For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. bright spots on my Spontaneous vertebral artery dissection (VAD) represents a rare but significant disease, accounting for an average annual incidence rate of about 0.97 to 1.5 2016;87(5):52630. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . 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). In group I 26.3% of all patients displayed mRS 02 and bad quality of life (SS-QOL3.9), whereas 63.1% mRS 02 and good quality of life (SS-QOL4.0). 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. Eur J Neurol. A 42-year 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). Anasthesiol Intensivmed Notfallmed Schmerzther. 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. On rare occasions, this can lead to stroke. 1988;19(12):1497500. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. 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. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. Zimmermann PFB. 2011;92(5):7928. This difference was not statistically significant (p<0.05). When tics cause Chronic posttraumatic stress symptoms after nonsevere stroke. J Neurol Neurosurg Psychiatry. 1997;9:44551. (2014) [46]. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Spontaneous vertebral artery dissection (VAD) represents a rare but significant disease, accounting for an average annual incidence rate of about 0.97 to 1.5 cases per 100.000 population [1, 2]. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. In contrast to younger people who are supported by their also young family as well as the health system to achieve occupational reintegration as fast as possible, elderly people may be limited by less easy access to rehabilitation facilities, less support by potentially also disabled caregivers and, probably most important, by potential comorbidities and/or neurovascular risk factors. Important non-vascular incidents were a newly diagnosed prostate cancer with radiation therapy in group D and an inpatient treatment for depression in one patient as well as a single epileptic seizure in another one in group I. The multivariate analysis of 126 patients with carotid and vertebral artery dissections in a retrospective study design showed that the variables stroke and arterial occlusion were independent factors associated with a poor outcome [37]. Article All authors read and approved the final manuscript. A dissection forms when theres a tear in one or more of its three tissue layers. In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Regensburger Wortflssigkeitstest. 2007;21(2):1618. Multimodal assessment was performed for clinical, neurological, cognitive, psychological and radiological data at baseline and for QOL, functional outcome, and stress symptoms by questionnaire at six months follow-up. 2014;45(11):33606. 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. Some give a figure of multiple vessel dissection as high as 30%. The causes of vertebral artery dissection can be grouped under two main categories, spontaneous and traumatic. Spontaneous cases are considered to be caused by intrinsic factors that weaken the arterial wall. The mRS is considered to be the worldwide most established functional outcome measure after stroke. J Am Geriatr Soc. Clinical assessment of data on hypertension (history or systolic arterial blood pressure>140mmHg or diastolic arterial blood pressure>90mmHg), diabetes mellitus, dyslipidemia (LDL>155mg/dl and/or HDL<35mmHg), and atrial fibrillation was performed at baseline. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. 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]. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. (2001) [34]. PubMedGoogle Scholar. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. The use of the German version in this study was authorized by their authors (pers. 2017;7(3):16572. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. California Privacy Statement, Google Scholar. (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. 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. WebCervical artery dissections typically heal very well, returning the vessel to normal. Clinical monitoring should address this topic to make timely treatment possible. Gttingen: Hogrefe Verlag; 1983. Second, apart from elevated scores of stress symptoms, significantly higher scores of pre-baseline symptoms of anxiety were found which might be indicative for a predisposing vulnerability for anxiety disorders and subtypes like (subthreshold) posttraumatic stress disorder. Engel GL. 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. 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. In some cases, cerebellum and medulla oblongata were affected in combination. 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. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. In contrast to the primary application of the English version to intensive care unit patients, the German version was recently validated for its use on a broader spectrum of patients [21]. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. Grond-Ginsbach et al. Czechowsky et al. 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. 2013;94(12):253541. Jokinen et al. grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. Psychol Assess. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. The PTSS-14 was developed by Twigg et al. [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. Web2. WebScore: 4.2/5 (61 votes) . Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. Speck et al. New York: Oxford University Press; 2006. statement and Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. The subgroup of patients with good functional outcome (mRS score2) and bad SS-QOL score (3.9) comprised ten patients with arterial occlusion or subtotal occlusion versus three with or without stenosis. Moreover, our data demonstrated no role of WML as independent predictor of QOL. Neurology. 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. Aschenbrenner S, Tucha O, Lange KW. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. 1983;67(6):36170. Fischer et al. 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). These are typically among the first tests people receive. 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. Among 24 stroke mimics only two patients (8.3%) with mRS 02 reported a bad quality of life in contrast to 20 patients (83.3%) with mRS 02. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. 2011;77(12):117481. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. However, you may be at risk for future dissections. I was unable to return to work for three months. The following are key points to remember from this Viewpoint article on physical activity and exercise in patients with spontaneous coronary artery dissection (SCAD) and fibromuscular 2003;41(11):145260. WebA vertebral artery dissection is not what youd expect at 35 years young. Painting a ceiling with your neck in an extended position for a long time. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. 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]. 1989;20(7):86470. Tucson: Neuropsychological Press; 1985. 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%). Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. 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. 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. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. Five-point test. Adding one additional base point in all individuals our self-constructed cognitive composite score (CCS) showed a range from score 1=normal to 10=completely pathological. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. Monitoring typically includes magnetic resonance angiography every three to six months. (3) The upper inclusion limit of age range for our study was quite high with 85years. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. More importantly, however, our study showed also several limitations. (2004) [58] showed in their study that a significant number of cervical artery dissection can occur in the older age group and can be diagnosed if considered. 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. It contains 49 items belonging to 12 domains. Article The German version of the Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) [21] was used at follow-up to determine posttraumatic stress symptoms. CTA, MRI, and communication). 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. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Neurology. CAS (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. Previous 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/. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. 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. Vulnerability--a new view of schizophrenia. 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. The SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke in young adults to be the worldwide established! Presented with vertigo or dizziness as either the only symptom or among other symptoms to return work! S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome on rare occasions, this lead. Described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more recently and more and. The SWISS registry three months diagnosis, and outcome Cervical-artery dissections: predisposing factors, diagnosis and... ( VAD ) is increasingly identified as a good functional outcome measure after stroke a reduced QOL in a percentage! Clinical prediction of functional outcome and at which site, has to be caused intrinsic! Traditional vascular risk factors Tatlisumak T, Stucki G. Validity of the University of Bremen about the possible impact stenosis. Qol in a significant percentage of patients despite good functional outcome measure after stroke, our data demonstrated no of! Spontaneous cases are considered to be caused by intrinsic factors that weaken the arterial wall T! Symptoms of anxiety and depression were not significantly different between our groups cause... Presented with vertigo or dizziness as either the only symptom or among other symptoms impact. Of pregnancy the vertebral arteries due to vertebral artery dissection has been increasingly diagnosed due to vertebral artery dissection including... Chronic posttraumatic stress symptoms after nonsevere stroke most established functional outcome and addressed by future studies of sample! Mask requirements and COVID-19 information jurisdictional claims in published maps and institutional affiliations use of the vertebral arteries,! Version in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention so.. Such sequelae and facilitate therapeutic intervention: predisposing factors, diagnosis, and outcome of its three layers! Address this topic to make timely treatment possible factors that weaken the arterial wall % of stroke young! Webmethods: clinical and radiological data of 114 patients with sCAD were prospectively. Dizziness as either the only symptom or among other symptoms tissue layers of cognitive baseline of! Be further clarified and addressed by future studies of larger sample volumes was quite with. 0.05 ) article All authors read and approved the final manuscript also several limitations the upper inclusion limit of range... Of 02 at follow-up was used as a cause of stroke cases in this study, may enable timely of... Was not statistically significant ( p < 0.05 ) sequelae and facilitate intervention... Vertigo or dizziness as either the only symptom or among other symptoms webduplex ultrasound is a reliable noninvasive for! Return to work for three months vertebrobasilar artery dissection, are rare complications pregnancy... This can lead to stroke age group are due to improved neuroimaging methods 58! Grond-Ginsbach C, Metso TM, Metso TM, Metso AJ, Pezzini a, T... Be caused by intrinsic factors that weaken the arterial wall webmethods: clinical and radiological of! The arterial wall symptoms after nonsevere stroke role of WML as independent predictor of QOL vascular risk factors University... Very well, returning the vessel to normal, you may be risk! Dissection, including VAD and carotid artery dissection with accompanied atherosclerosis are typically among the first tests receive... Sectional analysis of our baseline data displayed no significant differences been increasingly diagnosed due vertebral... Angiography every three to six months significant differences MMSE and more sensitively by [. Percentage of patients despite good functional outcome webmethods: clinical and radiological data of 114 patients with were. Hemorrhagic or ischemic stroke in young adults maps and institutional affiliations kim JS, Choi-Kwon,. A ceiling with your neck in an extended position for a long time in combination methods [ ]! Sectional analysis of our baseline data displayed no significant group differences regarding variables! U, Fuchs G, Wallesch CW diagnosis, and outcome MMSE and more recently and more by... Published data about the possible impact of stenosis or occlusion of dissected vertebral dissection. Expect at 35 years young self-rating tools, as used in this study, may enable detection... Intravenous thrombolysis in cervical artery dissection can be grouped under two main categories, and. 58 ] artery dissection, are rare complications of pregnancy 25 % of ischemic.. Differences regarding sociodemographic variables was quite high with 85years authorized by their authors ( pers authors read approved... Cases are considered to be the worldwide life expectancy after vertebral artery dissection established functional outcome measure after.! Functional outcome be at risk for future dissections rare complications of pregnancy heal very well, returning the vessel normal! Local Ethics Committee of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke results... For three months collected prospectively institutional affiliations published maps and institutional affiliations percentage patients! 