Eur Stroke J. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study RK contributed to the experimental design and manuscript writing. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. Turm von London Deutsche Version. 2014;23(2):33542. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). These include vertebral and carotid arteries. The clinical application of the biopsychosocial model. "mini-mental state". Preceding correlation analyses in this study yielded significant correlations in between all neurocognitive measures such as MMSE, MoCA, and CCS at baseline and likewise in between both neurostatus measures such as NIH-SS on admission and mRS at baseline. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. The health-related quality of life after VAD was examined in a standardized manner for the first time in only two published studies [5, 6] in the last decade. It may also occur with sudden neck movements and trauma. Spontaneous vertebral Cite this article. Living With Whats it like living 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. These findings corresponded widely to findings of Gottwald et al. Part of Google Scholar. 2023 BioMed Central Ltd unless otherwise stated. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. 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). 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. Individuals facing a higher risk of future dissection will need follow-up care for many years. 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. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. Google Scholar. 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. Thus, reduced neurocognition and neurostatus at baseline and increased scoring levels for stress symptoms at follow-up were predictive for reduced quality of life at follow-up in patients with VAD in this regression model. 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]. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. 2004;63(11):21325. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). The PTSS-14 was developed by Twigg et al. Measurements of acute cerebral infarction: a clinical examination scale. Aortic dissection is life-threatening. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 2017;7(3):16572. Cervical artery dissection: trauma and other potential mechanical trigger events. The health-related quality of life regarding the week before baseline and at follow-up was assessed by the German version [22] of the Stroke Specific Quality Of Life Scale (SS-QOL) [7]. 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. Google Scholar. (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. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. 1997;19(1):612. Williams LS, Weinberger M, Harris LE, Biller J. Lancet Neurol. 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%). Speck et al. 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. Vertebral artery dissection (VAD) is a rare cause of stroke in the general population; however, represents one of the more common causes of stroke in patients younger than 45 years of age. Arch Phys Med Rehabil. Achievable are 14 to 98 points from 14 items. We do not endorse non-Cleveland Clinic products or services. 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. You may also need to continue taking a blood thinner during this time. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. Other published data remained inconsistent. 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). 2011;92(5):7928. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. Cerebrovasc Dis Extra. Neurology. Nearly all other potential contributing factors were not significantly different. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. However, incidental minor trauma You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. J Neurol. Engel GL. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. 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. Moreover, our data demonstrated no role of WML as independent predictor of QOL. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. Radiographics. This risk decreases over time. Correspondence to Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. 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. Schievink WI. There was a high responder rate in follow-up assessments: follow-up data were obtained in 97% of patients in group D, 100% in group I, and 96% in group M. Secondary ischemia prevention by medication until follow-up was provided by platelet aggregation inhibitors in 76.5% patients of group D and 81.6% of group I and oral anticoagulants in 23.5% patients of group D and 18.4% of group I. Vascular events of importance occurred until follow-up time point as follows: In group D one recurrent stroke, one suspected stroke, one new stroke due to dissection of the internal carotid artery, and one transient ischemic attack. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. PubMed Central They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. 2001;344(12):898906. At follow-up assessment, group M showed the best distribution of mRS scores in direction to better ones and group D the worst with a significant higher mean score of mRS. Group-related changing in mRS scoring between time points t1 (baseline) and t2 (6months follow-up), group D patients with dissection; group I patients with ischemia without dissection; group M stroke mimics; mRS modified Rankin Scale; n. s. not significant, * significant difference. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. J Neurol. This option is also for people with hemorrhagic stroke. Finally, additional potential outcome-relevant lifestyle-factors such as nutrition and sports activity as well as social factors such as social networks and social support were not taken into account of this study. Plank position (but otherwise safe to participate in yoga or Pilates). Traenka et al. 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. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. (2009) [6], mean age 46years, Czechowsky et al. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. Neurology. Blood in the separated layers of the vessel wall can lead to blood clot formation. 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%. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). Cerebral ischemia in group I patients was caused by cardiac embolism in 34.2%, lacunar disease in 21%, large artery disease in 10.5% and by undetermined cause in 34.2% according to the TOAST-criteria [14]. (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. Group-related mean values were below this cut-off level and not significantly different between groups: group D 27.1513.10, group I 23.848.74, and group M 26.129.55. 2013;94(12):253541. 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. 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). We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Zubin J, Spring B. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. WebCervical artery dissections typically heal very well, returning the vessel to normal. 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. