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. Google Scholar. 2023 BioMed Central Ltd unless otherwise stated. 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. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . 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. 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). It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. 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. Neurology. The clinical application of the biopsychosocial model. Corresponding to their multivariate analysis, the NIH-SS score on admission was also found to be an independent predictor of QOL at follow-up in our univariate regression analysis. J Neurol Neurosurg Psychiatry. Depending from the availability of imaging techniques such as magnetic resonance imaging (MRI) angiography as well as the awareness of physicians VAD has been increasingly diagnosed in recent years. Although its pathophysiology and treatment closely resemble that of its sister condition, carotid artery dissection (CAD), the clinical presentation, etiology, and epidemiological profile of VADs are unique. 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. Neuropsychologia. 2002;13(3):1927. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. You may need a procedure. Horn W. L-P-S Leistungsprfsystem. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. At least 90 percent of adults with FMD are women. Because previous studies have shown no crucial role of neurovascular risk factors or sociodemographic factors for QOL of VAD patients, we focused our analysis of potential contributing factors for QOL on previously less investigated neurological, neurocognitive and psychological variables with special respect to the biopsychosocial model [12]. 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. Monitoring typically includes magnetic resonance angiography every three to six months. Cleveland Clinic is a non-profit academic medical center. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Data about pathological results of neuropsychological test battery assessment. 2013;80(21):19507. 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. TOAST. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. 2009;8(7):66878. Zimmermann PFB. Lancet Neurol. 2005;76(9):122933. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). Provided by the Springer Nature SharedIt content-sharing initiative. 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. Schievink WI. 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). 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. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. Vertebral artery dissection: presenting findings and predictors of outcome. (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. Subgroup analysis stratified for QOL by Stroke Specific Quality of Life Scale (SS-QOL) were done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 02). Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. WebCervical artery dissections typically heal very well, returning the vessel to normal. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). 2011;134(Pt 12):367286. Neurorehabil Neural Repair. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Quality of life in survivors after cervical artery dissection. Cervical artery dissection: trauma and other potential mechanical trigger events. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. 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]. Manage cookies/Do not sell my data we use in the preference centre. 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. 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. 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. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. VAD leads to impaired QOL at 6months follow-up due to multiple factors. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. (2001) [34]. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. No further differences were found in the other domains. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. Disabil Rehabil. PubMed Central Zubin J, Spring B. Achievable are 14 to 98 points from 14 items. Advertising on our site helps support our mission. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. AJR Am J Roentgenol. 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. Differential features of carotid and vertebral artery dissections: the CADISP study. Classification of subtype of acute ischemic stroke. 2014;45(11):33606. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. 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]. Get useful, helpful and relevant health + wellness information. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. Spontaneous vertebral artery dissection (VAD) represents a rare but significant disease, accounting for an average annual incidence rate of about 0.97 to 1.5 cases per 100.000 population [1, 2]. Med Hypotheses. 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. 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. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. It can also lead to swelling (dilation) of the artery. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. J Neurol Neurosurg Psychiatry. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. The stroke happened about a month after she was diagnosed with EDS. 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