Inpatient rehabilitation for several weeks was performed in 48.5% patients of group D, 60.5% of group I and in only one patient (4%) of group M. A change of employment at baseline to unemployment at follow-up was reported in 3 patients (9.4%) in group D, 5 patients (13.5%) in group I and 2 patients in group M. Figure2 displays group-related change of mRS scoring between baseline and follow-up: Mean mRS scores of about 2 at baseline were significantly higher (p<0.05) in group D and I in comparison to group M, reflecting a reduced functional status. Neurology. Ahl et al. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. J Neurol. Folstein MF, Folstein SE, McHugh PR. Gttingen: Hogrefe Verlag; 2004. 2004;251(10):12428. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. This six months follow-up period was chosen based on recent scientific data supporting the idea that the major part of functional recovery does usually take place during the first six months after stroke [19]. WebScore: 4.2/5 (61 votes) . PubMed It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. At least 90 percent of adults with FMD are women. 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 RK contributed to the experimental design and manuscript writing. 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. Speck et al. Youll need regular monitoring until healthcare providers confirm that healing has taken place. Most of the time, ischemic stroke is due to atherosclerosis (thickening of the artery from other risk factors, such as smoking, high blood pressure, high cholesterol, diabetes). Blood in the separated layers of the vessel wall can lead to blood clot formation. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Predictors for QOL at follow-up were analyzed by regression model. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, 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. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. Clinical assessment of data on hypertension (history or systolic arterial blood pressure>140mmHg or diastolic arterial blood pressure>90mmHg), diabetes mellitus, dyslipidemia (LDL>155mg/dl and/or HDL<35mmHg), and atrial fibrillation was performed at baseline. This process usually occurs within the first three to six months. 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. 2003;41(11):145260. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. 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. 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. This risk decreases over time. 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%). 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. On rare occasions, this can lead to stroke. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Sometimes, your healthcare provider may recommend conventional angiography. The finding of more neurocognitive impairments in form of lower mean values in cognitive measures in patients with ischemic lesions of both group D and group I patients did not reach significance. 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. These findings corresponded widely to findings of Gottwald et al. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. 2002;13(3):1927. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Neurorehabil Neural Repair. 2006;66(4):5136. Incidence and outcome of cervical artery dissection: a population-based study. California Privacy Statement, J Am Geriatr Soc. 2004;63(11):21325. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. Vertebral artery dissection is a rare cause of stroke in older adults. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. The role of cognitive impairment in the quality of life after ischaemic stroke. Table4 shows univariate linear regression analysis demonstrating that neurocognition scores at baseline (MMSE, MoCA, CCS), neurostatus at baseline (NIH-SS score on admission, mRS score) and stress symptoms at follow-up (PTSS-14 score) were predictors of quality of life at follow-up. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. 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. 2018;3(1):4756. Zubin J, Spring B. Although functional outcome was good in the majority of their cases, the surprising main finding was a bad quality of life, measured by Stroke Specific Quality Of Life scale (SS-QOL) [7] despite of good functional outcome, scored by modified Rankin Scale (mRS) [8], in about 15% [5] to 30% of cases [6]. Correspondence to 1996;243(8):599604. Med Hypotheses. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). Gttingen: Hogrefe Verlag; 2000. 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. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Differential features of carotid and vertebral artery dissections: the CADISP study. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. 37 patients fulfilled the inclusion criteria and were included into the study as group D. In addition, 38 patients with acute stroke or TIA of the posterior circulation were included as comparison group I and 27 stroke mimics of the posterior circulation as comparison group M (Fig. They finally hypothesized that the rate of incidence must be equal throughout life. Neuropsychologia. This option is also for people with hemorrhagic stroke. A Spearmans rank correlation analysis was performed for outcome-relevant variables. A vertebral artery dissection is not what youd expect at 35 years young. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the last 12 months Socials: www.instagram.com/aimzwells/ 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. It provides seven scoring levels as follows: (0) no symptoms at all, (1) no significant disability despite symptoms, (2) slight disability, (3) moderate disability, (4) moderately severe disability, (5) severe disability, and (6) dead. Traenka et al. There were significant more neurological impairments at baseline, that are higher scores of mRS for functional disability or NIH-SS for neurological deficit, in group D as well as I patients with ischemic stroke lesions compared to stroke mimics. WebA vertebral artery dissection is not what youd expect at 35 years young. PubMedGoogle Scholar. [13] and in the context of a fitting medical history, i.e. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Psychosom Med. statement and Turm von London Deutsche Version. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. That is in particular striking regarding VAD. 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. 2016;87(5):52630. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Your chances of experiencing a stroke are low. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. 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. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. 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. Neurology. Psychol Assess. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. BMC Neurology What symptoms/pain did you experience? 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. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. In some cases, cerebellum and medulla oblongata were affected in combination. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. The cerebellar cognitive profile. Noble et al. 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. Brain. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 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]. 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. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. 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). 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. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. Google Scholar. Factors affecting the quality of life after ischemic stroke: young versus old patients. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. Anasthesiol Intensivmed Notfallmed Schmerzther. 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