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. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. 1980;137(5):53544. (3) The upper inclusion limit of age range for our study was quite high with 85years. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. 2009;256(3):4439. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. 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. Google Scholar. Measurements of acute cerebral infarction: a clinical examination scale. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. 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). 2002;13(3):1927. Because of the great If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. 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. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. Gttingen: Hogrefe Verlag; 2000. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). However, incidental minor trauma 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. 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]. 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. 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]. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). CAS 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]. A total score of 40 points may be indicative for posttraumatic stress disorder. 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. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Most of the time, ischemic stroke is due to atherosclerosis (thickening of the artery from other risk factors, such as smoking, high blood pressure, high cholesterol, diabetes). All participants have given written informed consent. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. At least 90 percent of adults with FMD are women. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. 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. Cerebrovasc Dis. Arch Phys Med Rehabil. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. The method of evaluation, i.e. Disabil Rehabil. 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. 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. 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. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. PubMed What is the life expectance after successful repair of aortic Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. In our study, five patients (15%) of group D displayed scoring for posttraumatic stress symptoms (PTSS-14) above cut-off scores indicating PTSD compared to one patient each in group I as well as group M. Previous data [52], however, have already stressed that even subsyndromal scores may be of relevance, as can be assumed for our thirteen subgroup D patients with elevated PTSS-14 levels and bad QOL despite good functional outcome. The senior age of VAD patients may have several important implications for social life. Neurosci Biobehav Rev. Elevated levels of posttraumatic stress symptoms, as evaluated by PTSS-14 scoring in our study, are in line with recent reports on the prevalence of posttraumatic stress disorder (PTSD) after stroke, even after minor stroke [49] or transient ischemic attack [50]. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. 2017;7(3):16572. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. Stroke. The mRS is considered to be the worldwide most established functional outcome measure after stroke. J Neurol. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. typical type and onset of symptoms. Traenka et al. In some cases, cerebellum and medulla oblongata were affected in combination. Brain and intelligence: a quantitative study of the frontal lobes. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. Likewise, mean values of pre-baseline total QOL were not significantly different. 2014;76(9):6707. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. (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. On rare occasions, this can lead to stroke. Neurology. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. At first I just had a very bad neck pain, couldn't move it much. 2016;87(5):52630. Otherwise, antithrombotic therapy was Painting a ceiling with your neck in an extended position for a long time. Cervical artery dissection: trauma and other potential mechanical trigger events. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. Consequently, a valid and reliable evaluation of this variable as putative contributing factor appeared to be not adequately possible in our study: Besides the sample size being very small, it remains unclear how to operationalize best the vascular measurements such as (1) determination of grade/severity of stenosis and by which method (MRI or ultrasound), (2) length of stenosis or occlusion, or (3) site of stenosis (unilateral left or right, bilateral, additionally extra-vertebral). 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. Practicing yoga where hyperextension of your neck occurs. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. (2008) [55], for example, prospectively studied 105 subarachnoid hemorrhage patients at 3 and 13months post-ictus and found that 37 % met the diagnostic criteria of PTSD. 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. Regensburger Wortflssigkeitstest. Article Factors affecting the quality of life after ischemic stroke: young versus old patients. They deliver oxygen-rich blood to your brain and spine. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. Plank position (but otherwise safe to participate in yoga or Pilates). Ischemic stroke was found in only 33.9%. J Stroke Cerebrovasc Dis. 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. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. The authors declare that they have no competing interests. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Engel GL. The other variables showed no significant differences. 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%. 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. 2003;250(10):117984. While there were in groups D and I compared to group M frequent impairments in both global screening tests (MMSE, MoCA) and in single cognitive function tests of the neuropsychological test battery (Additionalfile1) and also in the resulting cognitive composite score (CCS), this difference reached statistical significance only in the MoCA assessment for group D compared to group M (Table2). It may also occur with sudden neck movements and trauma. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. J Neurol Neurosurg Psychiatry. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. The functional outcome, however, seems to be usually good in the majority of cases but there is still a lack of knowledge about the natural history of VAD and uncertainty concerning the appropriate follow-up management. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Neurology. 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. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. Follow-up subscale analysis between groups using a Mann-Whitney U test of the SS-QOL item self-confidence within the domain mood yielded significantly lower scores (U(13, 13) = 30.5; p<0.01) for VAD patients with bad QOL (SS-QOL3.9) versus good and also significantly lower scores (U(9, 25) = 24.5; p<0.001) for group I patients with bad versus good QOL. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. 2006;66(4):5136. 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