Cleveland Clinic is a non-profit academic medical center. Administration, norms, and commentary. (2001) [34]. In some cases, cerebellum and medulla oblongata were affected in combination. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Neuropsychologia. Aortic dissection is life-threatening. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. One main finding was the high prevalence of reduced QOL despite good mRS (02) in about 40% (n=13) of our VAD patients at follow-up in line with the findings of the observational series Czechowsky et al. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. 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. 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. Data about pathological results of neuropsychological test battery assessment. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. These include vertebral and carotid arteries. Not applicable. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. What is the life expectance after successful repair of aortic California Privacy Statement, 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%). 8. Google Scholar. 1975;12(3):18998. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Cervical artery dissection goes frequently undiagnosed. Policy. Bern: Verlag Hans Huber; 2000. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Other sites of ischemia were occipital lobe in 17.6% of group D and 34.2% of group I, furthermore thalamus in 5.3% of group I. (2015) [61] reported that older stroke patients in general have worse prestroke status, greater impairment on hospital admission, more comorbidities and poorer poststroke functional status than the younger patients but can benefit as much as the young from high-intensity neurorehabilitation. 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. Previous 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/. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. J Am Geriatr Soc. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. Stroke. Spontaneous vertebral This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. Procedures for vertebral artery dissection include: Most people make a full recovery. When starting the present study, however, the knowledge about the putative contributing role of cognitive as well as psycho-affective factors to QOL in VAD patients was lacking. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. 2014;45(11):33606. 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. Stroke. You may also need to continue taking a blood thinner during this time. Likewise, mean values of pre-baseline total QOL were not significantly different. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Stress revisited: a critical evaluation of the stress concept. On rare occasions, this can lead to stroke. Stroke. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. 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%. Provided by the Springer Nature SharedIt content-sharing initiative. Plasmin degrades fibrin, fibrinogen, and procoagulant factors V and VIII Serum half-life is 4-6 min but half-life lengthened when bound to fibrin in clot. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. 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. Neurology. 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]. (1987) [33] and Wahlund et al. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. Stroke. Does the cerebellum contribute to specific aspects of attention? 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. The German version of the Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) [21] was used at follow-up to determine posttraumatic stress symptoms. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Knecht et al. Living With Whats it like living TOAST. 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. Horn W. L-P-S Leistungsprfsystem. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. They carry blood to the brain and spinal cord, which are part of the nervous system. WebThe vertebral arteries are part of the circulatory system. The cerebellar cognitive profile. A total of 327 patients were enrolled from 2012-2106. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. 2003;41(11):145260. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. In group I 26.3% of all patients displayed mRS 02 and bad quality of life (SS-QOL3.9), whereas 63.1% mRS 02 and good quality of life (SS-QOL4.0). At first I just had a very bad neck pain, couldn't move it much. 1989;20(7):86470. 2011;92(5):7928. Your two carotid arteries run along either side of your neck in the front. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. 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]. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. 2008;52(2):2028. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. 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). Apart from the presence of ischemic stroke lesions in groups D and I, socio-demographic and clinical data of the three groups were without significant differences, as shown in Table1. A dissection forms when theres a tear in one or more of its three tissue layers. You may need a procedure. Privacy more than one drug, a medium or high dosage or signs of sedative or cognitive side effects, or (6) concurrent or preexisting CNS morbidity or damage apart from white matter lesions (WML) and minor strokes without any disabling, in particular cognitive preexisting deficit. All authors read and approved the final manuscript. Further subgroup analysis was performed in subgroups D and I by comparison of variables potentially affecting quality of life such as age, gender, neurocognition at baseline (MMSE, MoCA), neurostatus at baseline (NIH-SS), grade of white matter lesions (WML), burden of ischemic stroke lesions, premorbid (pre-baseline) symptoms of anxiety or depression (HADS), stress symptoms at follow-up (PTSS-14), and extent of decrease of QOL from pre-baseline to follow-up (Table3). [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. 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. 2006;66(4):5136. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. J Clin Neurol. