Classification of subtype of acute ischemic stroke. Stroke. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. 2017;88(14):131320. 2010;17(2):21925. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. Your two carotid arteries run along either side of your neck in the front. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. 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. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. 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. 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/. A total score of 40 points may be indicative for posttraumatic stress disorder. 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. 1983;67(6):36170. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. Jokinen et al. 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. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. VAD leads to impaired QOL at 6months follow-up due to multiple factors. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. 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]. Radiographics. 3rd ed. Brain and intelligence: a quantitative study of the frontal lobes. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. Article AJR Am J Roentgenol. 2001;344(12):898906. Trial of org 10172 in acute stroke treatment. They deliver oxygen-rich blood to your brain and spine. 2004;75(8):11946. 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]. 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%). 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. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. volume19, Articlenumber:312 (2019) Acta Psychiatr Scand. On rare occasions, this can lead to stroke. 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. (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. Neurorehabil Neural Repair. The finding of more neurocognitive impairments in form of lower mean values in cognitive measures in patients with ischemic lesions of both group D and group I patients did not reach significance. Differential features of carotid and vertebral artery dissections: the CADISP study. Vertebral artery dissection is a rare cause of stroke in older adults. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. The hospital anxiety and depression scale. It contains 49 items belonging to 12 domains. 1975;12(3):18998. 2006;66(4):5136. Measuring quality of life in a way that is meaningful to stroke patients. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. BMC Musculoskelet Disord. However, you may be at risk for future dissections. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. California Privacy Statement, No individual persons personal details, images or videos are being used in this study. Neurology. But timely treatment, About 40% of patients die immediately from complete rupture and bleeding out from the aorta. Ischemic stroke was found in only 33.9%. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. Painting a ceiling with your neck in an extended position for a long time. Although specific information about overall life expectancy after aortic dissection repair is not available, a recent study from the International Registry of Acute Aortic Dissection reported that about 85% of patients who have undergone successful repair of acute dissection involving the ascending aorta remain alive at 5 years. 1996;243(8):599604. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. Finally, mRS scoring at baseline proved to be an independent predictor for SS-QOL at follow-up not only according to our univariate but also to our multivariate regression analysis model, explaining 35.9% of QOL variance according to our regression model. 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. 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. Your chances of experiencing a stroke are low. Cerebrovasc Dis. MH contributed to the experimental design, data analyses and manuscript writing. Neuropsychologia. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. 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]. 2011;134(Pt 12):367286. Strauss E, Sherman EMS, Spreen O. Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. J Neurol. statement and 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. 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). Adding one additional base point in all individuals our self-constructed cognitive composite score (CCS) showed a range from score 1=normal to 10=completely pathological. 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. 2013;94(12):253541. 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. Both conditions fit if someone is suffering from a spontaneous artery dissection as well as subarachnoid hemorrhage in contrast to ischemic stroke caused by vascular risk factors which can be treated. 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. 2009;8(7):66878. (3) The upper inclusion limit of age range for our study was quite high with 85years. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. 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. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. Spontaneous dissections have been reported. 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. BMC Neurology A dissection is a tear in one or more tissue layers that make up your vertebral artery. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. The subgroup of patients with good functional outcome (mRS score2) and bad SS-QOL score (3.9) comprised ten patients with arterial occlusion or subtotal occlusion versus three with or without stenosis. Among 24 stroke mimics only two patients (8.3%) with mRS 02 reported a bad quality of life in contrast to 20 patients (83.3%) with mRS 02. 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. 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. When tics cause 1). If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. 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 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. Neurosci Biobehav Rev. Tucha O, Lange KW. Theyll use contrast dye and X-ray-guided imaging to look at blood flow through the artery itself along with the extent of the dissection or vessel injury in real-time. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. Terms and Conditions, 2009;40(2):5306. That is in particular striking regarding VAD. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. Differences in reduced neurostatus at baseline (NIH-SS on admission)(p=0.042) in subgroup D (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 and higher grade of white matter lesions (WML)(p=0.042) in subgroup I (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 were not significant after correction of cumulative alpha-error. 2006;37(10):2499503. Google Scholar. 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. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Ahl et al. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. 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. (2009) [6]. 2023 BioMed Central Ltd unless otherwise stated. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. Anasthesiol Intensivmed Notfallmed Schmerzther. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. (2001) [34]. WebScore: 4.2/5 (61 votes) . 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). Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. Neurology. The MRI-based evaluation of white matter lesions (WML) was reported because of previously published data about their potential role for the functional outcome [40] and neuropsychological performance after stroke [41]. 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Bg, Metso TM, Debette S, Pezzini a, et al Dougoud D, Gandjour J, al... Stroke patients in older adults, Huang HC, Tsai JY, Chung CP Conditions... A rare cause of life expectancy after vertebral artery dissection in this study a way that is to...

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