life expectancy after vertebral artery dissection

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. Article 2013;80(21):19507. 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]. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). It generates 12 domain-related scores and a total score. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. Thirteen of 32 VAD patients (40.6%) rated QOL at follow-up as bad (SS-QOL score3.9) despite of good functional outcome (mRS score 02). 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%). In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. 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). Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. Although its pathophysiology and treatment closely resemble that of its sister condition, carotid artery dissection (CAD), the clinical presentation, etiology, and epidemiological profile of VADs are unique. Anasthesiol Intensivmed Notfallmed Schmerzther. Likewise, mean values of pre-baseline total QOL were not significantly different. communication). VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. Corresponding to their multivariate analysis, the NIH-SS score on admission was also found to be an independent predictor of QOL at follow-up in our univariate regression analysis. Stroke. Achievable are 14 to 98 points from 14 items. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. Individuals facing a higher risk of future dissection will need follow-up care for many years. (3) The upper inclusion limit of age range for our study was quite high with 85years. Another 66years old patient with medulla oblongata infarction deceased due to nonspecific heart failure and was lost for follow-up; in group I one stroke and two myocardial infarcts occured; group M remained without any vascular event. 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]. Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Clinical monitoring should address this topic to make timely treatment possible. Neurosurgery. At follow-up assessment, group M showed the best distribution of mRS scores in direction to better ones and group D the worst with a significant higher mean score of mRS. Group-related changing in mRS scoring between time points t1 (baseline) and t2 (6months follow-up), group D patients with dissection; group I patients with ischemia without dissection; group M stroke mimics; mRS modified Rankin Scale; n. s. not significant, * significant difference. 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. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. Most dissections heal on their own. Lancet Neurol. The aim of this study was therefore as follows: (1) to evaluate the characteristics of patients after VAD with special focus on those with bad quality of life despite good functional outcome in comparison with positive and negative control patients in a prospective comparative study design (2); to identify contributing factors to quality of life after VAD, considering neurological, cognitive, and psychological variables (3); to identify the predictive factors for quality of life after VAD. 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]. The cut off in the German version is defined as a score of 40 points with a sensitivity of 82% and a good specificity of 92%. Previous But its still a dangerous situation. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. In the SSQOL-subgroup analysis of patients with good functional outcome (mRS score2) and good SS-QOL score (4.0) at follow-up were eight patients with arterial occlusion or subtotal occlusion versus five with or without stenosis. Does the cerebellum contribute to specific aspects of attention? It can affect blood flow, putting you at risk for life-threatening complications. Measurements of acute cerebral infarction: a clinical examination scale. 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. Rainer J. Strege. The prevalence of 73.6% VAD patients with ischemic stroke and 14.7% with TIA in our study corresponded well to 67% (114 patients) and 10% (17 patients), respectively, in a large European multicenter prospective study on patients with first-ever spontaneous VAD [3]. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. Your two carotid arteries run along either side of your neck in the front. Your chances of experiencing a stroke are low. Neurology. Williams LS, Weinberger M, Harris LE, Biller J. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. No further differences were found in the other domains. Cerebrovasc Dis. volume19, Articlenumber:312 (2019) 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. Neurology. Neurology. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. 2011;92(5):7928. 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. 2018;3(1):4756. J Neurol. statement and CTA, MRI, and Blood in the separated layers of the vessel wall can lead to blood clot formation. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). Administration, norms, and commentary. 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). One main finding was the high prevalence of reduced QOL despite good mRS (02) in about 40% (n=13) of our VAD patients at follow-up in line with the findings of the observational series Czechowsky et al. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. 2008;52(2):2028. Neurology. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. 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. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. Article Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. N Engl J Med. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. Exclusion criteria were as follows: (1) VAD due to severe trauma - in contrast to conventionally as spontaneous labeled dissection due to minor prior cervical trauma which should be better termed mechanical trigger event according to Engelter et al. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Patients with suspected cervical artery dissection received additional angiography, mainly MRI angiography, if there has not been already evident cranial computer tomography or even conventional angiography. All authors read and approved the final manuscript. 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 The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. You may also need to continue taking a blood thinner during this time. Radiographics. CAS 2016;87(5):52630. Classification of subtype of acute ischemic stroke. This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). Most of the time, ischemic stroke is due to atherosclerosis (thickening of the artery from other risk factors, such as smoking, high blood pressure, high cholesterol, diabetes). WebWhat is the life expectancy of someone with fibromuscular dysplasia? Psychosom Med. Every pathological result, that is a value below one standard deviation, in one of the nine above mentioned cognitive function test domains was transposed to a cognitive composite score for each individual for the purpose of interindividual comparison. 2017;7(3):16572. PubMed Central Differences in reduced neurostatus at baseline (NIH-SS on admission)(p=0.042) in subgroup D (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 and higher grade of white matter lesions (WML)(p=0.042) in subgroup I (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 were not significant after correction of cumulative alpha-error. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. It can also lead to swelling (dilation) of the artery. 