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%. Engel GL. In our study, there was a trend in patients with good functional outcome (mRS score 02) to higher association of occlusion/subtotal occlusion with worse QOL, though this was statistically nonsignificant (p<0.05). Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. 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. Zubin J, Spring B. Thus, somewhat unspecific symptoms in this age group and context of VAD history, if not critically reflected, may usually prompt otherwise evitable inpatient diagnostics for stroke and/or recurrence of dissection. Administration, norms, and commentary. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. (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. PubMedGoogle Scholar. It generates 12 domain-related scores and a total score. Zimmermann PFB. 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. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . Magnetic resonance angiography is the gold standard diagnostic test. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. Sometimes, your healthcare provider may recommend conventional angiography. J Stroke Cerebrovasc Dis. 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. Eur Heart J 2021;42:3825-3828. Cervical artery dissection: trauma and other potential mechanical trigger events. Magnetic resonance angiography is a sophisticated test thats not widely available. 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. Among 24 stroke mimics only two patients (8.3%) with mRS 02 reported a bad quality of life in contrast to 20 patients (83.3%) with mRS 02. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. These include vertebral and carotid arteries. 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/. A Spearmans rank correlation analysis was performed for outcome-relevant variables. Article Brain and intelligence: a quantitative study of the frontal lobes. This difference was not statistically significant (p<0.05). Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. Another woman (47years old; locked in-syndrome due to pontine infarction by basilar artery occlusion due to vertebral artery dissection) and a man (77years old; dizziness, nausea, vomiting, headache, ataxia, facial weakness, dysarthria, dysphagia; combined medulla oblongata and cerebellar infarction) without a sufficient ability to speak for participating in neuropsychological testing. But timely treatment, typically blood thinners or a procedure, can save your life. Previous 2016;87(5):52630. Importantly, our study cohort of VAD patients appeared to be not significantly biased by exclusion of eight patients, whose features and mean age of 64.5years widely resembled those of the study group. Definitions for use in a multicenter clinical trial. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. 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]. In contrast to the primary application of the English version to intensive care unit patients, the German version was recently validated for its use on a broader spectrum of patients [21]. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. (2004) [45]. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. communication). 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. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Ahl et al. Google Scholar. 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). Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. 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. The vertebral arteries have many small branches. 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 Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. J Neurol. BMC Neurol 19, 312 (2019). Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. The first data collection in each patient was performed at baseline (time point t1) in the acute phase in hospital after clinical stabilization: neuro-status at admission by National Institute of Health Stroke Scale (NIH-SS) score [18] according to patients records, neurostatus (mRS) and clinical data at baseline according to examination and interview, cognitive screening as well as extensive neuropsychological testing by battery at baseline, and administering self-rating protocols for symptoms of anxiety and depression pre-baseline as well as stroke-related QOL pre-baseline. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). volume19, Articlenumber:312 (2019) WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. Apart from the limits of our measurement method, we assumed that the neuroanatomical function of the affected stroke area was much more important than the extension. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. 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. WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. 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. We do not endorse non-Cleveland Clinic products or services. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Events most commonly occur in the postpartum period This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. 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%). (2013) [59] hypothesized that cervical artery dissection goes frequently undiagnosed, particularly in patients with subtle symptoms, which is true for VAD [3, 57], and dependently from the awareness of the responsible physician. Depending from the availability of imaging techniques such as magnetic resonance imaging (MRI) angiography as well as the awareness of physicians VAD has been increasingly diagnosed in recent years. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. Article (2014) [46]. Your chances of experiencing a stroke are low. 2012;13:164. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. Stroke. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. Quality of life in survivors after cervical artery dissection. 2017;88(14):131320. Rainer J. Strege. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. 2009;256(3):4439. 2001;32(6):131822. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. 2018;3(1):4756. 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. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. PubMed Central 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. Individuals facing a higher risk of future dissection will need follow-up care for many years. Advertising on our site helps support our mission. Herzogenrath: Vera Fimm; 2009. Clinical monitoring should address this topic to make timely treatment possible. The other variables showed no significant differences. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. Stroke. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. However, you may be at risk for future dissections. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. WebCervical artery dissections typically heal very well, returning the vessel to normal. The role of cognitive impairment in the quality of life after ischaemic stroke. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. 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. The clinical application of the biopsychosocial model. Kissela et al. Multimodal assessment was performed for clinical, neurological, cognitive, psychological and radiological data at baseline and for QOL, functional outcome, and stress symptoms by questionnaire at six months follow-up. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. Thomas LC, Rivett DA, Attia JR, Levi CR. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. You may also need to continue taking a blood thinner during this time. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. 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. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. Differences in reduced neurostatus at baseline (NIH-SS on admission)(p=0.042) in subgroup D (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 and higher grade of white matter lesions (WML)(p=0.042) in subgroup I (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 were not significant after correction of cumulative alpha-error. Five-point test. 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