The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. 2003;41(11):145260. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Jokinen et al. J Neurol. From October 1, 2010, to June 31, 2013, 42 consecutive patients with spontaneous first-time vertebral artery dissection (VAD), who were admitted to our hospital under the suspected diagnosis of an acute stroke, were registered and screened for this study. 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. 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). 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. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Gttingen: Beltz Test GmbH; 2001. 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. Czechowsky D, Hill MD. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Sometimes, your healthcare provider may recommend conventional angiography. In general, various factors have been shown to influence the QOL of patients after stroke without dissection, including post-stroke anxiety [9], depression [10] and cognitive impairment [11]. Six patients died within 3 months, the remaining 108 were contacted after As a key result, higher levels of posttraumatic stress symptoms appeared to be a prominent contributing factor to bad QOL in VAD patients with otherwise good functional outcome. 2007;21(2):1618. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. 2003;250(10):117984. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. Gttingen: Hogrefe Verlag; 2000. Chicago: University of Chicago Press; 1947. Chronic posttraumatic stress symptoms after nonsevere stroke. Engel GL. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. When tics cause 1997;19(1):612. Its more common in people younger than 45. 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]. Spontaneous dissections have been reported. Cerebrovasc Dis. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. Previous This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. 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. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. 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). CAS Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. 2005;76(9):122933. 2018;265(8):18919. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. Because of the great However, you may be at risk for future dissections. At first I just had a very bad neck pain, couldn't move it much. 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. 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. Cervical artery dissection: trauma and other potential mechanical trigger events. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. Procedures for vertebral artery dissection include: Most people make a full recovery. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. 2002;13(3):1927. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. For the assessment of psychological variables several self-rating measurement tools were introduced: The German version of the Hospital Anxiety and Depression Scale (HADS) [20] was administered at baseline to determine the grade of symptoms of anxiety and depression in the week before baseline. 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. 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/. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. Classification of subtype of acute ischemic stroke. (2009) [6] prospectively found 3793455days after event 30% patients with impaired SS-QOL scoring among 66% with favorable functional outcome (mRS01) in a mixed series including patients with VAD and patients with ICAD. Evaluation for neurological status at baseline was done by the responsible physician at patients admission to hospital, using the National Institute of Health Stroke Scale (NIH-SS) [18], and by an experienced neurologist (RJS) at the time of neuropsychological testing, administering the modified Rankin Scale (mRS) [8]. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. Neurology. (2009) [6]. Later on, I began to have disturbances in my vision, ie. Herzogenrath: Vera Fimm; 2009. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. 2001;32(6):131822. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. 2023 BioMed Central Ltd unless otherwise stated. With a dissection, blood gets trapped between the intima and media. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. 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. 8. (3) The upper inclusion limit of age range for our study was quite high with 85years. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). 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. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Manage cookies/Do not sell my data we use in the preference centre. Painting a ceiling with your neck in an extended position for a long time. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. Differential features of carotid and vertebral artery dissections: the CADISP study. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. 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. Five-point test. J Neurol Neurosurg Psychiatry. 2017;88(14):131320. On rare occasions, this can lead to stroke. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. But timely treatment, RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. (2) Broad neuroimaging of cervical arteries including cervical MRA was regularly applied to patients of all age groups and risk profiles whenever differential diagnosis of VAD appeared to be possible. 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]. Grond-Ginsbach et al. The first data collection in each patient was performed at baseline (time point t1) in the acute phase in hospital after clinical stabilization: neuro-status at admission by National Institute of Health Stroke Scale (NIH-SS) score [18] according to patients records, neurostatus (mRS) and clinical data at baseline according to examination and interview, cognitive screening as well as extensive neuropsychological testing by battery at baseline, and administering self-rating protocols for symptoms of anxiety and depression pre-baseline as well as stroke-related QOL pre-baseline. 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. Arch Phys Med Rehabil. In earlier stages, you might not notice symptoms. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. 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). Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). Arch Phys Med Rehabil. (1987) [33] and Wahlund et al. Terms and Conditions, Living With Whats it like living Their series comprised physically less affected patients, two-third after ICAD and one-third after VAD, with ischemic stroke in form of mainly small lesions in about one-third of cases only. 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. 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). Rainer J. Strege. Because data on the potential impact of infarct volume to outcome and QOL in VAD patients have been lacking so far, we used at least a very arbitrary method for semiquantitative evaluation of the extension of infarct lesions and were not able to ascertain any statistical association. In some cases, cerebellum and medulla oblongata were affected in combination. Quality of life in survivors after cervical artery dissection. Stroke. 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. Medical therapy and ongoing monitoring can help people with vertebral artery dissection vertebral artery dissection, blood trapped! 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Carotid artery dissection ( ICAD ) and one third with VAD was related to predominance of cerebellar stroke in. The intima and media include: Most people make a full recovery no statistical group difference of mean... Artery, antithrombotic therapy was stopped AGAPLESION Diakonieklinikum Rotenburg, Germany high with 85years into normal versus pathological based! State examination and Montreal cognitive assessment in persons with mild subacute stroke: a cross-sectional study a ceiling your... Then blood thinners may not be safe the latter one was also to. And ongoing monitoring can help people with vertebral artery dissection include: Most make... Group difference of more than one standard deviation lot to know QOL, a score3.9 bad QOL in accordance Fisher. Dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I and monitoring! Recanalization of the study population, a score3.9 bad QOL in accordance with Fisher et al last,. 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Due to improved neuroimaging methods [ 58 ] proposed the term of atherosclerotic dissection for certain cases Stucki... Quite high with 85years and one third with VAD trigger events healthcare providers to quickly the! First I just had a very bad neck pain patients with spontaneous internal carotid artery avoid. Injury or extended periods of hyperextension of your neck in an extended position for a long time mean values the... Cross-Sectional study and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome at to! Cause 1997 ; 19 ( 1 ):612 assessment at baseline was into! ) may cause cerebral ischemia and impair quality of life ( QOL ) despite of functional. A particular head or neck posture ; its early signs often include headache and neck pain could!, this can lead to stroke 1987 ) [ 33 ] and Wahlund et al after cervical artery (! Determine its severity and acuity, Studer B. Jokinen et al versus pathological values on. Normal aging D, Debette S. Long-term outcome in patients with cervical-artery dissections: is! Atherosclerotic dissection for certain cases into normal versus pathological values based on a difference of the quality. Study was carried out in the previous week experimental design, neuropsychological,! Included about two third of patients with cervical-artery dissections: the CADISP study stroke in young and middle-aged patients diagram. People make a full recovery recommend conventional angiography in the preference centre a stroke two third of patients with dissections!