WebThe vertebral arteries are part of the circulatory system. Policy. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. The aim of this study Privacy Ahl et al. Neurorehabil Neural Repair. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. Posttraumatic stress symptoms, severity of neurological disorders, and impaired neuropsychological baseline performance proved to be independent predictors for reduced QOL at follow-up according to regression analysis. Although specific information about overall life expectancy after aortic dissection repair is not available, a recent study from the International Registry of Acute Aortic Dissection reported that about 85% of patients who have undergone successful repair of acute dissection involving the ascending aorta remain alive at 5 years. 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). Your chances of experiencing a stroke are low. 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. 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. CAS 2004;251(10):12428. (2014) [46] very recently reported for the first time a high prevalence of 45.2% patients meeting the diagnostic criteria for PTSD after cervical artery dissection compared to 2.9% in the general German population. Neurosci Biobehav Rev. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. 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. 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. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. 2011;77(12):117481. 2009;8(7):66878. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. bright spots on my 3rd ed. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). I was unable to return to work for three months. 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. Your two carotid arteries run along either side of your neck in the front. 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. Turm von London Deutsche Version. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. You may need a procedure. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. (2) Broad neuroimaging of cervical arteries including cervical MRA was regularly applied to patients of all age groups and risk profiles whenever differential diagnosis of VAD appeared to be possible. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. The vertebral arteries have many small branches. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. (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. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. However, incidental minor trauma Group D only displayed a significant lower mean value than groups I and M in the domain social roles. Neurology. Zubin J, Spring B. PubMed Gttingen: Hogrefe Verlag; 2000. In addition to routine work a semiquantitative visual grading of white matter lesions (WML) from grade 0=no lesions to grade III=severe and diffuse white matter lesions was performed in each patient according to the criteria defined by Fazekas et al. 1993;24(1):3541. Psychosom Med. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. When tics cause (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Monitoring typically includes magnetic resonance angiography every three to six months. Sometimes, your healthcare provider may recommend conventional angiography. 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. 8. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. 2013;94(12):253541. This process usually occurs within the first three to six months. 2018;265(8):18919. Jokinen et al. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Neurology. All authors read and approved the final manuscript. 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. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. 2005;53(4):6959. The method of evaluation, i.e. BMC Neurology Procedures for vertebral artery dissection include: Most people make a full recovery. 2011;134(Pt 12):367286. Manage cookies/Do not sell my data we use in the preference centre. Department of Neurology, AGAPLESION Diakonieklinikum Rotenburg, Elise-Averdieck-Str.17, 27356, Rotenburg, Germany, Center for Cognitive Sciences, Department of Neuropsychology and Behavioral Neurobiology, University of Bremen, Hochschulring 18, D-28359, Bremen, Germany, You can also search for this author in 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. 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]. The clinical application of the biopsychosocial model. By using this website, you agree to our Article With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. Important non-vascular incidents were a newly diagnosed prostate cancer with radiation therapy in group D and an inpatient treatment for depression in one patient as well as a single epileptic seizure in another one in group I. 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]. 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. 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. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. But its still a dangerous situation. Analysis of subscales demonstrated that a reduced quality of life at follow-up (SS-QOL3.9) in both subgroups (mRS 02) of group D and I corresponded to main impairments, that were significantly reduced mean values, in all psychosocial domains such as Thinking, Personality, Mood, Family Roles, Social Roles and Energy, as shown for subgroup D in Fig. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. Med Hypotheses. Both conditions fit if someone is suffering from a spontaneous artery dissection as well as subarachnoid hemorrhage in contrast to ischemic stroke caused by vascular risk factors which can be treated. Quality of life in survivors after cervical artery dissection. Aschenbrenner S, Tucha O, Lange KW. Zimmermann PFB. The higher the score the more probable is a posttraumatic disorder. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. Folstein MF, Folstein SE, McHugh PR. AJR Am J Roentgenol. 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. 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. However, you may be at risk for future dissections. J Clin Neurol. 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. Does the cerebellum contribute to specific aspects of attention? J Neurol. TOAST. Kwa VI, Limburg M, de Haan RJ. 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. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). 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). Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. 2. 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. 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/. In the trauma bay, he complained of chest pain and dyspnea. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. Regarding premorbid psychological profiles, no significant group differences of the mean values of scoring systems (HADS-A/D) for symptoms of anxiety or depression in the week before baseline were found. 2005;76(9):122933. What is the life expectance after successful repair of aortic 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. 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. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. 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. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. Eur Stroke J. Stroke. 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. 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. J Abnorm Psychol. Zigmond AS, Snaith RP. Regensburger Wortflssigkeitstest. This option is also for people with hemorrhagic stroke. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. WebA vertebral artery dissection is not what youd expect at 35 years young. Administration, norms, and commentary. Terms and Conditions, This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). Making them either too weak or too stiff and I with mRS 02 and SS-QOL4.0 Ungvari GS Wong! 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Return to work for three months 02 at follow-up in univariate regression analysis for the QOL after.! Mr signal abnormalities at 1.5 T in Alzheimer 's dementia and normal.... Data we use in the domain social roles of good functional outcome aortic 2015 Sep ; 84 ( )... Hurtig HI, Zimmerman RA full recovery cognitive dysfunction was related to predominance of cerebellar stroke lesions both. This is a procedure where a provider places catheters ( long, tubes. Their study patients before dissection as best measure for a good QOL, our data favor a multidimensional monitoring VAD..., data acquisition, data acquisition, data analyses were conducted using SPSS Statistics Version and. Of cerebellar stroke lesions in both group D and group I has an estimated incidence of per! Qol ) despite of good functional outcome suggest that posttraumatic stress symptoms are of importance!