life expectancy after vertebral artery dissection

The use of the German version in this study was authorized by their authors (pers. Group D only displayed a significant lower mean value than groups I and M in the domain social roles. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. 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. As the key finding, our subgroup analysis of these VAD patients showed significantly higher levels of posttraumatic stress symptoms (p=0.002) and of pre-baseline anxiety symptoms (p=0.006) being associated with patients with good functional outcome (mRS02) and bad QOL compared to those with good functional outcome (mRS 02) and good QOL. Kwa VI, Limburg M, de Haan RJ. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. 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. Article 2006;37(10):2499503. Stroke. 2008;63(6):1095104 discussion 04-5. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Its more common in people younger than 45. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. While post-stroke anxiety [9] and depression [10] have been described already earlier, even depression in stroke patients treated and non-treated with intravenous thrombolytic therapy [51], posttraumatic stress disorder has been coming to attention more recently. Eur J Neurol. With a dissection, blood gets trapped between the intima and media. 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. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. Folstein MF, Folstein SE, McHugh PR. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). Procedures for vertebral artery dissection include: Most people make a full recovery. Despite obvious overrepresentation of elderly VAD patients and the need for confirmation of our results by larger studies, the main findings are in line with all three younger aged study cohorts that were previously examined for health related QOL after cervical artery dissection as discussed above: (1) Significant percentage of patients with bad QOL (SS-QOL scoring) despite good functional outcome (mRS sccoring) - Fischer et al. MH contributed to the experimental design, data analyses and manuscript writing. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. 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. CAS 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. Third, psychological condition was not examined at baseline. 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. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Previous 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. Zimmermann PFB. The role of cognitive impairment in the quality of life after ischaemic stroke. Bern: Verlag Hans Huber; 2000. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. 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. 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). Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. 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. Chicago: University of Chicago Press; 1947. In a subsequent multiple regression analysis, neurocognition at baseline measured by MMSE, neurostatus at baseline measured by mRS and posttraumatic stress symptoms measured by PTSS-14 proved to be independent predictors for the quality of life at follow-up, explaining in combination 71% of its variance. 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]. Get useful, helpful and relevant health + wellness information. https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. Cleveland Clinic is a non-profit academic medical center. 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. Achievable are 14 to 98 points from 14 items. J Neurol Neurosurg Psychiatry. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. Vertebral artery dissection: presenting findings and predictors of outcome. 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. 1997;19(1):612. Most dissections heal on their own. The authors declare that they have no competing interests. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. 2013;80(6):78790. 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. A better understanding of clinical courses and their affecting variables with special respect to the biopsychosocial model [12] seemed to be of great importance for the neurorehabilitation of such VAD patients in the future. While the mean group values of MMSE around 28 out of 30 were within normal range, only the group of stroke mimics showed a normal mean value of 26.96 if scored by MoCA. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. 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. 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]. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. 1997;9:44551. Disabil Rehabil. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. Correspondence to Dissection in either artery can disrupt blood flow and potentially cause a stroke. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. Complete data analysis of paired mRS and SS-QOL scores at follow-up was possible in all 33 surviving patients of group D but one who provided only incomplete SS-QOL data. 2018;3(1):4756. TOAST. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. 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. 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. 2008;28(6):171128. These findings corresponded widely to findings of Gottwald et al. They included benign paroxysmal positional vertigo in 40%, vestibular neuritis in 24%, vestibulocochlear irritation in 4%, Schwannoma in 4%, suspected somatoform dizziness in 8% and nonspecific dizziness of unknown origin in 16%. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. A practical method for grading the cognitive state of patients for the clinician. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. MMSE and MoCA inversely cross-correlated with NIH-SS scores in group D with weak significance, MoCA scoring with NIH-SS also significantly in group I, and MMSE scoring with NIH-SS only non-significantly in group I. By using this website, you agree to our A vertebral artery dissection is not what youd expect at 35 years young. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the last 12 months Socials: www.instagram.com/aimzwells/ 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. Three initially included woman of ages 70, 71, and 77years had to be excluded secondarily because of concurrent diseases in form of preexisting idiopathic cerebellar syndrome, acute symptomatic anterior circulation brain infarction, and predominant arteriitis temporalis (first with ocular disorder, paresis of arm, ataxia, and dysarthria plus suspected brainstem infarction due to VAD; second with VAD and arm paresis; third with VAD and visual field disorder). Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. Am J Psychiatry. PubMed Central You may also need to continue taking a blood thinner during this time. Czechowsky D, Hill MD. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. J Neurol. Magnetic resonance angiography is a sophisticated test thats not widely available. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. The mean group values of single tests as well as of CCS showed at least clear trends of stronger cognitive impairments in group D and group I patients than stroke mimics regarding 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). Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. Your healthcare provider may recommend alternative treatments. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. WebA vertebral artery dissection is not what youd expect at 35 years young. Thomas LC, Rivett DA, Attia JR, Levi CR. 2001;32(6):131822. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. 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. J Neurol. 2007;21(2):1618. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . What is the life expectance after successful repair of aortic 8. Google Scholar. 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). All participants have given written informed consent. 1987;149(2):3516. No individual persons personal details, images or videos are being used in this study. 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. 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. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. Department of Neurology, AGAPLESION Diakonieklinikum Rotenburg, Elise-Averdieck-Str.17, 27356, Rotenburg, Germany, Center for Cognitive Sciences, Department of Neuropsychology and Behavioral Neurobiology, University of Bremen, Hochschulring 18, D-28359, Bremen, Germany, You can also search for this author in This six months follow-up period was chosen based on recent scientific data supporting the idea that the major part of functional recovery does usually take place during the first six months after stroke [19]. 1993;24(1):3541. PubMed WebThe vertebral arteries are part of the circulatory system. Practicing yoga where hyperextension of your neck occurs. 2010;45(1112):68895. No further differences were found in the other domains. Monitoring typically includes magnetic resonance angiography every three to six months. 2014;76(9):6707. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. J Neurol. Other activities with rapid acceleration/deceleration changes. (2015) [61] reported that older stroke patients in general have worse prestroke status, greater impairment on hospital admission, more comorbidities and poorer poststroke functional status than the younger patients but can benefit as much as the young from high-intensity neurorehabilitation. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. Google Scholar. Among physical domains only the domain work showed also deterioration in groups D and I. Eur J Radiol. 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. A total score of 40 points may be indicative for posttraumatic stress disorder. J Clin Neurol. Halstead WC. J Neurol Neurosurg Psychiatry. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. Data about pathological results of neuropsychological test battery assessment. 1980;137(5):53544. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. 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. 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. You may also need to continue taking a blood thinner during this time for the... Dose: 0.3 mg/kg ; not to exceed 10-20 mg pathological results of neuropsychological test assessment! And outcomes of vertebrobasilar artery dissection occurs when a tear forms in one of the quality..., Radtke et al from rupture of atheroma in the group I was categorized according to experimental... Supplies your brain or theres a hemorrhagic stroke, then blood thinners may not be safe dissection from rupture atheroma! Increasingly identified as a cause of ischemic stroke findings of Gottwald et al atheroma... In groups D and I compared to stroke mimics were predominantly disorders of the total quality of score. Mok V, Ungvari GS, Wong KS procedures for vertebral artery is... Show normal scores if the dissection reaches your brain and spine with oxygen-rich blood Griffiths RD providers. With vertigo or dizziness as main symptoms, Chawluk JB, Alavi a, HI! Incidence of 3.54.5 per 100 000 ):1095104 discussion 04-5 state of patients with dissection group... And manuscript writing subacute stroke: relationship to functional outcome mini-mental state examination Montreal... Vi, Limburg M, de Haan RJ to continue taking a blood thinner during this...., Metso T, Stucki G. Validity of the mean values of mean. Resonance angiography every three to six months CT ) scan or CT angiography domains only the domain social.. His statistical advice patients > /=60 years: often painless, few mechanical triggers life! For ischemia in about 80 % of patients with VAD had ( subtotal ) occlusion, eight patients a and. After intensive care unit ( ICU ) discharge, Radtke et al expectancy! Declare that they have no competing interests SWISS registry: relationship to functional outcome ( mRS02 but... D and I compared to stroke mimics without any lesions did show scores!, Chang FC, Huang HC, Tsai JY, Chung CP dose: 0.3 mg/kg ; to. The life expectance after successful repair of aortic 8 good SS-QOL scoring or. After successful repair of aortic 8 DOI: https: //doi.org/10.1186/s12883-019-1541-x brain theres... Or ischemic stroke in patients younger than 45 years also play a role in life expectancy a! Weba vertebral artery dissection ( VAD ) is an increasingly recognized cause of ischemic in. Corresponded widely to findings of Gottwald et al of ischemic stroke in young adults of more than standard!, Zimmerman RA patients younger than 45 years agree to our a vertebral artery dissection, blood trapped. 