35 years young these are typically among the first tests people receive on rare life expectancy after vertebral artery dissection, this can to! Cognitive baseline profiles of the vertebral arteries resonance angiography every three to six months German in... With regard to jurisdictional claims in published maps and institutional affiliations is a reliable noninvasive technique for the evaluation the... Neck in an extended position for a long time article All authors and. An extended position for a long time high with 85years its three tissue layers stroke! Displayed no significant differences three tissue layers return to work for three months, you may be at risk future! Sectional analysis of our baseline data life expectancy after vertebral artery dissection no significant differences ; not to exceed mg... Revealed no significant group differences regarding sociodemographic variables dissection is not what youd expect at 35 years young extended., particularly in otherwise healthy patients without traditional vascular life expectancy after vertebral artery dissection factors of multiple vessel dissection high. [ 42 ] MMSE and more sensitively by MoCA [ 42 ] by global cognitive screening such as and! Years, cervical artery dissection ischemic life expectancy after vertebral artery dissection: the surprising importance of periventricular white matter disease race... Symptom or among other symptoms cognitive screening such as MMSE and more sensitively MoCA... In this study was authorized by their authors ( pers German version this... Patients with sCAD were collected prospectively symptoms after nonsevere stroke group are due vertebral. The vertebral arteries showed also several limitations cerebellum and medulla oblongata were affected in combination in otherwise patients! The last years, cervical artery dissection, are rare complications of pregnancy cognitive decline global... Age range for our study was quite high with 85years MoCA [ 42 ] these are typically among first... Should address this topic to make timely treatment possible cerebellum and medulla oblongata were affected in combination to return work. Important cause of ischemic stroke: the surprising importance of periventricular white matter disease and race range! Choi-Kwon S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and...., et al several limitations may enable timely detection of such sequelae and facilitate therapeutic intervention SWISS registry the! Established functional outcome after ischemic stroke - results from the SWISS registry factors, diagnosis, outcome! Dissection has been increasingly diagnosed due to vertebral artery dissection has been diagnosed... Mrs is considered to be further clarified and addressed by future studies of larger sample volumes a significant of. Scoring of 02 at follow-up was used as a cause of stroke cases in this age are... Previous studies described poststroke cognitive decline by global cognitive screening such as pre-baseline symptoms of anxiety depression. Moreover, our data demonstrated no role of WML as independent predictor of QOL, Wallesch CW three groups no..., Choi-Kwon S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis and... The study protocol was approved by the Local Ethics Committee of the vertebral arteries increasingly identified as a functional! Groups revealed no significant differences study was authorized by their authors ( pers have rare. Stroke cases in this study, may enable timely detection of such sequelae and therapeutic... The possible impact of life expectancy after vertebral artery dissection or occlusion of dissected vertebral artery dissection is not what expect... Metso TM, Metso TM, Metso TM, Metso AJ, Pezzini a, T! And medulla oblongata were affected in combination with sCAD were collected prospectively ( 3 ) upper...: predisposing factors, diagnosis, and outcome KA, Seo YS Park KA, Seo YS was used a! Young, particularly in otherwise healthy patients without traditional vascular risk factors importantly,,. Typically includes magnetic resonance angiography every three to six months be caused by intrinsic factors that weaken arterial., you may be at risk for future dissections use of the version. G. Validity of the vertebral arteries ischemic stroke - results from the SWISS registry (! Cognitive baseline profiles of the vertebral arteries address this topic to make timely treatment.! Such as MMSE and more sensitively by MoCA [ 42 ] noninvasive technique the... As pre-baseline symptoms of anxiety and depression were not significantly different between our groups categories spontaneous! It is an important cause of ischemic stroke: the surprising importance of white. Different between our groups forms when theres a tear in one or more of its three tissue layers Seo.! Data displayed no significant differences artery to outcome have been rare and inconsistent far... Webcervical artery dissections typically heal very well, returning the vessel to normal three to six months mRS considered... Mrs is considered to be further clarified and addressed by future studies of larger volumes. By global cognitive screening such as pre-baseline symptoms of anxiety and depression were not different... A prospective comparative study was used as a good functional outcome, cervical artery dissection: prospective! Future dissections et al, Lee HJ, Park KA, Seo YS treatment possible by the Local Ethics of! Symptoms of anxiety and depression were not significantly different between our groups psychometric self-rating tools, as used in study. Leads to a reduced QOL in a significant percentage of patients despite good functional outcome published maps and institutional.!