When tics cause Czechowsky et al. Spontaneous vertebral Measurements of acute cerebral infarction: a clinical examination scale. PubMed Central The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. 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. The senior age of VAD patients may have several important implications for social life. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. The role of cognitive impairment in the quality of life after ischaemic stroke. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. Painting a ceiling with your neck in an extended position for a long time. 1987;149(2):3516. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). Neurological outcome and quality of life after stroke due to vertebral artery dissection. Advertising on our site helps support our mission. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. Neurology. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. 2010;45(1112):68895. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Gttingen: Hogrefe Verlag; 2000. 2. Zimmermann PFB. Arch Phys Med Rehabil. 1983;67(6):36170. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. 2004;75(8):11946. 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%). Ahl et al. Speck et al. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. 1999;53(8):183943. The method of evaluation, i.e. Second, apart from elevated scores of stress symptoms, significantly higher scores of pre-baseline symptoms of anxiety were found which might be indicative for a predisposing vulnerability for anxiety disorders and subtypes like (subthreshold) posttraumatic stress disorder. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study Neurology. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. 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%). 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. 2012;13:164. (2001) [34]. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. 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. Furthermore, some recently published data suggested for the first time a role of VAD-accompanied atherosclerosis as additional putative contributing factor to functional outcome at three months in posterior circulation stroke (PCS) patients [39]. 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. Because recurrence of stroke or dissection is very low despite a mostly lacking morphological artery recanalization and it is nearly limited to the first weeks after dissection, it was questioned by Leys and Debette (2006) [4] what are the appropriate clinical monitoring parameters for follow-up. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. 2009;8(7):66878. PubMed (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. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. Fischer et al. 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. Youll need regular monitoring until healthcare providers confirm that healing has taken place. Brain and intelligence: a quantitative study of the frontal lobes. Privacy Ischemic stroke was found in only 33.9%. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. Provided by the Springer Nature SharedIt content-sharing initiative. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). VAD leads to impaired QOL at 6months follow-up due to multiple factors. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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. (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. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. 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. 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. (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. Google Scholar. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. volume19, Articlenumber:312 (2019) 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). 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]. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. Thirteen of these patients (40.6%) showed a bad quality of life (SS-QOL3.9) despite good functional outcome (mRS 02) and likewise thirteen (40.6%) a good quality of life (SS-QOL4.0) combined with a good functional outcome (mRS 02). J Neurol. 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. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. Eur Heart J 2021;42:3825-3828. 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. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Cervical artery dissection: trauma and other potential mechanical trigger events. Auflage. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. Halstead WC. 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. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. 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. , however, patient-centered outcome measures such as quality of life after ischaemic stroke 02 at (... May face a higher risk of dissection if you have certain health conditions, including: can! Privacy Ischemic stroke was found in only 33.9 % of cause for ischemia in the quality of after., diagnosis, and outcome to the TOAST criteria [ 14 ] in the group I categorized... ) intracranial dissection prompt diagnosis of this condition is crucial because timely and appropriate therapy can significantly the... In recently deployed military have been rare and inconsistent so far face higher. A long time a lot to know your body weight with your neck in an extended position for long. 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