Trial of org 10172 in acute stroke treatment. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. Terms and Conditions, 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. The hospital anxiety and depression scale. Achievable are 14 to 98 points from 14 items. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Stress revisited: a critical evaluation of the stress concept. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. 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). It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. 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. There was a high responder rate in follow-up assessments: follow-up data were obtained in 97% of patients in group D, 100% in group I, and 96% in group M. Secondary ischemia prevention by medication until follow-up was provided by platelet aggregation inhibitors in 76.5% patients of group D and 81.6% of group I and oral anticoagulants in 23.5% patients of group D and 18.4% of group I. Vascular events of importance occurred until follow-up time point as follows: In group D one recurrent stroke, one suspected stroke, one new stroke due to dissection of the internal carotid artery, and one transient ischemic attack. The importance of posttraumatic stress symptoms (PTSS) for QOL in our VAD patients was a new finding and further stressed by our subgroup analysis as follows. Preceding correlation analyses in this study yielded significant correlations in between all neurocognitive measures such as MMSE, MoCA, and CCS at baseline and likewise in between both neurostatus measures such as NIH-SS on admission and mRS at baseline. 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 (2014) [46], mean age 44.8years. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. Six patients died within 3 months, the remaining 108 were contacted after Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. However, you may be at risk for future dissections. Turm von London Deutsche Version. Noble et al. They carry blood to the brain and spinal cord, which are part of the nervous system. 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]. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. Engel GL. GA compendium of neuropsychological tests. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. communication). Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Neuropsychologia. Cervical artery dissection goes frequently undiagnosed. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. 2017;88(14):131320. Stroke. 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. 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). (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. As the key finding, our subgroup analysis of these VAD patients showed significantly higher levels of posttraumatic stress symptoms (p=0.002) and of pre-baseline anxiety symptoms (p=0.006) being associated with patients with good functional outcome (mRS02) and bad QOL compared to those with good functional outcome (mRS 02) and good QOL. Another 66years old patient with medulla oblongata infarction deceased due to nonspecific heart failure and was lost for follow-up; in group I one stroke and two myocardial infarcts occured; group M remained without any vascular event. 2008;63(6):1095104 discussion 04-5. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. Other published data remained inconsistent. 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. Gttingen: Hogrefe Verlag; 2000. Analysis of subscales demonstrated that a reduced quality of life at follow-up (SS-QOL3.9) in both subgroups (mRS 02) of group D and I corresponded to main impairments, that were significantly reduced mean values, in all psychosocial domains such as Thinking, Personality, Mood, Family Roles, Social Roles and Energy, as shown for subgroup D in Fig. 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. All participants have given written informed consent. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. A Spearmans rank correlation analysis was performed for outcome-relevant variables. Furthermore, the extension of lesions by acute infarction in cases of group D and I was measured and categorized into either a maximal diameter>10mm or10mm. 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%. 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. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. Sometimes, your healthcare provider may recommend conventional angiography. (2001) [34]. (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. We do not endorse non-Cleveland Clinic products or services. These findings corresponded widely to findings of Gottwald et al. Arch Phys Med Rehabil. Three initially included woman of ages 70, 71, and 77years had to be excluded secondarily because of concurrent diseases in form of preexisting idiopathic cerebellar syndrome, acute symptomatic anterior circulation brain infarction, and predominant arteriitis temporalis (first with ocular disorder, paresis of arm, ataxia, and dysarthria plus suspected brainstem infarction due to VAD; second with VAD and arm paresis; third with VAD and visual field disorder). New York: Oxford University Press; 2006. 2006;67(10):180912. 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/ Stroke. Spontaneous vertebral Speck et al. 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. By using this website, you agree to our A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. 1988;19(12):1497500. In earlier stages, you might not notice symptoms. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. 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. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a It generates 12 domain-related scores and a total score. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. At follow-up assessment, group M showed the best distribution of mRS scores in direction to better ones and group D the worst with a significant higher mean score of mRS. Group-related changing in mRS scoring between time points t1 (baseline) and t2 (6months follow-up), group D patients with dissection; group I patients with ischemia without dissection; group M stroke mimics; mRS modified Rankin Scale; n. s. not significant, * significant difference. His troponin was elevated at 0.094ng/mL. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. In contrast to younger people who are supported by their also young family as well as the health system to achieve occupational reintegration as fast as possible, elderly people may be limited by less easy access to rehabilitation facilities, less support by potentially also disabled caregivers and, probably most important, by potential comorbidities and/or neurovascular risk factors. As a key result, higher levels of posttraumatic stress symptoms appeared to be a prominent contributing factor to bad QOL in VAD patients with otherwise good functional outcome. 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. Folstein MF, Folstein SE, McHugh PR. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the All patients presented with acute myocardial infarction (MI) (26% ST-segment elevation MI [STEMI], 74% NSTEMI) and approximately 70% reported an emotional or physical stressor. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. Clinical monitoring should address this topic to make timely treatment possible. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Magnetic resonance angiography is the gold standard diagnostic test. Google Scholar. Med Hypotheses. A practical method for grading the cognitive state of patients for the clinician. 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. 2007;21(2):1618. 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). Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. Psychol Assess. VAD affected the right side in 13 patients (38.2%), the left side in 18 patients (53%), and both sides in three patients (8.8%). 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. Neurosci Biobehav Rev. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. J Clin Neurol. The aim of this study was therefore as follows: (1) to evaluate the characteristics of patients after VAD with special focus on those with bad quality of life despite good functional outcome in comparison with positive and negative control patients in a prospective comparative study design (2); to identify contributing factors to quality of life after VAD, considering neurological, cognitive, and psychological variables (3); to identify the predictive factors for quality of life after VAD. Likewise, mean values of pre-baseline total QOL were not significantly different. 2010;17(2):21925. Article J Stroke Cerebrovasc Dis. Article With a dissection, blood gets trapped between the intima and media. While SS-QOL at follow-up was normal and corresponded to pre-baseline in stroke mimics, SS-QOL scores significantly worsened in group D and I patients, mainly in the psychosocial domains. Five-point test. 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. 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]. These include vertebral and carotid arteries. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. 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. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. Classification of subtype of acute ischemic stroke. Thus, reduced neurocognition and neurostatus at baseline and increased scoring levels for stress symptoms at follow-up were predictive for reduced quality of life at follow-up in patients with VAD in this regression model. 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]. Its more common in people younger than 45. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. "mini-mental state". Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. 2011;77(12):117481. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. Your two carotid arteries run along either side of your neck in the front. This difference was not statistically significant (p<0.05). Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Anasthesiol Intensivmed Notfallmed Schmerzther. 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. RK contributed to the experimental design and manuscript writing. Differential features of carotid and vertebral artery dissections: the CADISP study. Plank position (but otherwise safe to participate in yoga or Pilates). The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. The other variables showed no significant differences. Although MMSE and MoCA significantly correlated to our cognitive composite score (CCS), further analysis of neurocognitive domain deficits by neuropsychological test battery yielded only some trends of mean group values, without statistical significance. You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). Kissela et al. Williams LS, Weinberger M, Harris LE, Biller J. NIH-SS and mRS scoring at baseline of groups D and I yielded scores significantly worse compared with group M, indicating a reduced neurological status of affected patients (Table2). WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. 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. 2002;13(3):1927. 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. The clinical application of the biopsychosocial model. (2014) [46]. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. CADISS Trial Investigators. What is the life expectance after successful repair of aortic Quality of life in survivors after cervical artery dissection. Apart from the limits of our measurement method, we assumed that the neuroanatomical function of the affected stroke area was much more important than the extension. I was unable to return to work for three months. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. Neurology. 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. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. It may also occur with sudden neck movements and trauma. Google Scholar. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. The higher the score the more probable is a posttraumatic disorder. Monitoring typically includes magnetic resonance angiography every three to six months. 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]. statement and A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. (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. 2012;13:164. 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. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. 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. Interpreted as maladaptive psychological state/condition JS, Choi-Kwon S, Kwon SU, HJ! Signs of a stroke found 81 % with good functional outcome, were. Study may be interpreted as maladaptive psychological state/condition may experience signs of a stroke Kleindorfer D et! For age-related white matter changes applicable to MRI and CT. stroke may recommend conventional.! 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