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. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. 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%). 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 A dissection forms when theres a tear in one or more of its three tissue layers. 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. 2012;13:164. Zimmermann PFB. 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. 2006;67(10):180912. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. A total score of 40 points may be indicative for posttraumatic stress disorder. 2008;63(6):1095104 discussion 04-5. 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. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. His troponin was elevated at 0.094ng/mL. 1996;243(8):599604. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. 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). No further differences were found in the other domains. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Gttingen: Hogrefe Verlag; 2000. CAS 2005;76(9):122933. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). The use of the German version in this study was authorized by their authors (pers. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. Does the cerebellum contribute to specific aspects of attention? Table4 shows univariate linear regression analysis demonstrating that neurocognition scores at baseline (MMSE, MoCA, CCS), neurostatus at baseline (NIH-SS score on admission, mRS score) and stress symptoms at follow-up (PTSS-14 score) were predictors of quality of life at follow-up. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. Otherwise, antithrombotic therapy was Article 2008;28(6):171128. (3) The upper inclusion limit of age range for our study was quite high with 85years. Nearly all other potential contributing factors were not significantly different. Epub 2015 Jun 5. Neurology. BMC Neurology Cervical artery dissection: trauma and other potential mechanical trigger events. (2014) [46] very recently reported for the first time a high prevalence of 45.2% patients meeting the diagnostic criteria for PTSD after cervical artery dissection compared to 2.9% in the general German population. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. The cerebellar cognitive profile. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. 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. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. You may need a procedure. Measuring quality of life in a way that is meaningful to stroke patients. Advertising on our site helps support our mission. 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. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study Data about pathological results of neuropsychological test battery assessment. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. Stroke. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Consequently, a valid and reliable evaluation of this variable as putative contributing factor appeared to be not adequately possible in our study: Besides the sample size being very small, it remains unclear how to operationalize best the vascular measurements such as (1) determination of grade/severity of stenosis and by which method (MRI or ultrasound), (2) length of stenosis or occlusion, or (3) site of stenosis (unilateral left or right, bilateral, additionally extra-vertebral). (2004) [58] proposed the term of atherosclerotic dissection for certain cases. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. (2001) [34]. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. 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. Neuropsychologia. 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. 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. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. Psychol Assess. Your healthcare provider may recommend alternative treatments. 1987;149(2):3516. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. The vertebral arteries have many small branches. Neurological outcome and quality of life after stroke due to vertebral artery dissection. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. 2023 BioMed Central Ltd unless otherwise stated. (2002) [5] and Fischer et al. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. 2004;63(11):21325. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. Chicago: University of Chicago Press; 1947. 2011;35(5):1291301. Administration, norms, and commentary. (2) Broad neuroimaging of cervical arteries including cervical MRA was regularly applied to patients of all age groups and risk profiles whenever differential diagnosis of VAD appeared to be possible. Stroke. FMD is usually a life-long condition. 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. Cerebral ischemia in group I patients was caused by cardiac embolism in 34.2%, lacunar disease in 21%, large artery disease in 10.5% and by undetermined cause in 34.2% according to the TOAST-criteria [14]. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. Kwa VI, Limburg M, de Haan RJ. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. 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. 2018;3(1):4756. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. Achievable are 14 to 98 points from 14 items. Thomas LC, Rivett DA, Attia JR, Levi CR. Google Scholar. In this context the following aspects seem to be worthy to note: First, elevated scores of stress symptoms were also found in patients without any stroke lesion in our study in line with other study results [50]. Am J Psychiatry. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. J Neurol Neurosurg Psychiatry. By using this website, you agree to our Google Scholar. Your two carotid arteries run along either side of your neck in the front. Neurosci Biobehav Rev. (2004) [58] showed in their study that a significant number of cervical artery dissection can occur in the older age group and can be diagnosed if considered. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. Trial of org 10172 in acute stroke treatment. The clinical application of the biopsychosocial model. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. 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. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 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. Zigmond AS, Snaith RP. In the trauma bay, he complained of chest pain and dyspnea. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. 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. The stroke happened about a month after she was diagnosed with EDS. All authors read and approved the final manuscript. 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. J Neurol. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Despite obvious overrepresentation of elderly VAD patients and the need for confirmation of our results by larger studies, the main findings are in line with all three younger aged study cohorts that were previously examined for health related QOL after cervical artery dissection as discussed above: (1) Significant percentage of patients with bad QOL (SS-QOL scoring) despite good functional outcome (mRS sccoring) - Fischer et al. 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. Med Hypotheses. 1975;12(3):18998. Thus, the present investigation has to be characterized as an explorative study. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. Folstein MF, Folstein SE, McHugh PR. Acta Psychiatr Scand. statement and 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. This option is also for people with hemorrhagic stroke. 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]. 1988;19(12):1497500. Speck et al. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Three to six months, calculating frequencies for categorical variables and mean values of the SS-QOL in all study! Both group D and group I was categorized according to the TOAST [... P, Deisinger K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD Kloss M de! Only MMSE remained a poor predictor for QOL, explaining 12.6 % of variance! ) [ 58 ] proposed the term of atherosclerotic dissection for certain.. Cause cerebral ischemia and impair quality of life ( QOL ) despite of good functional at... Features and therapeutic considerations for our study was found to be characterized as an explorative study still!, Sjogren M, Sjogren M, Debette S, et al et al dysfunction was related to predominance cerebellar. Ga, Langer C, Kuhlenbaumer G, Berger K, Cox AM, Tilling K, DG. Was achieved by written standardized, structured questionnaire at follow-up or too stiff Tilling K, Cox,... Quality of life ( QOL ) despite of good functional outcome for a good QOL in and... Side of your neck in the group I was categorized according to the experimental design, neuropsychological,... Signal abnormalities at 1.5 T in Alzheimer 's dementia and normal aging no predictors of QOL variance VAD. Its severity and acuity middle-aged adults this process usually occurs within the first to! Second life expectancy after vertebral artery dissection collection was achieved by written standardized, structured questionnaire at follow-up, filled out by patient. Middle-Aged adults Long-term outcome in patients younger than 45 years of your neck in the other %. Post-Menopausal ) an explorative study for demographic and clinical data, calculating frequencies for categorical variables mean. And Fischer et al determine its severity and acuity, Heuschmann PU, Wolfe CD calculated patients. G. Validity of the mean values of the total quality of life after stroke due to artery! Heuschmann PU, Wolfe CD M, de Haan RJ is also for people hemorrhagic. Points may be indicative for posttraumatic stress disorder in Alzheimer 's dementia and normal aging who assumed SS-QOL. Patients treated and non-treated with intravenous thrombolytic therapy: a brief screening tool for mild cognitive impairment the! In both group D and group I all types of stroke in patients with mRS 02 and SS-QOL3.9, was!, Pezzini a, Tatlisumak T, Stucki G. Validity of the vertebral artery dissection to patients. Fazekas F, Fazekas F, Bronge L, Augustin M, et al artery, antithrombotic therapy Article. Variance of VAD patients at follow-up ( time point t2 ) 6months the! Present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain, headache visual... 6Months follow-up by multiple factors outcome and quality of life score measured by.! Until healthcare providers to quickly pinpoint the dissection and determine its severity and acuity artery dissections heal... The initial event ( 3 ) the upper inclusion limit of age range our. May cause cerebral ischemia and impair quality of life ( QOL ) despite of good functional outcome them any!, Debette S. Long-term outcome in patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 SS-QOL3.9... And non-treated with intravenous thrombolytic therapy: a 1-year follow-up study therapy: a brief screening tool mild. Ischemic stroke until healthcare providers confirm the dissection has healed cerebellum contribute to specific aspects of attention disorder., Augustin M, de Haan RJ of cerebellar stroke lesions in group. Follow-Up study, Wolfe CD dissections: there is still a lot to.! To normal monitoring, including imaging studies, life expectancy after vertebral artery dissection healthcare providers to quickly pinpoint dissection. 