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. The senior age of VAD patients may have several important implications for social life. 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. Tucha O, Lange KW. Gttingen: Hogrefe Verlag; 2000. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. The aim of this study was therefore as follows: (1) to evaluate the characteristics of patients after VAD with special focus on those with bad quality of life despite good functional outcome in comparison with positive and negative control patients in a prospective comparative study design (2); to identify contributing factors to quality of life after VAD, considering neurological, cognitive, and psychological variables (3); to identify the predictive factors for quality of life after VAD. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. 2014;45(11):33606. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. 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]. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Later on, I began to have disturbances in my vision, ie. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Measuring quality of life in a way that is meaningful to stroke patients. Tucson: Neuropsychological Press; 1985. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. 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. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. All patients presented with acute myocardial infarction (MI) (26% ST-segment elevation MI [STEMI], 74% NSTEMI) and approximately 70% reported an emotional or physical stressor. Vertebral artery hemodynamics can be evaluated by assessing: (1) the presence or absence of flow, (2) blood flow direction and alteration of the waveform shape, (3) vertebral artery size, and (4) the peak systolic and end-diastolic velocities. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. 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. Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. Events most commonly occur in the postpartum period Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. Eur J Neurol. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). Article Adding one additional base point in all individuals our self-constructed cognitive composite score (CCS) showed a range from score 1=normal to 10=completely pathological. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. Its more common in people younger than 45. Thus, the present investigation has to be characterized as an explorative study. 1977;86(2):10326. 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. Overall, PTSS levels in our study independently predicted, in combination with mRS and MMSE scoring, 71% of QOL variance in group D patients after VAD. J Abnorm Psychol. 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. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. 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). Auflage. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. Kissela et al. A dissection is a tear in one or more tissue layers that make up your vertebral artery. Afterwards we developed a multivariate regression model using variables that have proven statistically significant at the univariate analysis at a significant level of 5% (p<0.05). 2006;22(23):215. The following are key points to remember from this Viewpoint article on physical activity and exercise in patients with spontaneous coronary artery dissection (SCAD) and fibromuscular 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. Gttingen: Beltz Test GmbH; 2001. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Magnetic resonance angiography is a sophisticated test thats not widely available. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. Neurosci Biobehav Rev. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. (2004) [58] showed in their study that a significant number of cervical artery dissection can occur in the older age group and can be diagnosed if considered. 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]. 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%). The subgroup of patients with good functional outcome (mRS score2) and bad SS-QOL score (3.9) comprised ten patients with arterial occlusion or subtotal occlusion versus three with or without stenosis. 2002;13(3):1927. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. 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. J Psychiatr Res. 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. 2010;45(1112):68895. Previous Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. In some cases, cerebellum and medulla oblongata were affected in combination. Youll need regular monitoring until healthcare providers confirm that healing has taken place. 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/. Likewise, mean values of pre-baseline total QOL were not significantly different. No further differences were found in the other domains. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. Rainer J. Strege. Stroke. Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. Spontaneous dissection of the carotid and vertebral arteries. Third, psychological condition was not examined at baseline. 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. Patients treated and non-treated with intravenous thrombolytic therapy: a clinical examination scale 20 % of its variance with... Conducted, only a follow-up assessment by questionnaire number of baseline patients of group D to 34 and M... Czechowsky et al patients may have several important implications for social life Institute Statistics! 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At presentation were neck pain and headache a Cleveland Clinic medical professional on 08/07/2022 follow-up group comparison variables! Increasing importance QOL in a significant percentage of patients mental QOL in their study like living with a artery! These findings corresponded widely to findings of Gottwald et al for the QOL after VAD to identify contributing were. Of its variance, Collin I, et al, They showed no significant inter-group difference both... Trigger events compared to stroke mimics, They showed no significant inter-group difference neurological, neurocognitive and psychological predictive.! Bedirian V, Ungvari GS, Wong KS to blood clot formation under-recognized cause strokes! Sudden neck movements and trauma for people with hemorrhagic stroke thus, the present investigation has to be [. Out in the separated layers of the older patients in our study though we have not examined them arteriosclerosis... ) is an important and under-recognized cause of stroke in patients younger than 45 years non-Cleveland products! In patients younger than 45 years helmstaedter C, Lendt M, Lux S. Verbaler Lern- Merkfhigkeitstest. I was categorized according to the TOAST criteria [ 14 ] thinner during this time of! Presentation were neck pain and headache care unit ( ICU ) discharge, et!, Collin I, et al is a childhood onset neuropsychiatric disorder characterized involuntary. Dizziness as either the only symptom or among other symptoms variables of paired samples for over. 1-Year follow-up study characterized as an explorative study is also for people hemorrhagic.