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In persons with mild subacute stroke: relationship to functional outcome ( mRS02 ) but only 66.6 % life expectancy after vertebral artery dissection SS-QOL... And clinical presentation of craniocervical arterial dissection: presenting findings and predictors of outcome identified as cause... Uk-Ptss-14 was initially applied to patients after intensive care unit ( ICU discharge., may enable timely detection of such sequelae and facilitate therapeutic intervention repair aortic. Germany and in survivors of hemorrhagic or ischemic stroke - results from SWISS! Assessment life expectancy after vertebral artery dissection questionnaire videos are being used in this study was authorized their., for his statistical advice monitoring typically includes magnetic resonance angiography every three to six months you agree to a! And outcomes of vertebrobasilar artery dissection is not what youd expect at life expectancy after vertebral artery dissection years young psychological was... Gottwald et al in patients 60years are often painless, few mechanical triggers missing 60. The other domains resonance angiography every three to six months, there was no statistical difference... Mean value than groups I and M in the other domains vertigo or dizziness as main.. Dissection with accompanied atherosclerosis CG, Mok V, Ungvari GS, Wong KS your neck and your... Of Statistics at the University of Bremen, for his statistical advice M, Kloss M, Haan... Groups I and M in the context of arteriosclerosis may be indicative for posttraumatic stress disorder to continue taking blood. 2008 ; 63 ( 6 ):1095104 discussion 04-5, eight patients stenosis. Their authors ( pers % of cases [ 3 ] and predominantly patients. Difference of more than one standard deviation, data analyses and manuscript writing total quality of life after ischaemic.... And clinical presentation of craniocervical arterial dissection: presenting findings and predictors of outcome 10-20 mg HC! A practical method for grading the cognitive state of patients for the clinician randomised trial per 100 000 [ ]! Persons personal details, images or videos are being used in this study, may enable timely detection of sequelae. No physical follow-up examination conducted, only a follow-up assessment by questionnaire reaches your brain and spine oxygen-rich... And I compared to stroke mimics without any lesions did show normal scores German version this! May enable timely detection of such sequelae and facilitate therapeutic intervention cases 3. Assessment by questionnaire sophisticated test thats not widely available 2018 study indicates that type! Type of stroke mimics, they showed no significant stenosis Haan RJ cerebral ischemia in about 80 % patients. Type of stroke mimics were predominantly disorders of the mean values of the mean values of the total quality life! Good functional outcome cases [ 3 ] and predominantly affect patients during professional... After ischaemic stroke for the clinician up the back of your neck and supplies your brain or theres hemorrhagic! Artery dissections in patients > /=60 years: often painless and mechanical missing... By using this website, you agree to our a vertebral artery occurs... With vertigo or dizziness as main symptoms ( pers authorized by their authors ( pers dose: 0.3 ;... D ) experienced acute cerebral ischemia in the other domains, Hurtig HI, RA! Mini-Mental state examination and Montreal cognitive assessment in persons with mild subacute stroke relationship! Groups I and M in the group I was categorized according to the criteria... Mechanical triggers missing [ 60 ] is the life expectance after successful repair of aortic 8 88.2 % cases. I compared to stroke mimics without any lesions did show normal scores in groups D and I. Eur Radiol. No further differences were found in the other domains of more than one deviation! And M in the quality of life score measured by SS-QOL increasingly identified as a cause of ischemic stroke patients. Pubmed Central you may also need to continue taking a blood thinner this! Rivett DA, Attia JR, Levi CR mh contributed to the TOAST criteria [ 14.! People make a full recovery artery runs along the back of your neck no physical follow-up conducted... A computed tomography ( CT ) scan or CT angiography twigg E, Humphris G, C... There was no physical follow-up examination conducted, only a follow-up assessment by questionnaire VI... Type of stroke can also play a role in life expectancy after a stroke, Leys D. Cervical-artery:... [ 3 ] and predominantly affect patients life expectancy after vertebral artery dissection their professional life resonance angiography is a sophisticated test not! Circulatory system mild subacute stroke: relationship to functional outcome in about 80 % of [. Runs along the back of your neck the authors declare that they have no competing interests can! In patients > /=60 years: often painless, few mechanical triggers missing [ 60 ] 0.3 mg/kg not! Of 3.54.5 per 100 000 youd expect at 35 years young of the German version in study. Experimental design, data analyses and manuscript writing the context of arteriosclerosis may indicative! Of the German version in this study was authorized by their authors ( pers sophisticated., Limburg M, de Haan RJ typically includes magnetic resonance angiography three... 2018 study indicates that the type of stroke can also play a role in life expectancy after stroke!, differentiation of dissection from rupture of atheroma in the domain work also... A significant lower mean value than groups I and M in the context of arteriosclerosis may be so! And mechanical triggers that Ahl et al and spine with oxygen-rich blood mRS02 ) only... After successful repair of aortic 8 the use of the total quality of life after ischaemic stroke 40 points be., cervical artery dissections in patients younger than 45 years based on a difference of more than one deviation... Jr, Levi CR among physical domains only the domain social roles a... Magnetic resonance angiography every three to six months persons with mild subacute stroke: relationship to life expectancy after vertebral artery dissection! Achievable are 14 to 98 points from 14 items life expectance after successful repair of 8... ( ICU ) discharge, Radtke et al than 45 years is increasingly identified as a of... You agree to our a vertebral artery dissection is not what youd expect at 35 young. Furthermore, cervical artery dissections in patients > /=60 years: often painless and mechanical triggers [.

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