1983;67(6):36170. However, you may be at risk for future dissections. Among physical domains only the domain work showed also deterioration in groups D and I. 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. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. 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. 1987;149(2):3516. 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. Another woman (47years old; locked in-syndrome due to pontine infarction by basilar artery occlusion due to vertebral artery dissection) and a man (77years old; dizziness, nausea, vomiting, headache, ataxia, facial weakness, dysarthria, dysphagia; combined medulla oblongata and cerebellar infarction) without a sufficient ability to speak for participating in neuropsychological testing. J Neurol Neurosurg Psychiatry. 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 Gttingen: Hogrefe Verlag; 1983. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. 2013;94(12):253541. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. 2017;7(3):16572. J Neurol. Likewise, mean values of pre-baseline total QOL were not significantly different. Rainer J. Strege. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. (2015) [61] reported that older stroke patients in general have worse prestroke status, greater impairment on hospital admission, more comorbidities and poorer poststroke functional status than the younger patients but can benefit as much as the young from high-intensity neurorehabilitation. Differential features of carotid and vertebral artery dissections: the CADISP study. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. The inclusion criteria were (1) a reliable diagnosis, (2) age between 18 and 85years, and (3)] medically stable psychological and physical condition for testing, i.e. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. 2006;66(4):5136. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. 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. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Ischemic stroke was found in only 33.9%. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. 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. Participants were examined for psychological, cognitive and neurological variables with special reference for functional outcome as well as quality of life 6months after the index event. 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. Blood in the separated layers of the vessel wall can lead to blood clot formation. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. 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). Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. California Privacy Statement, They showed ischemic stroke lesions in the majority of cases (73.6%) like the patients of group I (86.8%), larger than 10mm in maximal diameter in 67.6% versus 76.3%, respectively, as shown in Table2. Intergroup analysis of change of mean total scores of QOL, as measured by SS-QOL, from pre-baseline to follow-up displayed a significant deterioration (p<0.001; Wilcoxon signed-rank test) in groups D and I but not in group M. Further analysis of changing scores in the twelve SS-QOL domains yielded developing impairments from baseline to follow-up in all three groups D, I, and M. Impairments evolved mainly in psychosocial domains such as family roles, social roles and energy and less in physical domains. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. 2004;251(10):12428. 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). N Engl J Med. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. BMC Neurol 19, 312 (2019). Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Theyll use contrast dye and X-ray-guided imaging to look at blood flow through the artery itself along with the extent of the dissection or vessel injury in real-time. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. 1996;243(8):599604. 2005;76(9):122933. Likewise, functional impairment measured by mRS at follow-up significantly correlated with reduced SS-QOL at follow-up in concordance with the results of the mixed cervical artery dissection series of Fischer et al. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. 2008;63(6):1095104 discussion 04-5. Aschenbrenner S, Tucha O, Lange KW. 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. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. Bern: Verlag Hans Huber; 2000. Spontaneous dissection of the carotid and vertebral arteries. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. MH contributed to the experimental design, data analyses and manuscript writing. Advertising on our site helps support our mission. Schievink WI. 1988;19(12):1497500. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). Measurements of acute cerebral infarction: a clinical examination scale. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. CADISS Trial Investigators. Neuropsychologia. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. 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. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Med Hypotheses. 2010;45(1112):68895. We found reduced QOL at 6-month follow-up, as scored by SS-QOL3.9, despite good functional outcome (mRS 02) in a prevalently high percentage of about 40% in VAD patients. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. Knecht et al. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). (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. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). WebA vertebral artery dissection is not what youd expect at 35 years young. The findings were in line with modern concepts of cerebellar cognitive function [44] and also in accordance to previous data on cognitive impairments in patients with cerebellar stroke lesions, for example by Exner et al. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. Terms and Conditions, Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Eur J Neurol. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. 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