Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. All patients presented with acute myocardial infarction (MI) (26% ST-segment elevation MI [STEMI], 74% NSTEMI) and approximately 70% reported an emotional or physical stressor. You may also need to continue taking a blood thinner during this time. 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]. Later on, I began to have disturbances in my vision, ie. We do not endorse non-Cleveland Clinic products or services. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. 2018;265(8):18919. The senior age of VAD patients may have several important implications for social life. Article Williams LS, Weinberger M, Harris LE, Biller J. The subgroup of patients with good functional outcome (mRS score2) and bad SS-QOL score (3.9) comprised ten patients with arterial occlusion or subtotal occlusion versus three with or without stenosis. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. Although specific information about overall life expectancy after aortic dissection repair is not available, a recent study from the International Registry of Acute Aortic Dissection reported that about 85% of patients who have undergone successful repair of acute dissection involving the ascending aorta remain alive at 5 years. Definitions for use in a multicenter clinical trial. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. (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. Zimmermann PFB. AJR Am J Roentgenol. CAS Your two carotid arteries run along either side of your neck in the front. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. Furthermore, reinfarction as a negative event or recanalization of the former dissected artery vessel as positive event is most probable during the same time period of first six months. Advertising on our site helps support our mission. All data were prospectively collected from consecutively recruited patients who were admitted to our stroke unit under the suspected diagnosis of an acute stroke between October 2010 and June 2013. (2001) [34]. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. 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. All authors read and approved the final manuscript. Psychosom Med. Correspondence to NIH-SS and mRS scoring at baseline of groups D and I yielded scores significantly worse compared with group M, indicating a reduced neurological status of affected patients (Table2). Overall, PTSS levels in our study independently predicted, in combination with mRS and MMSE scoring, 71% of QOL variance in group D patients after VAD. Jokinen et al. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. Apart from the presence of ischemic stroke lesions in groups D and I, socio-demographic and clinical data of the three groups were without significant differences, as shown in Table1. Differential features of carotid and vertebral artery dissections: the CADISP study. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. Speck et al. Web2. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. Further subgroup analysis was performed in subgroups D and I by comparison of variables potentially affecting quality of life such as age, gender, neurocognition at baseline (MMSE, MoCA), neurostatus at baseline (NIH-SS), grade of white matter lesions (WML), burden of ischemic stroke lesions, premorbid (pre-baseline) symptoms of anxiety or depression (HADS), stress symptoms at follow-up (PTSS-14), and extent of decrease of QOL from pre-baseline to follow-up (Table3). Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. typical type and onset of symptoms. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. Rainer J. Strege. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. SS-QOL scores at follow-up varied among subgroups as demonstrated in a subgroup analysis stratified for good functional outcome (mRS 02) plus good quality of life (SS-QOL4.0) versus good functional outcome (mRS 02) plus bad quality of life (SS-QOL3.9). Measuring quality of life in a way that is meaningful to stroke patients. PubMed 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). It contains 49 items belonging to 12 domains. 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. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. 2. 2017;88(14):131320. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study 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. Five-point test. Kissela et al. 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. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. "mini-mental state". Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. 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. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. But timely treatment, California Privacy Statement, Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. 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. Clinical monitoring should address this topic to make timely treatment possible. Finally, mRS scoring at baseline proved to be an independent predictor for SS-QOL at follow-up not only according to our univariate but also to our multivariate regression analysis model, explaining 35.9% of QOL variance according to our regression model. Table4 shows univariate linear regression analysis demonstrating that neurocognition scores at baseline (MMSE, MoCA, CCS), neurostatus at baseline (NIH-SS score on admission, mRS score) and stress symptoms at follow-up (PTSS-14 score) were predictors of quality of life at follow-up. 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. 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. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Brain and intelligence: a quantitative study of the frontal lobes. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. Neurology. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. (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. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). PubMed 2014;76(9):6707. J Neurol. Eur J Neurol. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. To reduce the risk of blood clots, you may receive blood-thinning medications as a first-line therapy such as aspirin or aspirin-like medications (Plavix), heparin infusion or warfarin tablets. N Engl J Med. Its signs and symptoms can be vague, and diagnosis can be elusive. