nervous system. 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). 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. 2005;1(1):5968. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. Folstein MF, Folstein SE, McHugh PR. (2009) [6], mean age 46years, Czechowsky et al. Disabil Rehabil. Cerebrovasc Dis. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. A Spearmans rank correlation analysis was performed for outcome-relevant variables. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. Living With Whats it like living 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. Anasthesiol Intensivmed Notfallmed Schmerzther. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Provided by the Springer Nature SharedIt content-sharing initiative. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. 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]. At first I just had a very bad neck pain, couldn't move it much. Sometimes, your healthcare provider may recommend conventional angiography. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. J Neurol. The senior age of VAD patients may have several important implications for social life. TOAST. Vertebral artery dissection is a rare cause of stroke in older adults. You may also need to continue taking a blood thinner during this time. 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. Gttingen: Hogrefe Verlag; 2000. Stroke. 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. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. The authors declare that they have no competing interests. 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. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. Every pathological result, that is a value below one standard deviation, in one of the nine above mentioned cognitive function test domains was transposed to a cognitive composite score for each individual for the purpose of interindividual comparison. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). (1987) [33] and Wahlund et al. But timely treatment, typically blood thinners or a procedure, can save your life. Brain. Stroke. Individuals facing a higher risk of future dissection will need follow-up care for many years. 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. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. N Engl J Med. Most dissections heal on their own. 1987;149(2):3516. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. 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. 2009;8(7):66878. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. 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. Google Scholar. 2014;23(2):33542. 2014;45(11):33606. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. RK contributed to the experimental design and manuscript writing. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study 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. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. The PTSS-14 was developed by Twigg et al. Furthermore, some recently published data suggested for the first time a role of VAD-accompanied atherosclerosis as additional putative contributing factor to functional outcome at three months in posterior circulation stroke (PCS) patients [39]. The role of cognitive impairment in the quality of life after ischaemic stroke. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. 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]. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. However, incidental minor trauma 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%. Ischemic stroke was found in only 33.9%. 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. 3rd ed. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. Neurology. It can affect blood flow, putting you at risk for life-threatening complications. 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. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. Web2. 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. Its signs and symptoms can be vague, and diagnosis can be elusive. 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. 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]. Not applicable. Events most commonly occur in the postpartum period Six patients died within 3 months, the remaining 108 were contacted after By means of linear regression analysis, we first calculated the predictive value of certain variables for the variance of SS-QOL scores at follow-up in an univariate model. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. PubMed Central 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]. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. 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. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. Blood in the separated layers of the vessel wall can lead to blood clot formation. Stroke. 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