It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. 2011;77(12):117481. CADISS Trial Investigators. PubMed New York: Oxford University Press; 2006. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. 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. The PTSS-14 was developed by Twigg et al. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. Cookies policy. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Web2. 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. Six patients died within 3 months, the remaining 108 were contacted after 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]. On rare occasions, this can lead to stroke. 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. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Psychol Assess. J Neurol. 2003;250(10):117984. Cerebrovasc Dis. Speck et al. Acta Anaesthesiol Scand. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). Stroke. I was unable to return to work for three months. These include vertebral and carotid arteries. Disabil Rehabil. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. 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/. Engel GL. Arch Phys Med Rehabil. Spontaneous dissection of the carotid and vertebral arteries. Zimmermann PFB. 1989;20(7):86470. This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. Five-point test. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. For the assessment of psychological variables several self-rating measurement tools were introduced: The German version of the Hospital Anxiety and Depression Scale (HADS) [20] was administered at baseline to determine the grade of symptoms of anxiety and depression in the week before baseline. (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. Data about pathological results of neuropsychological test battery assessment. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. 2. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the Although its pathophysiology and treatment closely resemble that of its sister condition, carotid artery dissection (CAD), the clinical presentation, etiology, and epidemiological profile of VADs are unique. 1975;12(3):18998. CAS 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). Other important findings were found in subgroup I (mRS02) with bad QOL that were significantly higher mean values for premorbid anxiety symptoms (p=0.002) and depression symptoms (p<0.001). Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. There were significant more neurological impairments at baseline, that are higher scores of mRS for functional disability or NIH-SS for neurological deficit, in group D as well as I patients with ischemic stroke lesions compared to stroke mimics. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. 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. 1987;149(2):3516. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Your healthcare provider may recommend alternative treatments. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. 2004;251(10):12428. Neurosurgery. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. 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. Ischemic stroke was found in only 33.9%. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. On rare occasions, this can lead to stroke. Anasthesiol Intensivmed Notfallmed Schmerzther. J Stroke Cerebrovasc Dis. 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]. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. Lancet Neurol. However, incidental minor trauma Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. A total score of 40 points may be indicative for posttraumatic stress disorder. 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). Neurology. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. 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. statement and WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. It has been already earlier demonstrated in both patients with stroke and patients with Parkinsons disease that the type of psychosocial alterations, psychosocial adaptation and coping strategies seem to be of much greater impact than the degree of physical impairment [56]. It contains 49 items belonging to 12 domains. BMC Musculoskelet Disord. volume19, Articlenumber:312 (2019) They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. With a dissection, blood gets trapped between the intima and media. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. 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. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. Article Evaluation for neurological status at baseline was done by the responsible physician at patients admission to hospital, using the National Institute of Health Stroke Scale (NIH-SS) [18], and by an experienced neurologist (RJS) at the time of neuropsychological testing, administering the modified Rankin Scale (mRS) [8]. Vulnerability--a new view of schizophrenia. Individuals facing a higher risk of future dissection will need follow-up care for many years. Zigmond AS, Snaith RP. Neurological outcome and quality of life after stroke due to vertebral artery dissection. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. Eur Stroke J. 2011;92(5):7928. 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. 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]. It may also occur with sudden neck movements and trauma. 2010;17(2):21925. (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. 1999;53(8):183943. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. 2013;80(6):78790. Med Hypotheses. Gttingen: Hogrefe Verlag; 1983. Procedures for vertebral artery dissection include: Most people make a full recovery. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. J Neurol Neurosurg Psychiatry. 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. 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. The role of cognitive impairment in the quality of life after ischaemic stroke. BMC Neurology bright spots on my https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. Gttingen: Beltz Test GmbH; 2001. Williams LS, Weinberger M, Harris LE, Biller J. Neurology. Because of the great Previous Vertebral artery dissection: presenting findings and predictors of outcome. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Bern: Verlag Hans Huber; 2000. But its still a dangerous situation. 88.2% of patients with VAD suffered from acute cerebral ischemia. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. (2004) [45]. Zubin J, Spring B. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. It can also lead to swelling (dilation) of the artery. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. This process usually occurs within the first three to six months. J Neurol. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. 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. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. Tucson: Neuropsychological Press; 1985.