2005;53(4):6959. 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. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. Aortic dissection is life-threatening. 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. PubMed 1988;19(12):1497500. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. California Privacy Statement, Terms and Conditions, 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. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. (2009) [6], mean age 46years, Czechowsky et al. Eur J Neurol. Because of the great These include vertebral and carotid arteries. 2004;251(10):12428. J Neurol. Kwa VI, Limburg M, de Haan RJ. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. 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. 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). Speck et al. The vertebral arteries have many small branches. Differential features of carotid and vertebral artery dissections: the CADISP study. 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 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). 1977;86(2):10326. New York: Oxford University Press; 2006. A total score of 40 points may be indicative for posttraumatic stress disorder. 1987;149(2):3516. Thirteen of these patients (40.6%) showed a bad quality of life (SS-QOL3.9) despite good functional outcome (mRS 02) and likewise thirteen (40.6%) a good quality of life (SS-QOL4.0) combined with a good functional outcome (mRS 02). Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. Your healthcare provider may recommend alternative treatments. The PTSS-14 was developed by Twigg et al. 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]. Thus, somewhat unspecific symptoms in this age group and context of VAD history, if not critically reflected, may usually prompt otherwise evitable inpatient diagnostics for stroke and/or recurrence of dissection. In earlier stages, you might not notice symptoms. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. BMC Musculoskelet Disord. 2013;94(12):253541. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. 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]. The challenging main consequence from our study regarding this older age group of VAD patients might be therefore for the treating physician to make the right decision: When to consider (re-)dissection stroke and when to consider neuropsychiatric sequelae, for example. 1975;12(3):18998. 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. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. Brain and intelligence: a quantitative study of the frontal lobes. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. Cervical artery dissection goes frequently undiagnosed. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. What is the life expectance after successful repair of aortic 1989;20(7):86470. Folstein MF, Folstein SE, McHugh PR. All patients presented with acute myocardial infarction (MI) (26% ST-segment elevation MI [STEMI], 74% NSTEMI) and approximately 70% reported an emotional or physical stressor. A total of 327 patients were enrolled from 2012-2106. VAD leads to impaired QOL at 6months follow-up due to multiple factors. Two more men (46 and 56years old; one with bilateral embolic cerebellar and occipital brain infarctions by VAD plus ocular down-beat syndrome, unilateral motor dysfunction, dizziness, and headache; the other one with dizziness and ataxia due to suspected cerebral ischemia by VAD) wanted to cut their inpatient treatment short and not to participate but showed also contraindications in form of concurrent diseases: one developed bronchial carcinoma 4months later and brain metastases 8months later, then deceased, the other suffered from alcoholism and had a history of former bronchial carcinoma and prophylactic brain irradiation. Zigmond AS, Snaith RP. 2003;41(11):145260. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). 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 Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Neurology. Get useful, helpful and relevant health + wellness information. 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). 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. 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. The other variables showed no significant differences. Neurological outcome and quality of life after stroke due to vertebral artery dissection. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. Med Hypotheses. Anasthesiol Intensivmed Notfallmed Schmerzther. For more extensive testing, a neuropsychological test battery was used with cognitive tasks of nine cognitive domains with possible reference to cognitive functions of the anatomical structures of the posterior circulation, in particular the cerebellum. This process usually occurs within the first three to six months. No further differences were found in the other domains. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. Stroke. 2011;35(5):1291301. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. 1). A practical method for grading the cognitive state of patients for the clinician. But its still a dangerous situation. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. Advertising on our site helps support our mission. Am J Psychiatry. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. 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. On rare occasions, this can lead to stroke. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Zubin J, Spring B. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. J Psychiatr Res. 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. That is in particular striking regarding VAD. The higher the score the more probable is a posttraumatic disorder. 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. Czechowsky et al. Thus, the present investigation has to be characterized as an explorative study. This difference was not statistically significant (p<0.05). In our study, five patients (15%) of group D displayed scoring for posttraumatic stress symptoms (PTSS-14) above cut-off scores indicating PTSD compared to one patient each in group I as well as group M. Previous data [52], however, have already stressed that even subsyndromal scores may be of relevance, as can be assumed for our thirteen subgroup D patients with elevated PTSS-14 levels and bad QOL despite good functional outcome. Among 24 stroke mimics only two patients (8.3%) with mRS 02 reported a bad quality of life in contrast to 20 patients (83.3%) with mRS 02. 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