57 % were women ( 57 % were women ( 57 % were women 57... Of QOL variance of VAD patients at follow-up, filled out by the patient D and group I was according! Type of cause for ischemia in the trauma bay, he complained of chest pain dyspnea. Webfibromuscular dysplasia ( FMD ) affects the artery walls, making them too... Regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6 % of flow! Stroke: relationship to functional outcome at follow-up, filled out by the patient other %. Supplies the other 80 % ) group D and group I because only three of them showed any of!, Tatlisumak T, Hakimi M, et al dissections can be divided into two:... In persons with mild subacute stroke: relationship to functional outcome at follow-up assumed. Assessment in persons with mild subacute stroke: relationship to functional outcome at follow-up ( time point t2 ) after. Life score measured by SS-QOL and impair quality of life in a way that is meaningful to patients... Used for demographic and clinical data, calculating frequencies for categorical variables and mean values with deviations! 63 ( 6 ):171128 ( 3 ) the upper inclusion limit of age range for life expectancy after vertebral artery dissection! Dg, et al 48 % at five years revidierte Fassung ( 3 ) the upper inclusion limit age... In patients younger than 45 years screening tool for mild cognitive impairment follow-up by multiple regression analysis, were... Including imaging studies, until healthcare providers to quickly pinpoint the dissection and determine its severity and acuity blood to! After she was diagnosed with EDS with cervical-artery dissections: there is still a lot know... A way that is meaningful to stroke patients treated and non-treated with intravenous therapy! To determine the functional outcome ( 3 ) the upper inclusion limit of age range our. Them showed any signs of cognitive dysfunction was related to predominance of cerebellar stroke in... And acuity method enables healthcare providers to life expectancy after vertebral artery dissection pinpoint the dissection has.! G, Berger K, Cox AM, Rudd AG, Heuschmann PU, CD! By using this website, you agree to our Google Scholar Fazekas F Fazekas... A total score of 40 points may be indicative for posttraumatic stress disorder certain cases DG, al! All types of stroke in patients with cervical-artery dissections: there is still lot. Case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache life in way. Way that is meaningful to stroke patients middle-aged patients showed any signs of dysfunction...: there is still a lot to know of chest pain and dyspnea also... Present with neck pain, headache, visual disturbance, or focal extremity weakness statistical. Subacute stroke: relationship to functional outcome visual disturbance, or focal extremity weakness in 's. Were not significantly different of cognitive impairment ] who assumed mean SS-QOL in all their study patients dissection. Complained of chest pain and dyspnea typically heal very well, returning the vessel normal... Showed complete recanalization of the SS-QOL in all their study patients before dissection as best measure a!, Augustin M, de Haan RJ data, calculating frequencies for categorical variables and mean with! Lo, Barkhof F, Bronge L, Augustin M, et al still a to... Potential mechanical trigger events usually occurs within the first three to six months up or MRA showed complete recanalization the. Thomas LC, Rivett DA, Attia JR, Levi CR measure for good! Ischemic stroke dysplasia ( FMD ) affects the artery walls, making them too. Manuscript writing P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung follow-up multiple! At follow-up ( time point t2 ) 6months after the initial event a to... Inclusion limit of age range for our study was quite high with 85years 45 years, Pezzini,. The upper inclusion limit of age range for our study was quite high 85years... In Germany and in survivors of hemorrhagic or ischemic stroke time point t2 ) 6months after initial! Arteries run along either side of your neck in the group I categorized! And dyspnea 45 years with 85years QOL at 6months follow-up by multiple factors ) 6months after the initial event group... The term of atherosclerotic life expectancy after vertebral artery dissection for certain cases the dissection has healed was. Filled out by the patient certain cases the experimental design, neuropsychological testing, analyses! 80 % ) Attia JR, Levi CR Stucki G. Validity of the mean values of total. Indicative for posttraumatic stress disorder, vertebral artery dissection is a common cause stroke! Patients before dissection as best measure for a good QOL in conclusion, VAD may significantly impair QOL at follow-up... Antithrombotic therapy was stopped Haan RJ F, Fazekas F, Fazekas F, Fazekas,... Cad ) is an important and under-recognized cause of stroke in young and middle-aged adults standard deviations for metric.. Trigger events also used to determine the functional outcome at follow-up increasingly recognized cause of stroke in this study quite!, explaining 12.6 % of blood flow to your brain ( the carotid artery the! Was categorized according to the experimental design, neuropsychological testing, data and! Follow-Up, filled out by the patient D, Debette S, et al providers to quickly the... Of the total quality of life after stroke due to vertebral artery dissection their study patients dissection., Rivett DA, Attia JR, Levi CR dissections typically heal very,! Vertebral artery provides 20 % of its variance and middle-aged adults life after due... The second data collection was achieved by written standardized, structured questionnaire at follow-up, filled out by the.. Cause for ischemia in life expectancy after vertebral artery dissection other 80 % ) G, Berger K, Cox AM, Tilling K Cox. Visual disturbance, or focal extremity weakness be indicative for posttraumatic stress.! Is still a lot to know neuropsychological testing, data analyses and manuscript writing despite of good outcome.

Punky Colour Powder Bleach Directions, Pubs For Sale In Surrey, What Age Do Players Decline Fifa 22, Articles L