Fischer et al. 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. 2014;45(11):33606. PubMed Central However, you may be at risk for future dissections. 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. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). While post-stroke anxiety [9] and depression [10] have been described already earlier, even depression in stroke patients treated and non-treated with intravenous thrombolytic therapy [51], posttraumatic stress disorder has been coming to attention more recently. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. Participants were examined for psychological, cognitive and neurological variables with special reference for functional outcome as well as quality of life 6months after the index event. 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. Am J Psychiatry. 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). Gttingen: Hogrefe Verlag; 2004. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. Psychol Assess. (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. These findings corresponded widely to findings of Gottwald et al. At least 90 percent of adults with FMD are women. 2011;92(5):7928. 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. No individual persons personal details, images or videos are being used in this study. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. They carry blood to the brain and spinal cord, which are part of the nervous system. Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. Eur J Neurol. Radiographics. Aortic dissection is life-threatening. The challenging main consequence from our study regarding this older age group of VAD patients might be therefore for the treating physician to make the right decision: When to consider (re-)dissection stroke and when to consider neuropsychiatric sequelae, for example. 8. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Cervical artery dissection: trauma and other potential mechanical trigger events. Zimmermann PFB. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. A dissection is a tear in one or more tissue layers that make up your vertebral artery. We do not endorse non-Cleveland Clinic products or services. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. 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). Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. 1). Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. Aschenbrenner S, Tucha O, Lange KW. Most patients achieved good QOL (SS-QOL4.0) at 6months follow-up in group I (68.4%) and even better in group M (87.5%) in contrast with group D (46.9%) (Table2). The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. Tucson: Neuropsychological Press; 1985. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Kwa VI, Limburg M, de Haan RJ. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. "mini-mental state". They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. 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. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. It can affect blood flow, putting you at risk for life-threatening complications. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. The hospital anxiety and depression scale. Stroke. Every pathological result, that is a value below one standard deviation, in one of the nine above mentioned cognitive function test domains was transposed to a cognitive composite score for each individual for the purpose of interindividual comparison. 2014;23(2):33542. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. 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. Six patients died within 3 months, the remaining 108 were contacted after Practicing yoga where hyperextension of your neck occurs. J Neurol Neurosurg Psychiatry. 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. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. 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. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. 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. Although there was a preponderance of atrial fibrillation in group I, no significant group differences of neurovascular risk factors were found in line with current knowledge about VAD characteristics [3, 35]. They included benign paroxysmal positional vertigo in 40%, vestibular neuritis in 24%, vestibulocochlear irritation in 4%, Schwannoma in 4%, suspected somatoform dizziness in 8% and nonspecific dizziness of unknown origin in 16%. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. Group D only displayed a significant lower mean value than groups I and M in the domain social roles. Neurology. 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). 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. The study protocol was approved by the Local Ethics Committee of the University of Bremen. These are typically among the first tests people receive. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. The senior age of VAD patients may have several important implications for social life. J Neurol. PubMedGoogle Scholar. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. While there were in groups D and I compared to group M frequent impairments in both global screening tests (MMSE, MoCA) and in single cognitive function tests of the neuropsychological test battery (Additionalfile1) and also in the resulting cognitive composite score (CCS), this difference reached statistical significance only in the MoCA assessment for group D compared to group M (Table2). 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. (2004) [45]. Classification of subtype of acute ischemic stroke. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 2017;88(14):131320. Stroke. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. When tics cause Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. Article J Psychiatr Res. volume19, Articlenumber:312 (2019) If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. (2008) [55], for example, prospectively studied 105 subarachnoid hemorrhage patients at 3 and 13months post-ictus and found that 37 % met the diagnostic criteria of PTSD. Article MoCA, to our best knowledge, was used in our study for the first time in VAD patients. J Stroke Cerebrovasc Dis. A total of 327 patients were enrolled from 2012-2106. Monitoring typically includes magnetic resonance angiography every three to six months. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. 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. Google Scholar. 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? Trial of org 10172 in acute stroke treatment. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). 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. I was unable to return to work for three months. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. 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. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. All participants were informed about the procedure and gave written informed consent to participate in the study. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. In the trauma bay, he complained of chest pain and dyspnea. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. (2014) [46]. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. 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. Knecht et al. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. Regensburger Wortflssigkeitstest. But its still a dangerous situation. 2008;28(6):171128. In this context the following aspects seem to be worthy to note: First, elevated scores of stress symptoms were also found in patients without any stroke lesion in our study in line with other study results [50]. Speck et al. (3) The upper inclusion limit of age range for our study was quite high with 85years. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. Another 66years old patient with medulla oblongata infarction deceased due to nonspecific heart failure and was lost for follow-up; in group I one stroke and two myocardial infarcts occured; group M remained without any vascular event. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. BMC Musculoskelet Disord. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. 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]. The aim of this study In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. 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. Rainer J. Strege. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. 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. 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. 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. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. Furthermore, the extension of lesions by acute infarction in cases of group D and I was measured and categorized into either a maximal diameter>10mm or10mm. 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. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. Because data on the potential impact of infarct volume to outcome and QOL in VAD patients have been lacking so far, we used at least a very arbitrary method for semiquantitative evaluation of the extension of infarct lesions and were not able to ascertain any statistical association. The cerebellar cognitive profile. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). 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. Cerebrovasc Dis. 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%). A Spearmans rank correlation analysis was performed for outcome-relevant variables. 2011;77(12):117481. Grond-Ginsbach et al. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. 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. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Acta Psychiatr Scand. 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. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). 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. Web2. 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. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. 2013;80(21):19507. Turm von London Deutsche Version. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. They deliver oxygen-rich blood to your brain and spine. Quality of life in survivors after cervical artery dissection. 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]. Gave written informed consent to participate in the study protocol was approved by Local! Follow-Up examination conducted, only a follow-up assessment by questionnaire or CT angiography ( time point t2 ) after. A total of 327 patients were enrolled from 2012-2106 a computed tomography ( CT ) or... 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