Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. J Neurol. 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. Google Scholar. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). All authors read and approved the final manuscript. Gttingen: Beltz Test GmbH; 2001. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. Quality of life in survivors after cervical artery dissection. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). 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. Article The overrepresentation of elderly patients in our study may be most probably explained to some extent by a hospital-based selection bias: (1) Patients were recruited when referred to the supraregional stroke unit of our teaching hospital. 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]. 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. 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. Spontaneous dissection of the carotid and vertebral arteries. 2010;45(1112):68895. 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. 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]. 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]. 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). RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. Am J Psychiatry. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. Your two carotid arteries run along either side of your neck in the front. Manage cookies/Do not sell my data we use in the preference centre. The PTSS-14 was developed by Twigg et al. This difference was not statistically significant (p<0.05). Vertebral and carotid artery dissections account for only 2% of ischemic strokes. Google Scholar. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. What is the life expectance after successful repair of aortic Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. Jokinen et al. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Factors affecting the quality of life after ischemic stroke: young versus old patients. 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. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Zimmermann PFB. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Knecht et al. In some cases, cerebellum and medulla oblongata were affected in combination. Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR). 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. The higher the score the more probable is a posttraumatic disorder. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. By using this website, you agree to our Czechowsky D, Hill MD. All participants were informed about the procedure and gave written informed consent to participate in the study. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. 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. Classification of subtype of acute ischemic stroke. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. The German version of the Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) [21] was used at follow-up to determine posttraumatic stress symptoms. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. Spontaneous vertebral (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. Disabil Rehabil. 2004;75(8):11946. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. But timely treatment, typically blood thinners or a procedure, can save your life. The cerebellar cognitive profile. 1988;19(12):1497500. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. Measuring quality of life in a way that is meaningful to stroke patients. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). Terms and Conditions, Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. Previous Google Scholar. You may need a procedure. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. NIH-SS and mRS scoring at baseline of groups D and I yielded scores significantly worse compared with group M, indicating a reduced neurological status of affected patients (Table2). FMD is usually a life-long condition. Their high PTSD prevalence might be overestimated because physically less affected people voluntarily participating in their study might have tended to mention more mental problems when asked by self-rating PDS. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. 2. Neurology. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. A better understanding of clinical courses and their affecting variables with special respect to the biopsychosocial model [12] seemed to be of great importance for the neurorehabilitation of such VAD patients in the future. Psychological self assessment for symptoms of depression (HADS-D/D), symptoms of anxiety (HADS-D/A), and posttraumatic stress symptoms (PTSS-14) showed significantly positive correlations in all groups. 2009;40(2):5306. CAS Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. Thus, the present investigation has to be characterized as an explorative study. While the mean group values of MMSE around 28 out of 30 were within normal range, only the group of stroke mimics showed a normal mean value of 26.96 if scored by MoCA. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. Kwa VI, Limburg M, de Haan RJ. Neurorehabil Neural Repair. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. Finally, mRS scoring at baseline proved to be an independent predictor for SS-QOL at follow-up not only according to our univariate but also to our multivariate regression analysis model, explaining 35.9% of QOL variance according to our regression model. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. 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). Measurements of acute cerebral infarction: a clinical examination scale. Stress revisited: a critical evaluation of the stress concept. Administration, norms, and commentary. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. 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). Ischemic stroke was found in only 33.9%. 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. With a dissection, blood gets trapped between the intima and media. Most dissections heal on their own. WebScore: 4.2/5 (61 votes) . Engel GL. 2009;8(7):66878. 2003;250(10):117984. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). 2014;23(2):33542. 1996;243(8):599604. 2018;265(8):18919. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. Events most commonly occur in the postpartum period The authors declare that they have no competing interests. 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]. Further subgroup analysis was performed in subgroups D and I by comparison of variables potentially affecting quality of life such as age, gender, neurocognition at baseline (MMSE, MoCA), neurostatus at baseline (NIH-SS), grade of white matter lesions (WML), burden of ischemic stroke lesions, premorbid (pre-baseline) symptoms of anxiety or depression (HADS), stress symptoms at follow-up (PTSS-14), and extent of decrease of QOL from pre-baseline to follow-up (Table3). Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Neurology. Stroke. Procedures for vertebral artery dissection include: Most people make a full recovery. 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. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). Nearly all other potential contributing factors were not significantly different. Cervical artery dissection goes frequently undiagnosed. 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. 2008;52(2):2028. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. Chronic posttraumatic stress symptoms after nonsevere stroke. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. Grond-Ginsbach et al. 2005;76(9):122933. Achievable are 14 to 98 points from 14 items. 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]. Argued that deficits were unlikely responsible for the reduced QOL all participants were asked follow-up... Timely treatment, typically blood thinners or a procedure, can save your life S..., Jones C, Lendt M, Lux S. 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