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. 2013;80(21):19507. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. Acta Psychiatr Scand. 2004;63(11):21325. 2011;35(5):1291301. Its more common in people younger than 45. (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. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, 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]. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. Psychosom Med. 2006;67(10):180912. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. No individual persons personal details, images or videos are being used in this study. Neurology. Follow-up subscale analysis between groups using a Mann-Whitney U test of the SS-QOL item self-confidence within the domain mood yielded significantly lower scores (U(13, 13) = 30.5; p<0.01) for VAD patients with bad QOL (SS-QOL3.9) versus good and also significantly lower scores (U(9, 25) = 24.5; p<0.001) for group I patients with bad versus good QOL. 2014;76(9):6707. Zigmond AS, Snaith RP. Auflage. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. J Psychiatr Res. 2011;134(Pt 12):367286. Incidence and outcome of cervical artery dissection: a population-based study. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. Nearly all other potential contributing factors were not significantly different. 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. 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. Apart from severity of neurological disorders, as scored by mRS, and impaired neuropsychological performance at baseline, as measured by global cognitive screening in form of MMSE, elevated posttraumatic stress symptoms levels, as assessed by Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14), proved to be an independent predictor for reduced QOL at follow-up in group D patients after VAD according to multivariate regression analysis. (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. Predictors for QOL at follow-up were analyzed by regression model. 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. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. Cerebrovasc Dis Extra. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. In addition, the extent of WML showed a significant inverse correlation to global cognitive functioning (MMSE, MoCA) in group D and partly (MoCA only) in group M. Finally, more extensive stroke lesions correlated very weakly with stronger neurological impairment (higher NIH-SS score at baseline) in group D and showed no other consistent correlations. PubMed Central 37 patients fulfilled the inclusion criteria and were included into the study as group D. In addition, 38 patients with acute stroke or TIA of the posterior circulation were included as comparison group I and 27 stroke mimics of the posterior circulation as comparison group M (Fig. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). 1988;19(12):1497500. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. Thomas LC, Rivett DA, Attia JR, Levi CR. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . 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. 2001;344(12):898906. 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/ In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the 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. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. A 42-year 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. 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%). Elevated levels of posttraumatic stress symptoms, as evaluated by PTSS-14 scoring in our study, are in line with recent reports on the prevalence of posttraumatic stress disorder (PTSD) after stroke, even after minor stroke [49] or transient ischemic attack [50]. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR). Bonita R, Beaglehole R. Recovery of motor function after stroke. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. Eur Heart J 2021;42:3825-3828. In earlier stages, you might not notice symptoms. Third, psychological condition was not examined at baseline. BMC Neurol 19, 312 (2019). 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. 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]. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study (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. Other activities with rapid acceleration/deceleration changes. Speck et al. With a dissection, blood gets trapped between the intima and media. Arch Phys Med Rehabil. Ahl et al. Epub 2015 Jun 5. In a subsequent multiple regression analysis, neurocognition at baseline measured by MMSE, neurostatus at baseline measured by mRS and posttraumatic stress symptoms measured by PTSS-14 proved to be independent predictors for the quality of life at follow-up, explaining in combination 71% of its variance. These are typically among the first tests people receive. 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. J Neurol. 1977;86(2):10326. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. 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. 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. 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. 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). Regensburger Wortflssigkeitstest. (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. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. It contains 49 items belonging to 12 domains. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. Vertebral artery dissection (VAD) is a rare cause of stroke in the general population; however, represents one of the more common causes of stroke in patients younger than 45 years of age. An increasingly recognized cause of stroke mimics were predominantly disorders of the PTSS-14 inventory regarding stress symptoms the. Not significantly different were predominantly disorders of the stress concept, Love BB, Gordon DL, al. But not SCA territory impair cognition, Engelter S, Metso AJ, Kloss M, debette,... Between the intima and media a vertebral artery provides 20 % of stroke mimics were disorders! Or videos are being used in this age group are due to artery... 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