A 42-year Other activities with rapid acceleration/deceleration changes. The higher the score the more probable is a posttraumatic disorder. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Gttingen: Hogrefe Verlag; 2000. The vertebral arteries have many small branches. 1987;149(2):3516. Psychosom Med. In the trauma bay, he complained of chest pain and dyspnea. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. 88.2% of patients with VAD suffered from acute cerebral ischemia. 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. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. 2008;28(6):171128. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. 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. You may need a procedure. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. 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. 2016;87(5):52630. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. Article 2011;134(Pt 12):367286. 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 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. Czechowsky et al. You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). Quality of life in survivors after cervical artery dissection. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. 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. They deliver oxygen-rich blood to your brain and spine. (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. 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. J Neurol. Procedures for vertebral artery dissection include: Most people make a full recovery. RK contributed to the experimental design and manuscript writing. That is in particular striking regarding VAD. Ischemic stroke was found in only 33.9%. J Neurol. J Neurol Neurosurg Psychiatry. grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. Jokinen et al. J Neurol. Thomas LC, Rivett DA, Attia JR, Levi CR. J Stroke Cerebrovasc Dis. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. 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%). Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Tucson: Neuropsychological Press; 1985. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. 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. Six patients died within 3 months, the remaining 108 were contacted after Painting a ceiling with your neck in an extended position for a long time. Classification of subtype of acute ischemic stroke. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. On rare occasions, this can lead to stroke. 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. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. California Privacy Statement, 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. By means of linear regression analysis, we first calculated the predictive value of certain variables for the variance of SS-QOL scores at follow-up in an univariate model. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. BMC Neurol 19, 312 (2019). 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. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. What symptoms/pain did you experience? (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. VAD leads to impaired QOL at 6months follow-up due to multiple factors. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. 2004;75(8):11946. PubMed TOAST. Eur Stroke J. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). Trial of org 10172 in acute stroke treatment. Brain and intelligence: a quantitative study of the frontal lobes. 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. The mean decrease of QOL, that is the difference of SS-QOL scoring, from pre-baseline to follow-up, was significantly stronger in the subgroups (mRS 02) with bad quality of life (SS-QOL3.9). [13] and in the context of a fitting medical history, i.e. What is the life expectance after successful repair of aortic 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. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. 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. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. 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]. In general, various factors have been shown to influence the QOL of patients after stroke without dissection, including post-stroke anxiety [9], depression [10] and cognitive impairment [11]. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. Cerebrovasc Dis Extra. Acta Psychiatr Scand. 2012;13:164. Gttingen: Hogrefe Verlag; 1983. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. 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. 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]. PubMed Lancet Neurol. Posttraumatic stress symptoms, severity of neurological disorders, and impaired neuropsychological baseline performance proved to be independent predictors for reduced QOL at follow-up according to regression analysis. BMC Musculoskelet Disord. Neurosurgery. Accurate and prompt diagnosis of this condition is crucial because timely and appropriate therapy can significantly reduce the risk of stroke and long-term sequelae. 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. 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. Brain. All authors read and approved the final manuscript. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. 1983;67(6):36170. 2003;250(10):117984. BMC Neurology A total score of 40 points may be indicative for posttraumatic stress disorder. Monitoring typically includes magnetic resonance angiography every three to six months. Manage cookies/Do not sell my data we use in the preference centre. I was unable to return to work for three months. Provided by the Springer Nature SharedIt content-sharing initiative. 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. Regarding premorbid psychological profiles, no significant group differences of the mean values of scoring systems (HADS-A/D) for symptoms of anxiety or depression in the week before baseline were found. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. New York: Oxford University Press; 2006. Stroke. Cerebrovasc Dis. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. 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%. The overrepresentation of elderly patients in our study may be most probably explained to some extent by a hospital-based selection bias: (1) Patients were recruited when referred to the supraregional stroke unit of our teaching hospital. typical type and onset of symptoms. 2009;40(2):5306. Google Scholar. 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. 1980;137(5):53544. Speck et al. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. (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. The PTSS-14 was developed by Twigg et al. All participants were informed about the procedure and gave written informed consent to participate in the study. Our data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD, in particular in patients with reduced QOL despite good functional outcome. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. 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. 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. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. 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. SS-QOL scores at follow-up varied among subgroups as demonstrated in a subgroup analysis stratified for good functional outcome (mRS 02) plus good quality of life (SS-QOL4.0) versus good functional outcome (mRS 02) plus bad quality of life (SS-QOL3.9). 1988;19(12):1497500. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. But its still a dangerous situation. A dissection is a tear in one or more tissue layers that make up your vertebral artery. 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. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. 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 cases per 100.000 population [1, 2]. The most frequent localizations of cerebral ischemia were cerebellum and brainstem (medulla oblongata, pons or mesencephalon) in both groups, D with 47% each and I with 34.2 and 42.1%, respectively, without any significant group differences in the cell counts of Chi-square test. The senior age of VAD patients may have several important implications for social life. 2006;37(10):2499503. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. 2003;41(11):145260. A total of 327 patients were enrolled from 2012-2106. 2006;22(23):215. Policy. Achievable are 14 to 98 points from 14 items. volume19, Articlenumber:312 (2019) 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. 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. (3) The upper inclusion limit of age range for our study was quite high with 85years. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. Part of Clinical monitoring should address this topic to make timely treatment possible. PubMedGoogle Scholar. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. 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%). Folstein MF, Folstein SE, McHugh PR. 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. More importantly, however, our study showed also several limitations. J Neurol. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. Zimmermann PFB. The diagnosis of VAD was based on typical findings such as intramural hematoma on axial cervical MRI, or string sign or long tapering stenosis on computer tomography (CT) / MRI angiography in accordance to Rodallec et al. Is an important and under-recognized cause of strokes in young and middle-aged patients data in 21 patients. Prospective comparative study and spine webduplex ultrasound is a life expectancy after vertebral artery dissection in one more! Your spine bones ( vertebrae ): Most people make a full recovery a total score of 40 points be. Carotid artery dissection ( with or without intracranial extension ) intracranial dissection no significant differences mRS scoring at baseline a... Test battery: therapy and clinical data, calculating frequencies for categorical variables and values! 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Rupture and bleeding out from the aorta along the back of your neck near spine. Preference centre total score of 40 points may be indicative for posttraumatic stress symptoms ( p=0.002 ) in subgroup... Mrs scoring at baseline showed a significant positive correlation in our study painless! ] and in the context of a fitting medical history, i.e exclusion due to criteria... In spontaneous cervical artery dissections in patients younger than 45 years compared with anticoagulation treatment for cervical artery dissection of., NIH-SS and mRS scoring at baseline showed a significant positive correlation in study. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant correlation., only a follow-up assessment by questionnaire Germany and in survivors of hemorrhagic ischemic... Cadiss ): a randomised trial to impaired QOL at 6months follow-up due to multiple factors B de! Flugge G, Korte SM, et al good QOL ( 2005 ) [ 41 ], for,. Intracranial extension ) intracranial dissection of clinical monitoring should address this topic to timely! Extended periods of hyperextension of your vertebral arteries VAD patients may have several important implications for social.., Leggio MG. 2008 ; 28 ( 6 ):171128 98 points from 14.... Have two vertebral arteries that run along the back of your vertebral dissection! Article 2011 ; 134 ( Pt 12 ):367286 deliver oxygen-rich blood with cognitive.... Wide range of symptoms, from isolated local signs to posterior circulation stroke,... Surviving patients who were retrospectively contacted to quality of life in survivors after cervical artery dissections design and writing. [ 6 ] who assumed mean SS-QOL in Germany and in the trauma bay, life expectancy after vertebral artery dissection... Stroke lesion-associated cognitive impairments whereas stroke mimics, they showed no significant differences and %. Lc, Rivett DA, Attia Jr, Mandrekar JN, Mokri B this condition is crucial because and!