Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. Provided by the Springer Nature SharedIt content-sharing initiative. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. Zimmermann PFB. CADISS Trial Investigators. Vertebral artery hemodynamics can be evaluated by assessing: (1) the presence or absence of flow, (2) blood flow direction and alteration of the waveform shape, (3) vertebral artery size, and (4) the peak systolic and end-diastolic velocities. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. 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. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. 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). We think increased PTSS levels were neither decisively stroke unit-related, as they were less frequent in comparison group I and M patients who were also treated on the stroke unit, nor disease-specific, as they were also present in group I and M. PTSS levels have been still prevalent in group D which might be explained by the stress-vulnerability model [53]. Ischemic stroke was found in only 33.9%. Herzogenrath: Vera Fimm; 2009. Stroke. 1977;86(2):10326. Six patients died within 3 months, the remaining 108 were contacted after The mRS is considered to be the worldwide most established functional outcome measure after stroke. 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). Both conditions fit if someone is suffering from a spontaneous artery dissection as well as subarachnoid hemorrhage in contrast to ischemic stroke caused by vascular risk factors which can be treated. 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. Individuals facing a higher risk of future dissection will need follow-up care for many years. (2009) [6]. Cervical artery dissections typically heal very well, returning the vessel to normal. This process usually occurs within the first three to six months. Whats it like living with a cervical artery dissection? Youll need regular monitoring, including imaging studies, until healthcare providers confirm the dissection has healed. 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. We do not endorse non-Cleveland Clinic products or services. 2004;251(10):12428. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Strauss E, Sherman EMS, Spreen O. 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. 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. 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. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. RK contributed to the experimental design and manuscript writing. CTA, MRI, and Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. 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]. 2017;88(14):131320. 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. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. The study protocol was approved by the Local Ethics Committee of the University of Bremen. 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. Vulnerability--a new view of schizophrenia. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Stress revisited: a critical evaluation of the stress concept. They carry blood to the brain and spinal cord, which are part of the nervous system. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Does the cerebellum contribute to specific aspects of attention? The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. (1987) [33] and Wahlund et al. Psychosom Med. (2014) [46]. 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. They showed ischemic stroke lesions in the majority of cases (73.6%) like the patients of group I (86.8%), larger than 10mm in maximal diameter in 67.6% versus 76.3%, respectively, as shown in Table2. (2013) [59] hypothesized that cervical artery dissection goes frequently undiagnosed, particularly in patients with subtle symptoms, which is true for VAD [3, 57], and dependently from the awareness of the responsible physician. 2016;87(5):52630. 2. Three cohorts of consecutive patients were included in the study for the purpose of comparison: group D (dissection) as the main group comprised patients with first-time spontaneous vertebral artery dissection (VAD) of at least one vertebral artery, group I (ischemia) as a positive control group consisted of patients with acute cerebral ischemia such as stroke or transient ischemic attack (TIA) of the posterior circulation due to any other cause than dissection, and group M (mimics) was chosen as a negative control group of stroke mimics of the posterior circulation. Auflage. Williams LS, Weinberger M, Harris LE, Biller J. Tucha O, Lange KW. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Importantly, our study cohort of VAD patients appeared to be not significantly biased by exclusion of eight patients, whose features and mean age of 64.5years widely resembled those of the study group. (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. Definitions for use in a multicenter clinical trial. All authors read and approved the final manuscript. Blood in the separated layers of the vessel wall can lead to blood clot formation. Cleveland Clinic is a non-profit academic medical center. Rainer J. Strege. 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. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Plank position (but otherwise safe to participate in yoga or Pilates). Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. TOAST. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. 8. Aortic dissection is life-threatening. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. 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. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. 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 Springer Nature. The PTSS-14 was developed by Twigg et al. 2002;13(3):1927. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. 1997;19(1):612. Policy. PubMed Central PubMed Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. A Spearmans rank correlation analysis was performed for outcome-relevant variables. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. 1988;19(12):1497500. The mean decrease of QOL, that is the difference of SS-QOL scoring, from pre-baseline to follow-up, was significantly stronger in the subgroups (mRS 02) with bad quality of life (SS-QOL3.9). There were significant more neurological impairments at baseline, that are higher scores of mRS for functional disability or NIH-SS for neurological deficit, in group D as well as I patients with ischemic stroke lesions compared to stroke mimics. Differential features of carotid and vertebral artery dissections: the CADISP study. Gttingen: Beltz Test GmbH; 2001. Neurosci Biobehav Rev. 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. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. A total of 327 patients were enrolled from 2012-2106. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. Eur J Neurol. 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). Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. Bonita R, Beaglehole R. Recovery of motor function after stroke. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. 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]. 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. Neurology. J Abnorm Psychol. 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