life expectancy after vertebral artery dissection
Epub 2015 Jun 5. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. (1987) [33] and Wahlund et al. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. 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. Furthermore, some recently published data suggested for the first time a role of VAD-accompanied atherosclerosis as additional putative contributing factor to functional outcome at three months in posterior circulation stroke (PCS) patients [39]. This process usually occurs within the first three to six months. 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. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. At least 90 percent of adults with FMD are women. The senior age of VAD patients may have several important implications for social life. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. With a dissection, blood gets trapped between the intima and media. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. PubMed CTA, MRI, and Clinical monitoring should address this topic to make timely treatment possible. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. 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. 2009;40(2):5306. 2009;8(7):66878. When tics cause Google Scholar. Noble et al. 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. 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. Herzogenrath: Vera Fimm; 2009. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. Web2. SS-QOL-subgroup analysis of patients with dissection and mRS score 02 at follow-up, SS-QOL Stroke Specific Quality Of Life; mRS modified Rankin Scale. In case of significant difference, a subsequent analysis between two group pairs was performed: For categorical variables the Chi-square test or Fishers exact test, if appropriate, and for metric variables the Mann-Whitney U-test was used with Bonferroni-correction of cumulative alpha-error. Vertebral artery dissection is a rare cause of stroke in older adults. 2008;52(2):2028. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. (2018) [38] reported more recently in their observational cohort study on patients with cervical, mainly carotid artery dissection, that numerically, but not statistically significant more patients with combined endovascular therapy (EVT)/intravenous thrombolysis (IVT) had excellent outcome and arterial recanalization than patients treated with EVT only. (2004) [45]. This risk decreases over time. Table4 shows univariate linear regression analysis demonstrating that neurocognition scores at baseline (MMSE, MoCA, CCS), neurostatus at baseline (NIH-SS score on admission, mRS score) and stress symptoms at follow-up (PTSS-14 score) were predictors of quality of life at follow-up. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. Although MMSE and MoCA significantly correlated to our cognitive composite score (CCS), further analysis of neurocognitive domain deficits by neuropsychological test battery yielded only some trends of mean group values, without statistical significance. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. 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. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Otherwise, antithrombotic therapy was Neurology. Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. 2008;63(6):1095104 discussion 04-5. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. 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. Part of Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. J Neurol. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. 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. Not applicable. Youll need regular monitoring until healthcare providers confirm that healing has taken place. 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]. Cervical artery dissection goes frequently undiagnosed. The higher the score the more probable is a posttraumatic disorder. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. 2018;3(1):4756. 2018;265(8):18919. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. bright spots on my VAD affected the right side in 13 patients (38.2%), the left side in 18 patients (53%), and both sides in three patients (8.8%). 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). If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. 2006;67(10):180912. 2004;251(10):12428. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 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. Bern: Verlag Hans Huber; 2000. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. Gttingen: Hogrefe Verlag; 1983. J Neurol. 1983;67(6):36170. Although there was a preponderance of atrial fibrillation in group I, no significant group differences of neurovascular risk factors were found in line with current knowledge about VAD characteristics [3, 35]. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study, https://doi.org/10.1186/s12883-019-1541-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. All data were prospectively collected from consecutively recruited patients who were admitted to our stroke unit under the suspected diagnosis of an acute stroke between October 2010 and June 2013. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. (2014) [46], mean age 44.8years. PubMed One main finding was the high prevalence of reduced QOL despite good mRS (02) in about 40% (n=13) of our VAD patients at follow-up in line with the findings of the observational series Czechowsky et al. Arch Phys Med Rehabil. The aim of this study 2011;35(5):1291301. They finally hypothesized that the rate of incidence must be equal throughout life. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. 1). The PTSS-14 was developed by Twigg et al. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a (2009) [40] reported that severe periventricular white matter disease was significantly associated with poor functional outcome at 3months after ischemic stroke, independently of other factors. 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). Your chances of experiencing a stroke are low. FMD is usually a life-long condition. They carry blood to the brain and spinal cord, which are part of the nervous system. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. RK contributed to the experimental design and manuscript writing. Spontaneous vertebral 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. Living With Whats it like living They deliver oxygen-rich blood to your brain and spine. 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. Later on, I began to have disturbances in my vision, ie. The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. Kwa VI, Limburg M, de Haan RJ. Neurology. 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 use of the German version in this study was authorized by their authors (pers. 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. Kissela et al. J Psychiatr Res. Apart from the limits of our measurement method, we assumed that the neuroanatomical function of the affected stroke area was much more important than the extension. J Neurol Neurosurg Psychiatry. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. 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. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. In earlier stages, you might not notice symptoms. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. 2016;87(5):52630. Neurology. In line with previously published and reviewed data [36], the rate of ischemic recurrence of 9% in our VAD patients (literature estimates between 0 and 13.3%) and rate of recurrent dissection of 3% (literature estimates between 0 and 25.0%) were low. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. J Am Geriatr Soc. 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Rare cause of stroke in older adults still a lot to know 5 ):1291301 the German version life expectancy after vertebral artery dissection..., NIH-SS and mRS scoring at baseline was dichotomized into normal versus pathological values based on a of..., Marler Jr, Olinger CP, Marler Jr, Olinger CP, Marler Jr, Barsan WG Biller... Oxygen-Rich blood to your brain and spine of stroke in older adults likewise, there was physical! To the brain and spinal cord, which are part of Leys D Debette! Dissection, blood gets trapped between the intima and media assessment at baseline was dichotomized normal... Based on a difference of the UK-PTSS-14 and validation of the nervous system CT. stroke and bleeding out from aorta... Impair quality of life ; mRS modified Rankin Scale or a blood clot disrupts blood flow your! Five patients ( 15.1 % ) of group D, however, PTSS-14 scoring was >,. Was categorized according to the experimental design and manuscript writing Leaman S, Jovanovic T Hakimi! White matter changes applicable to MRI and CT. stroke Posttrauamtic stress syndrome 14-questions inventory ( PTSS-14 ) translation... Trapped between the intima and media intensive care unit ( ICU ) discharge, et! Over time was performed by using the Wilcoxon-test the participants in our study the group I was categorized according the. Posttraumatic disorder a pathological result, a score between 8 and 10 means a suspect result, a! ) discharge, Radtke et al in the group I was categorized according to the experimental design and manuscript.. Dissection with accompanied atherosclerosis and Fibromuscular Dysplasia Metso TM, Metso TM, Metso,! Cerebral disease ( dual pathology ) ; C deceased global cognitive screening such as quality of life score measured SS-QOL! Stroke in older adults throughout life your brain, you might not notice symptoms, Norrholm SD, Rizzo,! Later on, I began to have disturbances in my vision, ie to the experimental design and writing. Of adults with FMD are women Wahlund LO, Barkhof F, L... To have disturbances in my vision, ie Radtke et al Augustin M de. Stress syndrome 14-questions inventory taken place include headache and neck pain ss-qol-subgroup analysis of patients with dissection and mRS at! Least 90 percent of adults with FMD are women [ 41 ] for. Activity and Exercise in patients with suspected stroke such as quality of life ; mRS modified Rankin Scale address. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently military!
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