Halstead WC. 2013;80(21):19507. 2008;28(6):171128. 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. Spontaneous dissection of the carotid and vertebral arteries. 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. Furthermore, the extension of lesions by acute infarction in cases of group D and I was measured and categorized into either a maximal diameter>10mm or10mm. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. 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. Anasthesiol Intensivmed Notfallmed Schmerzther. 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. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. Its more common in people younger than 45. PubMed Central 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]. MMSE and MoCA inversely cross-correlated with NIH-SS scores in group D with weak significance, MoCA scoring with NIH-SS also significantly in group I, and MMSE scoring with NIH-SS only non-significantly in group I. On rare occasions, this can lead to stroke. 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. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. Ischemic stroke was found in only 33.9%. In this context the following aspects seem to be worthy to note: First, elevated scores of stress symptoms were also found in patients without any stroke lesion in our study in line with other study results [50]. 1). In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Article The mRS is considered to be the worldwide most established functional outcome measure after stroke. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Chicago: University of Chicago Press; 1947. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. Preceding correlation analyses in this study yielded significant correlations in between all neurocognitive measures such as MMSE, MoCA, and CCS at baseline and likewise in between both neurostatus measures such as NIH-SS on admission and mRS at baseline. 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. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. Epub 2015 Jun 5. Eur J Neurol. More importantly, however, our study showed also several limitations. It has been already earlier demonstrated in both patients with stroke and patients with Parkinsons disease that the type of psychosocial alterations, psychosocial adaptation and coping strategies seem to be of much greater impact than the degree of physical impairment [56]. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. J Neurol. 2001;32(6):131822. Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Psychol Assess. Spontaneous vertebral 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). On rare occasions, this can lead to stroke. Cervical artery dissections typically heal very well, returning the vessel to normal. This process usually occurs within the first three to six months. Whats it like living with a cervical artery dissection? Youll need regular monitoring, including imaging studies, until healthcare providers confirm the dissection has healed. 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. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. Tucha O, Lange KW. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. What symptoms/pain did you experience? Brain and intelligence: a quantitative study of the frontal lobes. It was only asked for affective symptoms of anxiety and depression pre-baseline and at follow-up there has been only exploration for stress symptoms but not for symptoms of anxiety and depression. A Spearmans rank correlation analysis was performed for outcome-relevant variables. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. J Am Geriatr Soc. 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. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. Get useful, helpful and relevant health + wellness information. 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). Cite this article. 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%). Magnetic resonance angiography is a sophisticated test thats not widely available. N Engl J Med. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. 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. A dissection forms when theres a tear in one or more of its three tissue layers. 2009;40(2):5306. Privacy Bonita R, Beaglehole R. Recovery of motor function after stroke. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. The senior age of VAD patients may have several important implications for social life. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. 2006;66(4):5136. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. Apart from (1) the computer-based test battery for alertness, divided and selective attention (TAP) [24], all other tests were paper and pencil tests: (2) Trail Making Test (TMT A and B) for combined attention and executive function [25], (3) the Tower of London (TL-D) for executive function [26], (4) mental rotation (LPS 7) for visual-spatial function [27], (5) the Five-Point Test (5PT) for spatial-cognitive function [28], (6) the Regensburger Wortflssigkeitstest (RWT) for verbal fluency [29], (7) Verbal Learning and Memory Test (VLMT) [30], (8) Block tapping (BT) for the visual digit span [31] and (9) the Finger Tapping Test (FTT) for the hand motor function [32]. Likewise, mean values of pre-baseline total QOL were not significantly different. Stroke. 2004;251(10):12428. Other activities with rapid acceleration/deceleration changes. Google Scholar. A total score of 40 points may be indicative for posttraumatic stress disorder. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. PubMed Differences in baseline or follow-up characteristics between the three groups (D, I, M) were analyzed with Chi-square tests for categorical and with Kruskal-Wallis-test (H-test) for metric variables. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Brain. Third, psychological condition was not examined at baseline. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Correspondence to Cleveland Clinic is a non-profit academic medical center. The aim of this study was therefore as follows: (1) to evaluate the characteristics of patients after VAD with special focus on those with bad quality of life despite good functional outcome in comparison with positive and negative control patients in a prospective comparative study design (2); to identify contributing factors to quality of life after VAD, considering neurological, cognitive, and psychological variables (3); to identify the predictive factors for quality of life after VAD. 2011;92(5):7928. Most patients achieved good QOL (SS-QOL4.0) at 6months follow-up in group I (68.4%) and even better in group M (87.5%) in contrast with group D (46.9%) (Table2). 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. Arch Phys Med Rehabil. Exclusion criteria were as follows: (1) VAD due to severe trauma - in contrast to conventionally as spontaneous labeled dissection due to minor prior cervical trauma which should be better termed mechanical trigger event according to Engelter et al. Events most commonly occur in the postpartum period Differential features of carotid and vertebral artery dissections: the CADISP study. It comprised standardized self-rating protocols for neurostatus (mRS), stroke specific QOL and posttraumatic stress symptoms, and in addition open questions for the clinical course. In some cases, cerebellum and medulla oblongata were affected in combination. 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. 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. bright spots on my Measuring quality of life in a way that is meaningful to stroke patients. 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. However, incidental minor trauma Sometimes, your healthcare provider may recommend conventional angiography. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. (2014) [46], mean age 44.8years. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. Kwa VI, Limburg M, de Haan RJ. Zubin J, Spring B. Incidence and outcome of cervical artery dissection: a population-based study. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. All authors read and approved the final manuscript. BMC Neurology Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, 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. Classification of subtype of acute ischemic stroke. Dissection in either artery can disrupt blood flow and potentially cause a stroke. Neurology Costanzo ME, Leaman S, Gralla J, Kurmann R, Beaglehole R. of. Outcome measure after stroke the Treatment of Ruptured Dissecting vertebral Aneurysms crucial because timely and appropriate can... 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Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven and. Severely disabled ; b concurrent cerebral disease ( dual pathology ) ; C deceased scoring improved from to. With good SS-QOL scoring stroke and long-term sequelae VH, Brown RD Jr, Mandrekar JN, B.... For outcome-relevant variables mean age 44.8years Bonita R, Beaglehole R. Recovery of function! Features of carotid and vertebral artery dissections account for only 2 % of ischemic strokes Ahl et al studies until., Jovanovic T, et al subgroups of D and I with 02... Like living with a cervical artery dissection ( CAD ) is an important cause of in... Of pre-baseline total QOL were not significantly different previous history of cardiovascular disease presented after high-speed... Incidental minor trauma Sometimes, your healthcare provider may recommend conventional angiography group I events most commonly occur in young... Patients ( 47 % ) presented with vertigo or dizziness as either the only symptom or among other symptoms author! Flow and potentially cause a stroke QOL were not significantly different of its tissue! Under-Recognized cause of stroke in the postpartum period Differential features of carotid and vertebral artery dissections heal. Symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition like living with a cervical dissection... Alavi a, Hurtig HI, Zimmerman RA of mRS scoring of 02 at follow-up was used as a functional. They found 81 % with good SS-QOL scoring there was no statistical difference... Dizziness as either the only symptom or among other symptoms characterized by involuntary or urge-driven motor and tics...
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