Magnetic resonance angiography is a sophisticated test thats not widely available. Traenka et al. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. These are typically among the first tests people receive. 2002;13(3):1927. Some give a figure of multiple vessel dissection as high as 30%. The causes of vertebral artery dissection can be grouped under two main categories, spontaneous and traumatic. Spontaneous cases are considered to be caused by intrinsic factors that weaken the arterial wall. Gttingen: Hogrefe Verlag; 1983. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. Youll need regular monitoring until healthcare providers confirm that healing has taken place. The hospital anxiety and depression scale. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Anasthesiol Intensivmed Notfallmed Schmerzther. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. Spontaneous vertebral If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. 2014;23(2):33542. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. Cerebrovasc Dis Extra. 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 No individual persons personal details, images or videos are being used in this study. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. At least 90 percent of adults with FMD are women. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). Moreover, our data demonstrated no role of WML as independent predictor of QOL. By using this website, you agree to our 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 some cases, cerebellum and medulla oblongata were affected in combination. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Herzogenrath: Vera Fimm; 2009. Speck et al. All participants were informed about the procedure and gave written informed consent to participate in the study. J Clin Neurol. 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. 2. Among physical domains only the domain work showed also deterioration in groups D and I. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. 1975;12(3):18998. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. The vertebral arteries have many small branches. A practical method for grading the cognitive state of patients for the clinician. (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. Google Scholar. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. 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. Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. Their high PTSD prevalence might be overestimated because physically less affected people voluntarily participating in their study might have tended to mention more mental problems when asked by self-rating PDS. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. NIH-SS and mRS scoring at baseline of groups D and I yielded scores significantly worse compared with group M, indicating a reduced neurological status of affected patients (Table2). Cervical artery dissection: trauma and other potential mechanical trigger events. Measurements of acute cerebral infarction: a clinical examination scale. Vulnerability--a new view of schizophrenia. Data about pathological results of neuropsychological test battery assessment. This investigation is, to the best of our knowledge, the first study that evaluated contributing factors to QOL six months after VAD in a pure prospective and comparative study design on a pure VAD study population, including a standardized neuropsychological testing in the acute phase. (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. Blood in the separated layers of the vessel wall can lead to blood clot formation. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. 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. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. 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. All data were prospectively collected from consecutively recruited patients who were admitted to our stroke unit under the suspected diagnosis of an acute stroke between October 2010 and June 2013. On rare occasions, this can lead to stroke. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. 2009;256(3):4439. 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. Does the cerebellum contribute to specific aspects of attention? Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. J Neurol. 2016;87(5):52630. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. You may also need to continue taking a blood thinner during this time. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. It may also occur with sudden neck movements and trauma. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. Administration, norms, and commentary. 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. (2014) [46], mean age 44.8years. Stroke. Gttingen: Hogrefe Verlag; 2004. As the second most important limitation, the statistical evidence is limited due to the exploratory character of this single center field study design and its small sample size which is explained by the rarity of examined disease. 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. Painting a ceiling with your neck in an extended position for a long time. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. 2008;52(2):2028. 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. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. 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. WebScore: 4.2/5 (61 votes) . Third, apart from elevated scores of stress symptoms significantly lower scores of the SS-QOL item self-confidence within the domain mood were found at follow-up. It generates 12 domain-related scores and a total score. Czechowsky D, Hill MD. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. Med Hypotheses. A better understanding of clinical courses and their affecting variables with special respect to the biopsychosocial model [12] seemed to be of great importance for the neurorehabilitation of such VAD patients in the future. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. 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). However, you may be at risk for future dissections. 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. Auflage. 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. Previous We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. 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. 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. With a dissection, blood gets trapped between the intima and media. WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. Subgroup analysis stratified for QOL by Stroke Specific Quality of Life Scale (SS-QOL) were done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 02). Its signs and symptoms can be vague, and diagnosis can be elusive. Thus, the present investigation has to be characterized as an explorative study. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. The other variables showed no significant differences. 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]. PubMed Central Am J Psychiatry. CTA, MRI, and WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. (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. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. You may need a procedure. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. 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. 2014;45(11):33606. (2004) [45]. Turm von London Deutsche Version. 2013;94(12):253541. 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 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. Trial of org 10172 in acute stroke treatment. 2013;80(21):19507. PubMed Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Ahl et al. 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. Zimmermann PFB. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. 2009;40(2):5306. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. 2023 BioMed Central Ltd unless otherwise stated. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. 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. Differential features of carotid and vertebral artery dissections: the CADISP study. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. 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. 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). Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. This difference was not statistically significant (p<0.05). 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. CAS Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. 2011;134(Pt 12):367286. The aim of this study 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. 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]. Five patients were excluded from the dissection study group after screening according to the inclusion/exclusion study criteria: One woman (70years old; ataxia, dizziness, facial weakness; medulla oblongata infarction by vertebral artery occlusion suspicious for but not yet proven dissection) deceased due to unexpected cardiopulmonary failure not otherwise specified in the acute phase. 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. [13] and in the context of a fitting medical history, i.e. 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. Chicago: University of Chicago Press; 1947. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. Eur J Neurol. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. Three initially included woman of ages 70, 71, and 77years had to be excluded secondarily because of concurrent diseases in form of preexisting idiopathic cerebellar syndrome, acute symptomatic anterior circulation brain infarction, and predominant arteriitis temporalis (first with ocular disorder, paresis of arm, ataxia, and dysarthria plus suspected brainstem infarction due to VAD; second with VAD and arm paresis; third with VAD and visual field disorder). communication). 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. 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. Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. PubMed Central J Neurol Neurosurg Psychiatry. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. (2009) [6], mean age 46years, Czechowsky et al. Neurological outcome and quality of life after stroke due to vertebral artery dissection. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Eur Heart J 2021;42:3825-3828. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). 2003;41(11):145260. A total of 327 patients were enrolled from 2012-2106. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. Noble AJ, Baisch S, Mendelow AD, Allen L, Kane P, Schenk T. Posttraumatic stress disorder explains reduced quality of life in subarachnoid hemorrhage patients in both the short and long term. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. Spontaneous dissections have been reported. Clinical monitoring should address this topic to make timely treatment possible. RK contributed to the experimental design and manuscript writing. You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). 2004;75(8):11946. 2017;88(14):131320. 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. 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/. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. Horn W. L-P-S Leistungsprfsystem. Noble et al. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. We think increased PTSS levels were neither decisively stroke unit-related, as they were less frequent in comparison group I and M patients who were also treated on the stroke unit, nor disease-specific, as they were also present in group I and M. PTSS levels have been still prevalent in group D which might be explained by the stress-vulnerability model [53]. bright spots on my Kwa VI, Limburg M, de Haan RJ. 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). statement and 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. Dissection: trauma and other potential mechanical trigger events characteristics and outcomes of vertebrobasilar artery dissection can vague! Dissection -- clinical features, risk factors, therapy and outcome in 126 patients is considered! 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