(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). 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. When tics cause White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. Kissela et al. 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. They deliver oxygen-rich blood to your brain and spine. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. Achievable are 14 to 98 points from 14 items. Fischer et al. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. In addition, the extent of WML showed a significant inverse correlation to global cognitive functioning (MMSE, MoCA) in group D and partly (MoCA only) in group M. Finally, more extensive stroke lesions correlated very weakly with stronger neurological impairment (higher NIH-SS score at baseline) in group D and showed no other consistent correlations. 2006;22(23):215. 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]. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. bright spots on my Predictors for QOL at follow-up were analyzed by regression model. 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. These are typically among the first tests people receive. (2004) [45]. Regensburger Wortflssigkeitstest. 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. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Likewise, functional impairment measured by mRS at follow-up significantly correlated with reduced SS-QOL at follow-up in concordance with the results of the mixed cervical artery dissection series of Fischer et al. A 42-year Engel GL. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. 1987;149(2):3516. Article (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. 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]. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. Arch Phys Med Rehabil. 2003;41(11):145260. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. By means of linear regression analysis, we first calculated the predictive value of certain variables for the variance of SS-QOL scores at follow-up in an univariate model. 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. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. It provides seven scoring levels as follows: (0) no symptoms at all, (1) no significant disability despite symptoms, (2) slight disability, (3) moderate disability, (4) moderately severe disability, (5) severe disability, and (6) dead. Fourth, maladaptive coping strategies were significant predictors for and associated with posttraumatic stress disorder in patients with cervical artery dissection in the study of Speck et al. Trial of org 10172 in acute stroke treatment. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. (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. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. J Neurol. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. 1988;19(12):1497500. (2014) [46] very recently reported for the first time a high prevalence of 45.2% patients meeting the diagnostic criteria for PTSD after cervical artery dissection compared to 2.9% in the general German population. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. Radiographics. You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). 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). Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. 2011;77(12):117481. 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. Thus, the present investigation has to be characterized as an explorative study. J Neurol Neurosurg Psychiatry. Intergroup analysis of change of mean total scores of QOL, as measured by SS-QOL, from pre-baseline to follow-up displayed a significant deterioration (p<0.001; Wilcoxon signed-rank test) in groups D and I but not in group M. Further analysis of changing scores in the twelve SS-QOL domains yielded developing impairments from baseline to follow-up in all three groups D, I, and M. Impairments evolved mainly in psychosocial domains such as family roles, social roles and energy and less in physical domains. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Article Gttingen: Hogrefe Verlag; 2000. 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. more than one drug, a medium or high dosage or signs of sedative or cognitive side effects, or (6) concurrent or preexisting CNS morbidity or damage apart from white matter lesions (WML) and minor strokes without any disabling, in particular cognitive preexisting deficit. Bonita R, Beaglehole R. Recovery of motor function after stroke. A total of 327 patients were enrolled from 2012-2106. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. A dissection is a tear in one or more tissue layers that make up your vertebral artery. Quality of life in survivors after cervical artery dissection. The PTSS-14 was developed by Twigg et al. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. 2009;40(2):5306. Google Scholar. Cervical artery dissection: trauma and other potential mechanical trigger events. Cerebrovasc Dis. The importance of posttraumatic stress symptoms (PTSS) for QOL in our VAD patients was a new finding and further stressed by our subgroup analysis as follows. 37 patients fulfilled the inclusion criteria and were included into the study as group D. In addition, 38 patients with acute stroke or TIA of the posterior circulation were included as comparison group I and 27 stroke mimics of the posterior circulation as comparison group M (Fig. (2002) [5] and Fischer et al. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. Kwa VI, Limburg M, de Haan RJ. Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. At first I just had a very bad neck pain, couldn't move it much. 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. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. 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). 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]. The cerebellar cognitive profile. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. 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. 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]. It has been already earlier demonstrated in both patients with stroke and patients with Parkinsons disease that the type of psychosocial alterations, psychosocial adaptation and coping strategies seem to be of much greater impact than the degree of physical impairment [56]. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. On rare occasions, this can lead to stroke. Noble et al. Grond-Ginsbach et al. They carry blood to the brain and spinal cord, which are part of the nervous system. 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]. 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. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. PubMed Central By using this website, you agree to our Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. This risk decreases over time. 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. 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