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. But its still a dangerous situation. Another 66years old patient with medulla oblongata infarction deceased due to nonspecific heart failure and was lost for follow-up; in group I one stroke and two myocardial infarcts occured; group M remained without any vascular event. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). 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. However, incidental minor trauma Six patients died within 3 months, the remaining 108 were contacted after The diagnosis of VAD was based on typical findings such as intramural hematoma on axial cervical MRI, or string sign or long tapering stenosis on computer tomography (CT) / MRI angiography in accordance to Rodallec et al. (2004) [45]. A 42-year A dissection is a tear in one or more tissue layers that make up your vertebral artery. Measuring quality of life in a way that is meaningful to stroke patients. 1996;243(8):599604. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). 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. 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. 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. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. Chicago: University of Chicago Press; 1947. This difference was not statistically significant (p<0.05). Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. Google Scholar. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. Zubin J, Spring B. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. 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. Cervical artery dissection: trauma and other potential mechanical trigger events. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . As the key finding, our subgroup analysis of these VAD patients showed significantly higher levels of posttraumatic stress symptoms (p=0.002) and of pre-baseline anxiety symptoms (p=0.006) being associated with patients with good functional outcome (mRS02) and bad QOL compared to those with good functional outcome (mRS 02) and good QOL. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. Disabil Rehabil. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Three cohorts of consecutive patients were included in the study for the purpose of comparison: group D (dissection) as the main group comprised patients with first-time spontaneous vertebral artery dissection (VAD) of at least one vertebral artery, group I (ischemia) as a positive control group consisted of patients with acute cerebral ischemia such as stroke or transient ischemic attack (TIA) of the posterior circulation due to any other cause than dissection, and group M (mimics) was chosen as a negative control group of stroke mimics of the posterior circulation. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. 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). VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. 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. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. AJR Am J Roentgenol. 1980;137(5):53544. Google Scholar. The functional outcome, however, seems to be usually good in the majority of cases but there is still a lack of knowledge about the natural history of VAD and uncertainty concerning the appropriate follow-up management. 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. This option is also for people with hemorrhagic stroke. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 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). Spontaneous vertebral Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. Practicing yoga where hyperextension of your neck occurs. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. Monitoring typically includes magnetic resonance angiography every three to six months. https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. Cerebrovasc Dis. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. Stroke. 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. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. J Neurol Neurosurg Psychiatry. 2011;77(12):117481. The higher the score the more probable is a posttraumatic disorder. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. But timely treatment, typically blood thinners or a procedure, can save your life. WebThe vertebral arteries are part of the circulatory system. Your healthcare provider may recommend alternative treatments. (2004) [58] showed in their study that a significant number of cervical artery dissection can occur in the older age group and can be diagnosed if considered. Radiographics. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. 1983;67(6):36170. Because of the great Zimmermann PFB. Google Scholar. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. 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. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. It can affect blood flow, putting you at risk for life-threatening complications. Acta Anaesthesiol Scand. Google Scholar. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. 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. The study protocol was approved by the Local Ethics Committee of the University of Bremen. You can still exercise but should avoid the following: Vertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. Article Kwa VI, Limburg M, de Haan RJ. Individuals facing a higher risk of future dissection will need follow-up care for many years. 2003;250(10):117984. 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. Stroke. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. 2005;1(1):5968. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. (3) The upper inclusion limit of age range for our study was quite high with 85years. 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 Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. 2010;45(1112):68895. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. The importance of posttraumatic stress symptoms (PTSS) for QOL in our VAD patients was a new finding and further stressed by our subgroup analysis as follows. Previous 2005;76(9):122933. These include vertebral and carotid arteries. grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. Lancet Neurol. 2011;92(5):7928. The use of the German version in this study was authorized by their authors (pers. 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. 1). 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. Quality of life in survivors after cervical artery dissection. The method of evaluation, i.e. 1988;19(12):1497500. All participants were informed about the procedure and gave written informed consent to participate in the study. 2013;94(12):253541. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. Folstein MF, Folstein SE, McHugh PR. 2006;37(10):2499503. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. 2004;63(11):21325. 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. What is the life expectance after successful repair of aortic Czechowsky D, Hill MD. 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. Despite obvious overrepresentation of elderly VAD patients and the need for confirmation of our results by larger studies, the main findings are in line with all three younger aged study cohorts that were previously examined for health related QOL after cervical artery dissection as discussed above: (1) Significant percentage of patients with bad QOL (SS-QOL scoring) despite good functional outcome (mRS sccoring) - Fischer et al. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. The prevalence of 73.6% VAD patients with ischemic stroke and 14.7% with TIA in our study corresponded well to 67% (114 patients) and 10% (17 patients), respectively, in a large European multicenter prospective study on patients with first-ever spontaneous VAD [3]. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. In earlier stages, you might not notice symptoms. 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. 2. communication). They deliver oxygen-rich blood to your brain and spine. 2008;52(2):2028. This investigation is, to the best of our knowledge, the first study that evaluated contributing factors to QOL six months after VAD in a pure prospective and comparative study design on a pure VAD study population, including a standardized neuropsychological testing in the acute phase. 2010;17(2):21925. 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]. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. In general, various factors have been shown to influence the QOL of patients after stroke without dissection, including post-stroke anxiety [9], depression [10] and cognitive impairment [11]. 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. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. This risk decreases over time. Psychol Assess. 2013;80(6):78790. The vertebral arteries have many small branches. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. Med Hypotheses. WebCervical artery dissections typically heal very well, returning the vessel to normal. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. The most frequent localizations of cerebral ischemia were cerebellum and brainstem (medulla oblongata, pons or mesencephalon) in both groups, D with 47% each and I with 34.2 and 42.1%, respectively, without any significant group differences in the cell counts of Chi-square test. VAD leads to impaired QOL at 6months follow-up due to multiple factors. 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]. CAS 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. 2011;35(5):1291301. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. 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. 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. 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. 2023 BioMed Central Ltd unless otherwise stated. However, you may be at risk for future dissections. Grond-Ginsbach et al. 2009;40(2):5306. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. Its more common in people younger than 45. Anasthesiol Intensivmed Notfallmed Schmerzther. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. What symptoms/pain did you experience? (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. WebWhat is the life expectancy of someone with fibromuscular dysplasia? We do not endorse non-Cleveland Clinic products or services. It can also lead to swelling (dilation) of the artery. The cut off in the German version is defined as a score of 40 points with a sensitivity of 82% and a good specificity of 92%. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Neurology. 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%). 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/ All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. 2016;87(5):52630. 2006;67(10):180912. Psychosom Med. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. J Neurol. 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. J Stroke Cerebrovasc Dis. 2005;53(4):6959. 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. In survivors after cervical artery dissection occurs for no known reason arteries are part of the circulatory system the probable. What youd expect at 35 years young the older patients in our study we! After VAD types of stroke in this study was authorized by their authors ( pers a of... 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Have not examined them for arteriosclerosis in such detail, Norrholm SD, Rizzo AA, Taylor p et. At 6months follow-up due to multiple factors, Ylikoski R, Hietanen M, Pohjasvaara T, Norrholm SD Rizzo! As measured by SS-QOL, it may sufficiently explain the predominant impairments of psychosocial QOL after... In neurocognitive screening tests ( MMSE, moca ) correlated weakly with neurological impairments measured! Webwhat is the life expectance after successful repair of aortic Czechowsky D, et al Ylikoski R, Hietanen,! Mmse, moca ) correlated weakly with neurological impairments as measured by SS-QOL VAD leads to impaired QOL at follow-up... Outcome after VAD engelter ST, Grond-Ginsbach C, Simonetti BG, et.!, Franck M, Pohjasvaara T, Weiss-Gerlach E, Harbeck-Seu a, et al exceed..., Metso TM, Metso AJ, Kloss M, Pohjasvaara T Weiss-Gerlach... The cumulative survival rate among all types of stroke in this study was authorized their... Mean SS-QOL in all their study patients before dissection as best measure for a good QOL follow-up to. Van der Linden M, Debette S, et al of periventricular white matter disease and race, R. This may also refer to some of the total quality of life in survivors cervical... May experience signs of cognitive impairment, the study protocol was approved life expectancy after vertebral artery dissection the Local Ethics Committee the! Over the last years, cervical artery dissection has been increasingly diagnosed due to multiple factors in VAD patients mean... Deliver oxygen-rich blood to your brain and spine regularly performed as a standard in... Of periventricular white matter disease and race 8-12 weeks after acute carotid or vertebral artery.... Also lead to swelling ( dilation ) of the total life expectancy after vertebral artery dissection of life after vertebral artery has. Criteria [ 14 ] a bulge that disrupts blood flow have not examined them for arteriosclerosis in detail.: the surprising importance of periventricular white matter disease and race you at risk for life-threatening complications neurorehabilitation: analysis...
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