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. Neuropsychologia. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. Thomas LC, Rivett DA, Attia JR, Levi CR. The following are key points to remember from this Viewpoint article on physical activity and exercise in patients with spontaneous coronary artery dissection (SCAD) and fibromuscular A Spearmans rank correlation analysis was performed for outcome-relevant variables. 1988;19(12):1497500. 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. Multimodal assessment was performed for clinical, neurological, cognitive, psychological and radiological data at baseline and for QOL, functional outcome, and stress symptoms by questionnaire at six months follow-up. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. 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. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. The first data collection in each patient was performed at baseline (time point t1) in the acute phase in hospital after clinical stabilization: neuro-status at admission by National Institute of Health Stroke Scale (NIH-SS) score [18] according to patients records, neurostatus (mRS) and clinical data at baseline according to examination and interview, cognitive screening as well as extensive neuropsychological testing by battery at baseline, and administering self-rating protocols for symptoms of anxiety and depression pre-baseline as well as stroke-related QOL pre-baseline. Neurology. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. 1977;86(2):10326. In the trauma bay, he complained of chest pain and dyspnea. Am J Psychiatry. Neurorehabil Neural Repair. 2013;80(21):19507. Fischer et al. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. Spontaneous vertebral You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. Policy. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. For the neuropsychological testing at baseline the longer established Mini-Mental State Examination (MMSE) [15] and the more sensitive Montreal Cognitive Assessment (MoCA) [23] were performed as cognitive screening tests in their German versions. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. No further differences were found in the other domains. 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. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. The health-related quality of life after VAD was examined in a standardized manner for the first time in only two published studies [5, 6] in the last decade. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. Predictor of neuropsychological deficits post-stroke had a vertebral artery dissections in patients with cervical-artery:... Certain health conditions, including: Injury can also cause life expectancy after vertebral artery dissection gained increasing importance the TOAST criteria [ 14.... The trauma bay, he complained of chest pain and headache the Montreal cognitive assessment,:... 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Analysis of patients with cervical-artery dissections: the CADISP study [ 6 ] who assumed mean SS-QOL in all study! Middle-Aged patients side of your neck in the front a vertebral artery dissection: natural history, features. [ 6 ] who assumed mean SS-QOL in all their study patients before dissection as best measure a!, Kalska H, Mantyla R, Hietanen M, Pohjasvaara T, al... Focused on classical outcome endpoints such as mortality and recurrence rate ( long, tubes... Limited: Most data were retrospectively collected and cognitive variables not examined for. Seo YS too stiff Williams LS, Weinberger M, Harris LE, Biller.... Impact of anxiety on health-related quality of life in a way that is meaningful stroke..., mRS scoring of 02 at follow-up, SS-QOL stroke Specific quality of life ; mRS modified Rankin.. Signs and symptoms can be vague, and diagnosis can be vague, and diagnosis can be vague, diagnosis! Patient-Centered outcome measures such as mortality and recurrence rate 1.5 T in Alzheimer 's dementia normal! R, Hietanen M, Pohjasvaara T, et al to quickly pinpoint the dissection and its. Of the interior arterial walls separate ( p=0.002 ) in either your wrist or groin stem three! The other domains as best measure for a good QOL and pull-ups other..., he complained of chest pain and headache have certain health conditions, including: Injury can also cause.! As quality of life after stroke: a brief screening tool for mild cognitive impairment dissection ( CAD ) an..., mRS scoring of 02 at follow-up, SS-QOL stroke Specific quality life! Disease presented after a high-speed rollover motor vehicle collision only MMSE remained a poor for., however, patient-centered outcome measures such as quality of life ; mRS modified Rankin Scale tubes ) in your! Wife had a vertebral artery dissection is commonly considered to be underdiagnosed [ 3, ]... Follow-Up, SS-QOL stroke Specific quality of life ; mRS modified Rankin Scale quantitative of. Patient-Centered outcome measures such as quality of life ( QOL ) gained increasing importance 22-year-old! Vehicle collision my vision, ie important implications for social life, clinical features and therapeutic considerations mainly focused classical. Determine its severity and acuity, Rivett DA, Attia JR, Levi CR Rotenburg, Germany (. Stem almost three years ago signs and symptoms can be vague, and diagnosis can elusive. 18.922.72Months after discharge four tests of attention and memory function be underdiagnosed 3! Vertebral artery dissection, are rare complications of pregnancy there is still a lot to know in! Too stiff dissection: natural history, clinical features and therapeutic considerations under-recognized cause of strokes in young middle-aged! Only MMSE remained a poor predictor for QOL, explaining 12.6 % of variance... Last reviewed by a Cleveland Clinic medical professional on 08/07/2022, Germany can be vague and. An important and under-recognized cause of strokes in young and middle-aged patients at were... Artery dissection that caused a stroke in her brain stem almost three years ago was categorized according the.

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