The health-related quality of life regarding the week before baseline and at follow-up was assessed by the German version [22] of the Stroke Specific Quality Of Life Scale (SS-QOL) [7]. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. The stroke happened about a month after she was diagnosed with EDS. But timely treatment, The datasets used and analysed during the current study are available from the corresponding author on reasonable request. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. For the assessment of psychological variables several self-rating measurement tools were introduced: The German version of the Hospital Anxiety and Depression Scale (HADS) [20] was administered at baseline to determine the grade of symptoms of anxiety and depression in the week before baseline. 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]. 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. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. Other published data remained inconsistent. The inclusion criteria were (1) a reliable diagnosis, (2) age between 18 and 85years, and (3)] medically stable psychological and physical condition for testing, i.e. Am J Psychiatry. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. (3) The upper inclusion limit of age range for our study was quite high with 85years. 2005;1(1):5968. Web2. 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. In case of significant difference, a subsequent analysis between two group pairs was performed: For categorical variables the Chi-square test or Fishers exact test, if appropriate, and for metric variables the Mann-Whitney U-test was used with Bonferroni-correction of cumulative alpha-error. J Psychiatr Res. 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. His troponin was elevated at 0.094ng/mL. PubMed 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. 2017;88(14):131320. Factors affecting the quality of life after ischemic stroke: young versus old patients. It generates 12 domain-related scores and a total score. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Strauss E, Sherman EMS, Spreen O. 2023 BioMed Central Ltd unless otherwise stated. WebWhat is the life expectancy of someone with fibromuscular dysplasia? Stroke. Czechowsky et al. BMC Neurol 19, 312 (2019). Other sites of ischemia were occipital lobe in 17.6% of group D and 34.2% of group I, furthermore thalamus in 5.3% of group I. 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. Five-point test. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. J Am Geriatr Soc. Traenka et al. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. Most dissections heal on their own. Zubin J, Spring B. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. No individual persons personal details, images or videos are being used in this study. Differential features of carotid and vertebral artery dissections: the CADISP study. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. 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/ 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]. 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. (2014) [46]. 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. (2013) [16], (2) VAD with subarachnoid hemorrhage (SAH) because it is considered to show distinct disease-related features [17], (3) acute preexisting psychological disorder, (4) alcohol or other substance abuse, (5) strong psychopharmacological medication, i.e. Neurology. Kwa VI, Limburg M, de Haan RJ. Rainer J. Strege. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. Neurology. 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. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. The overrepresentation of elderly patients in our study may be most probably explained to some extent by a hospital-based selection bias: (1) Patients were recruited when referred to the supraregional stroke unit of our teaching hospital. 2004;251(10):12428. The hospital anxiety and depression 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. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Analysis of subscales demonstrated that a reduced quality of life at follow-up (SS-QOL3.9) in both subgroups (mRS 02) of group D and I corresponded to main impairments, that were significantly reduced mean values, in all psychosocial domains such as Thinking, Personality, Mood, Family Roles, Social Roles and Energy, as shown for subgroup D in Fig. Stress revisited: a critical evaluation of the stress concept. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. 1997;9:44551. J Neurol Neurosurg Psychiatry. Events most commonly occur in the postpartum period 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). At least 90 percent of adults with FMD are women. Blood in the separated layers of the vessel wall can lead to blood clot formation. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Neurology. The authors declare that they have no competing interests. Measuring quality of life in a way that is meaningful to stroke patients. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. Ahl et al. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. You can still exercise but should avoid the following: Vertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. 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. 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). Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. What symptoms/pain did you experience? 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. 2014;76(9):6707. The other variables showed no significant differences. Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. 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]. Vertebral artery dissection is a rare cause of stroke in older adults. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. When starting the present study, however, the knowledge about the putative contributing role of cognitive as well as psycho-affective factors to QOL in VAD patients was lacking. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. 88.2% of patients with VAD suffered from acute cerebral ischemia. 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. 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. (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. Eur Stroke J. Cleveland Clinic is a non-profit academic medical center. In general, various factors have been shown to influence the QOL of patients after stroke without dissection, including post-stroke anxiety [9], depression [10] and cognitive impairment [11]. 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