Google Scholar. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. 2004;63(11):21325. California Privacy Statement, 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. Because of the great (2018) [38] reported more recently in their observational cohort study on patients with cervical, mainly carotid artery dissection, that numerically, but not statistically significant more patients with combined endovascular therapy (EVT)/intravenous thrombolysis (IVT) had excellent outcome and arterial recanalization than patients treated with EVT only. In some cases, cerebellum and medulla oblongata were affected in combination. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. Dissection in either artery can disrupt blood flow and potentially cause a stroke. Trial of org 10172 in acute stroke treatment. Stroke. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. 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. 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. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. (2) Broad neuroimaging of cervical arteries including cervical MRA was regularly applied to patients of all age groups and risk profiles whenever differential diagnosis of VAD appeared to be possible. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. Google Scholar. The hospital anxiety and depression scale. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. Vertebral artery dissection is a rare cause of stroke in older adults. It contains 49 items belonging to 12 domains. 2008;63(6):1095104 discussion 04-5. 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). VAD affected the right side in 13 patients (38.2%), the left side in 18 patients (53%), and both sides in three patients (8.8%). 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. CAS 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. Plank position (but otherwise safe to participate in yoga or Pilates). Speck et al. 2006;22(23):215. Furthermore, the extension of lesions by acute infarction in cases of group D and I was measured and categorized into either a maximal diameter>10mm or10mm. 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). 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. The study protocol was approved by the Local Ethics Committee of the University of Bremen. (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. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. Tucha O, Lange KW. (2014) [46]. Anasthesiol Intensivmed Notfallmed Schmerzther. The PTSS-14 was developed by Twigg et al. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Most patients achieved good QOL (SS-QOL4.0) at 6months follow-up in group I (68.4%) and even better in group M (87.5%) in contrast with group D (46.9%) (Table2). Definitions for use in a multicenter clinical trial. RK contributed to the experimental design and manuscript writing. (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. 2004;75(8):11946. Folstein MF, Folstein SE, McHugh PR. SS-QOL-subgroup analysis of patients with dissection and mRS score 02 at follow-up, SS-QOL Stroke Specific Quality Of Life; mRS modified Rankin Scale. 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. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. 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. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. Stroke. On rare occasions, this can lead to stroke. 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). A dissection forms when theres a tear in one or more of its three tissue layers. Preceding correlation analyses in this study yielded significant correlations in between all neurocognitive measures such as MMSE, MoCA, and CCS at baseline and likewise in between both neurostatus measures such as NIH-SS on admission and mRS at baseline. More importantly, however, our study showed also several limitations. J Clin Neurol. Living With Whats it like living Article 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]. Eur Heart J 2021;42:3825-3828. WebWhat is the life expectancy of someone with fibromuscular dysplasia? (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. Gttingen: Beltz Test GmbH; 2001. Cerebral ischemia in group I patients was caused by cardiac embolism in 34.2%, lacunar disease in 21%, large artery disease in 10.5% and by undetermined cause in 34.2% according to the TOAST-criteria [14]. Grond-Ginsbach et al. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. Provided by the Springer Nature SharedIt content-sharing initiative. Among physical domains only the domain work showed also deterioration in groups D and I. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. However, you may be at risk for future dissections. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. 2010;45(1112):68895. 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. What is the life expectance after successful repair of aortic Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. 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. Bonita R, Beaglehole R. Recovery of motor function after stroke. 1988;19(12):1497500. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. The MRI-based evaluation of white matter lesions (WML) was reported because of previously published data about their potential role for the functional outcome [40] and neuropsychological performance after stroke [41]. CTA, MRI, and We do not endorse non-Cleveland Clinic products or services. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. All participants were informed about the procedure and gave written informed consent to participate in the study. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Psychol Assess. His troponin was elevated at 0.094ng/mL. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Participants were examined for psychological, cognitive and neurological variables with special reference for functional outcome as well as quality of life 6months after the index event. Neuropsychologia. It generates 12 domain-related scores and a total score. 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). In this context the following aspects seem to be worthy to note: First, elevated scores of stress symptoms were also found in patients without any stroke lesion in our study in line with other study results [50]. Neurological outcome and quality of life after stroke due to vertebral artery dissection. And manuscript writing state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship functional... 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