That is in particular striking regarding VAD. Kissela et al. Get useful, helpful and relevant health + wellness information. 8. (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. The method of evaluation, i.e. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. PubMed Central In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. 2017;88(14):131320. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). 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. Speck et al. J Neurol. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. Blood in the separated layers of the vessel wall can lead to blood clot formation. Trial of org 10172 in acute stroke treatment. Although functional outcome was good in the majority of their cases, the surprising main finding was a bad quality of life, measured by Stroke Specific Quality Of Life scale (SS-QOL) [7] despite of good functional outcome, scored by modified Rankin Scale (mRS) [8], in about 15% [5] to 30% of cases [6]. It generates 12 domain-related scores and a total score. 2013;94(12):253541. typical type and onset of symptoms. Neurology. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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]. 2016;87(5):52630. Arch Phys Med Rehabil. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Gttingen: Hogrefe Verlag; 2004. 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. 1997;9:44551. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. A total score of 40 points may be indicative for posttraumatic stress disorder. Measuring quality of life in a way that is meaningful to stroke patients. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. 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. In the trauma bay, he complained of chest pain and dyspnea. 88.2% of patients with VAD suffered from acute cerebral ischemia. (2001) [34]. 2001;32(6):131822. Our data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD, in particular in patients with reduced QOL despite good functional outcome. (2009) [6]. Other sites of ischemia were occipital lobe in 17.6% of group D and 34.2% of group I, furthermore thalamus in 5.3% of group I. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. Speck et al. 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. (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. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. 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. 2011;35(5):1291301. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). Not applicable. J Neurol. Auflage. More importantly, however, our study showed also several limitations. 2014;45(11):33606. 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. Practicing yoga where hyperextension of your neck occurs. J Abnorm Psychol. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. Spontaneous dissections have been reported. 2005;1(1):5968. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. Cerebrovasc Dis. Your healthcare provider may recommend alternative treatments. Because of the great N Engl J Med. Article Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. You may need a procedure. Cookies policy. Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. Thus, the present investigation has to be characterized as an explorative study. Chicago: University of Chicago Press; 1947. Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR). 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%. 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. Halstead WC. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. Policy. 2. 2006;67(10):180912. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. All participants have given written informed consent. The role of cognitive impairment in the quality of life after ischaemic stroke. I was unable to return to work for three months. 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. 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. Eur J Neurol. Fourth, maladaptive coping strategies were significant predictors for and associated with posttraumatic stress disorder in patients with cervical artery dissection in the study of Speck et al. The study protocol was approved by the Local Ethics Committee of the University of Bremen. 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). 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. CADISS Trial Investigators. The main findings were found in subgroup D (mRS 02) with bad QOL3.9 that were significantly higher mean values for premorbid anxiety symptoms (p=0.006) and stress symptoms at follow-up (p=0.002). The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. TOAST. California Privacy Statement, No individual persons personal details, images or videos are being used in this study. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. Thus, reduced neurocognition and neurostatus at baseline and increased scoring levels for stress symptoms at follow-up were predictive for reduced quality of life at follow-up in patients with VAD in this regression model. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. The following are key points to remember from this Viewpoint article on physical activity and exercise in patients with spontaneous coronary artery dissection (SCAD) and fibromuscular Further subgroup analysis was performed in subgroups D and I by comparison of variables potentially affecting quality of life such as age, gender, neurocognition at baseline (MMSE, MoCA), neurostatus at baseline (NIH-SS), grade of white matter lesions (WML), burden of ischemic stroke lesions, premorbid (pre-baseline) symptoms of anxiety or depression (HADS), stress symptoms at follow-up (PTSS-14), and extent of decrease of QOL from pre-baseline to follow-up (Table3). Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. J Stroke Cerebrovasc Dis. 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