WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. J Neurol. Google Scholar. FMD is usually a life-long condition. The role of cognitive impairment in the quality of life after ischaemic stroke. Classification of subtype of acute ischemic stroke. Exclusion criteria were as follows: (1) VAD due to severe trauma - in contrast to conventionally as spontaneous labeled dissection due to minor prior cervical trauma which should be better termed mechanical trigger event according to Engelter et al. typical type and onset of symptoms. It was only asked for affective symptoms of anxiety and depression pre-baseline and at follow-up there has been only exploration for stress symptoms but not for symptoms of anxiety and depression. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. 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. 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). 2009;40(2):5306. This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). In earlier stages, you might not notice symptoms. Trends towards worse cognitive function without statistical significance were found in group D and I compared to group M for 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). Chicago: University of Chicago Press; 1947. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. Data about pathological results of neuropsychological test battery assessment. It comprised standardized self-rating protocols for neurostatus (mRS), stroke specific QOL and posttraumatic stress symptoms, and in addition open questions for the clinical course. (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. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. Painting a ceiling with your neck in an extended position for a long time. A total of 327 patients were enrolled from 2012-2106. Corresponding to their multivariate analysis, the NIH-SS score on admission was also found to be an independent predictor of QOL at follow-up in our univariate regression analysis. Tucson: Neuropsychological Press; 1985. 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. 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. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. Procedures for vertebral artery dissection include: Most people make a full recovery. 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. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. 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. 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. Google Scholar. Rainer J. Strege. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. (2009) [6] prospectively found 3793455days after event 30% patients with impaired SS-QOL scoring among 66% with favorable functional outcome (mRS01) in a mixed series including patients with VAD and patients with ICAD. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Manage cookies/Do not sell my data we use in the preference centre. It contains 49 items belonging to 12 domains. 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). The other variables showed no significant differences. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Some give a figure of multiple vessel dissection as high as 30%. The causes of vertebral artery dissection can be grouped under two main categories, spontaneous and traumatic. Spontaneous cases are considered to be caused by intrinsic factors that weaken the arterial wall. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. The following are key points to remember from this Viewpoint article on physical activity and exercise in patients with spontaneous coronary artery dissection (SCAD) and fibromuscular The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. Engel GL. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. At least 90 percent of adults with FMD are women. Previous 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. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. 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 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. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Knecht et al. Complete data analysis of paired mRS and SS-QOL scores at follow-up was possible in all 33 surviving patients of group D but one who provided only incomplete SS-QOL data. WebScore: 4.2/5 (61 votes) . It generates 12 domain-related scores and a total score. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. Halstead WC. CAS In addition, the autopsy findings of the 66years old patient with medulla oblongata infarction by VAD who deceased due to unexpected heart failure after baseline confirmed the diagnosis of VAD and support the validity of our data. Other activities with rapid acceleration/deceleration changes. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Part of Disabil Rehabil. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. PubMed Central 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]. 2001;344(12):898906. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study 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. 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. They finally hypothesized that the rate of incidence must be equal throughout life. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. J Clin Neurol. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. 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 To reduce the risk of blood clots, you may receive blood-thinning medications as a first-line therapy such as aspirin or aspirin-like medications (Plavix), heparin infusion or warfarin tablets. Achievable are 14 to 98 points from 14 items. 2009;256(3):4439. Group-related mean values were below this cut-off level and not significantly different between groups: group D 27.1513.10, group I 23.848.74, and group M 26.129.55. 1997;19(1):612. Administration, norms, and commentary. Trial of org 10172 in acute stroke treatment. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. By using this website, you agree to our Vertebral artery dissection: natural history, clinical features and therapeutic considerations. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. Kissela et al. In our study, there was a trend in patients with good functional outcome (mRS score 02) to higher association of occlusion/subtotal occlusion with worse QOL, though this was statistically nonsignificant (p<0.05). BMC Neurology Vulnerability--a new view of schizophrenia. 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. The authors declare that they have no competing interests. GA compendium of neuropsychological tests. 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%). Subgroup analysis stratified for QOL by Stroke Specific Quality of Life Scale (SS-QOL) were done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 02). Cookies policy. 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. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Because recurrence of stroke or dissection is very low despite a mostly lacking morphological artery recanalization and it is nearly limited to the first weeks after dissection, it was questioned by Leys and Debette (2006) [4] what are the appropriate clinical monitoring parameters for follow-up. Neurology. 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