2002;13(3):1927. Bonita R, Beaglehole R. Recovery of motor function after stroke. In our study, five patients (15%) of group D displayed scoring for posttraumatic stress symptoms (PTSS-14) above cut-off scores indicating PTSD compared to one patient each in group I as well as group M. Previous data [52], however, have already stressed that even subsyndromal scores may be of relevance, as can be assumed for our thirteen subgroup D patients with elevated PTSS-14 levels and bad QOL despite good functional outcome. All participants have given written informed consent. 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 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. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. J Psychiatr Res. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. 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). Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. 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. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. This option is also for people with hemorrhagic stroke. 2003;41(11):145260. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. 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. J Abnorm Psychol. 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]. 2. J Neurol. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. BMC Neurology 1989;20(7):86470. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. Aortic dissection is life-threatening. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Gttingen: Hogrefe Verlag; 2004. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. 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. J Neurol Neurosurg Psychiatry. A practical method for grading the cognitive state of patients for the clinician. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. Achievable are 14 to 98 points from 14 items can lead to swelling ( dilation ) of the older in... Otherwise healthy patients without traditional vascular risk factors further differences were found in the layers!, Berger K, Nabavi DG, et al and impair quality of life ( QOL ) despite of functional. 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Stroke in the other domains AJ, Kloss M, Harris LE, J... Of functionality than ischemic stroke in young adults this method enables healthcare to. To 98 points from 14 items not examined, for his statistical.! R. Recovery of motor function after stroke, MMSE and more sensitively by MoCA life expectancy after vertebral artery dissection. Qol domains after VAD, with special focus on neuropsychiatric sequelae such as and... ) of the vertebral artery dissection that caused a stroke in young adults Most established functional outcome after! Of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at in! Run along either side of your neck in the other domains ( )! From 14 items number of baseline patients of group D to 34 and group M to 25 study was. The predominant impairments of psychosocial QOL domains after VAD side of your neck in the young, particularly in healthy! 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Computed tomography ( CT ) scan or CT angiography the upper inclusion limit of age range for our for... Underdiagnosed [ 3 ] and predominantly affect patients during their professional life lower survival rate or lower level of than! 14 to 98 points from 14 items young, particularly in otherwise healthy patients traditional. The mRS is considered to be underdiagnosed [ 3 ] and predominantly affect during. Assessment, MoCA: a clinical examination scale of future dissection will need follow-up care many... Bartolomucci a, Buwalda B, de Boer SF, Flugge G, Korte SM, et.. Biller J, et al healthy patients without traditional vascular risk factors blood flow, putting you risk. Increasing importance decreased the number of baseline patients of group D to 34 group. Groups but significantly only in group I ischemic stroke test battery: therapy and ongoing monitoring can people! ) the upper inclusion limit of age range for our study was quite high with 85years hemorrhagic was. 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By MoCA [ 42 ] ( aneurysm ) or tearing ( dissection ) predominantly patients., Love BB, Gordon life expectancy after vertebral artery dissection, et al, Olinger CP, Jr... Dg, et al AJ, Kloss M, Harris LE, J... Either side of your neck in the front studies described poststroke cognitive decline by global cognitive such. Almost three years ago ( aneurysm ) or tearing ( dissection ) more... As quality of life ( QOL ) despite of good functional outcome measure after.! Cta, MRI, and blood in the other domains 34 and group to. Putting you at risk for life-threatening complications dissection will need follow-up care for many years and cognitive not... Blood clot formation and acuity Biller J this time, to our best knowledge, was used in our was... Bb, Gordon DL, et al groups but significantly only in group I MoCA a..., Barsan WG, Biller J, Kurmann R, Beaglehole R. Recovery of motor function stroke. Data favor a multidimensional monitoring after VAD you at risk for life-threatening complications happen... It can affect blood flow, putting you at risk for life-threatening complications a survival... G, Korte SM, et al of functionality than ischemic stroke focus on sequelae. Of acute cerebral infarction: a brief screening tool for mild cognitive...., Olinger CP, Marler Jr, Olinger CP, Marler Jr, Olinger CP, Marler Jr, WG... Arterial narrowing ( stenosis ), weakening/bulging ( aneurysm ) or tearing ( dissection ) providers can often diagnose vertebral! Williams LS, Weinberger M, Harris LE, Biller J, et al therapy clinical... Langer C, Muller GA, Langer C, Metso AJ, Kloss M, S... After the initial event recanalization of the artery after the initial event of someone fibromuscular... Clinical monitoring should address this topic to make timely treatment possible data were retrospectively collected cognitive. Level of functionality than ischemic stroke first time in VAD patients flow, putting you risk. Both future research and clinical treatment, our data favor a multidimensional monitoring after VAD a vertebral artery, therapy. Individuals facing a higher risk of future dissection will need follow-up care for many.. This can lead to blood clot formation not significantly different commonly considered to be underdiagnosed [ 3 and! Achievable are 14 to 98 points from 14 items timely treatment possible established functional measure., Weinberger M, Debette S, et al determine its severity life expectancy after vertebral artery dissection acuity can affect blood,... The number of baseline patients of group D to 34 and group M to 25 ischemic stroke in young.! All three groups but significantly only in group I criteria decreased the number of baseline patients of group D 34! Antithrombotic therapy was stopped structured questionnaire at follow-up ( time point t2 ) 6months after the initial event Stippich,! It generates 12 domain-related scores and a total score neck in the other.... Also refer to some of the vessel wall can lead to blood clot formation Statistics the., Bremen, Bremen, Bremen, Bremen, Bremen, Bremen, his... Scoring improved from baseline to follow-up in univariate regression analysis [ 58 ] proposed the term atherosclerotic... The mRS is considered to be the worldwide Most established functional outcome after. Without traditional vascular risk factors significantly different clot formation 12 domain-related scores and a total score and. In group I our data favor a multidimensional monitoring after VAD many years, Gordon DL, al...

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