Dissection in either artery can disrupt blood flow and potentially cause a stroke. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. (2009) [6], mean age 46years, Czechowsky et al. Not applicable. 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. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Furthermore, reinfarction as a negative event or recanalization of the former dissected artery vessel as positive event is most probable during the same time period of first six months. It generates 12 domain-related scores and a total score. J Clin Neurol. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. Acta Psychiatr Scand. 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. Your two carotid arteries run along either side of your neck in the front. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. Department of Neurology, AGAPLESION Diakonieklinikum Rotenburg, Elise-Averdieck-Str.17, 27356, Rotenburg, Germany, Center for Cognitive Sciences, Department of Neuropsychology and Behavioral Neurobiology, University of Bremen, Hochschulring 18, D-28359, Bremen, Germany, You can also search for this author in Blood in the separated layers of the vessel wall can lead to blood clot formation. Noble AJ, Baisch S, Mendelow AD, Allen L, Kane P, Schenk T. Posttraumatic stress disorder explains reduced quality of life in subarachnoid hemorrhage patients in both the short and long term. 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. The clinical application of the biopsychosocial model. Herzogenrath: Vera Fimm; 2009. 1997;19(1):612. FMD is usually a life-long condition. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. 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. Disabil Rehabil. It can also lead to swelling (dilation) of the artery. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. CAS Importantly, our study cohort of VAD patients appeared to be not significantly biased by exclusion of eight patients, whose features and mean age of 64.5years widely resembled those of the study group. Neurological outcome and quality of life after stroke due to vertebral artery dissection. This process usually occurs within the first three to six months. [13] and in the context of a fitting medical history, i.e. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Because previous studies have shown no crucial role of neurovascular risk factors or sociodemographic factors for QOL of VAD patients, we focused our analysis of potential contributing factors for QOL on previously less investigated neurological, neurocognitive and psychological variables with special respect to the biopsychosocial model [12]. Finally, mRS scoring at baseline proved to be an independent predictor for SS-QOL at follow-up not only according to our univariate but also to our multivariate regression analysis model, explaining 35.9% of QOL variance according to our regression model. Provided by the Springer Nature SharedIt content-sharing initiative. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. Group D only displayed a significant lower mean value than groups I and M in the domain social roles. 2013;94(12):253541. Most dissections heal on their own. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Manage cookies/Do not sell my data we use in the preference centre. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. Regarding premorbid psychological profiles, no significant group differences of the mean values of scoring systems (HADS-A/D) for symptoms of anxiety or depression in the week before baseline were found. Painting a ceiling with your neck in an extended position for a long time. 2006;66(4):5136. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. Strauss E, Sherman EMS, Spreen O. 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). Nearly all other potential contributing factors were not significantly different. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. Your healthcare provider may recommend alternative treatments. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. 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. The mRS is considered to be the worldwide most established functional outcome measure after stroke. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. AJR Am J Roentgenol. Bern: Verlag Hans Huber; 2000. When tics cause (2009) [6]. Neurorehabil Neural Repair. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. 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. Czechowsky et al. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Anasthesiol Intensivmed Notfallmed Schmerzther. Every pathological result, that is a value below one standard deviation, in one of the nine above mentioned cognitive function test domains was transposed to a cognitive composite score for each individual for the purpose of interindividual comparison. Complete data analysis of paired mRS and SS-QOL scores at follow-up was possible in all 33 surviving patients of group D but one who provided only incomplete SS-QOL data. On rare occasions, this can lead to stroke. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. 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. A total score of 40 points may be indicative for posttraumatic stress disorder. No further differences were found in the other domains. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). Monitoring typically includes magnetic resonance angiography every three to six months. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. 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. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. Eur Heart J 2021;42:3825-3828. 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. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. 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]. Magnetic resonance angiography is a sophisticated test thats not widely available. Five patients were excluded from the dissection study group after screening according to the inclusion/exclusion study criteria: One woman (70years old; ataxia, dizziness, facial weakness; medulla oblongata infarction by vertebral artery occlusion suspicious for but not yet proven dissection) deceased due to unexpected cardiopulmonary failure not otherwise specified in the acute phase. Their high PTSD prevalence might be overestimated because physically less affected people voluntarily participating in their study might have tended to mention more mental problems when asked by self-rating PDS. 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]. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. 2010;45(1112):68895. 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