life expectancy after vertebral artery dissectionlife expectancy after vertebral artery dissection

Individuals facing a higher risk of future dissection will need follow-up care for many years. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. The stroke happened about a month after she was diagnosed with EDS. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Stroke. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. Chicago: University of Chicago Press; 1947. Knecht 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). 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. Horn W. L-P-S Leistungsprfsystem. Neurology. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. The authors declare that they have no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Your healthcare provider may recommend alternative treatments. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. Zubin J, Spring B. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. I was unable to return to work for three months. Stroke. (2004) [45]. (2008) [55], for example, prospectively studied 105 subarachnoid hemorrhage patients at 3 and 13months post-ictus and found that 37 % met the diagnostic criteria of PTSD. (2014) [46]. Lancet Neurol. 2023 BioMed Central Ltd unless otherwise stated. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. 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). A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. 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. Anasthesiol Intensivmed Notfallmed Schmerzther. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. The clinical application of the biopsychosocial model. A dissection forms when theres a tear in one or more of its three tissue layers. BMC Musculoskelet Disord. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. 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. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. Spontaneous dissections have been reported. A Spearmans rank correlation analysis was performed for outcome-relevant variables. 2001;344(12):898906. (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. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. They finally hypothesized that the rate of incidence must be equal throughout life. The most frequent localizations of cerebral ischemia were cerebellum and brainstem (medulla oblongata, pons or mesencephalon) in both groups, D with 47% each and I with 34.2 and 42.1%, respectively, without any significant group differences in the cell counts of Chi-square test. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. 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 VAD leads to impaired QOL at 6months follow-up due to multiple factors. For more extensive testing, a neuropsychological test battery was used with cognitive tasks of nine cognitive domains with possible reference to cognitive functions of the anatomical structures of the posterior circulation, in particular the cerebellum. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. Although MMSE and MoCA significantly correlated to our cognitive composite score (CCS), further analysis of neurocognitive domain deficits by neuropsychological test battery yielded only some trends of mean group values, without statistical significance. 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. Practicing yoga where hyperextension of your neck occurs. The role of cognitive impairment in the quality of life after ischaemic stroke. volume19, Articlenumber:312 (2019) Clinical monitoring should address this topic to make timely treatment possible. 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. Article The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. 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]. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Get useful, helpful and relevant health + wellness information. Other activities with rapid acceleration/deceleration changes. 2012;13:164. 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). Advertising on our site helps support our mission. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. 8. 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. 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. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. Tucson: Neuropsychological Press; 1985. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. 2006;66(4):5136. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. 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. Schievink WI. The diagnosis of VAD was based on typical findings such as intramural hematoma on axial cervical MRI, or string sign or long tapering stenosis on computer tomography (CT) / MRI angiography in accordance to Rodallec et al. Eur Stroke J. Vertebral artery dissection is a rare cause of stroke in older adults. Differential features of carotid and vertebral artery dissections: the CADISP study. Correspondence to Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. Article 1989;20(7):86470. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. 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. statement and Cervical artery dissection: trauma and other potential mechanical trigger events. Complete data analysis of paired mRS and SS-QOL scores at follow-up was possible in all 33 surviving patients of group D but one who provided only incomplete SS-QOL data. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. From October 1, 2010, to June 31, 2013, 42 consecutive patients with spontaneous first-time vertebral artery dissection (VAD), who were admitted to our hospital under the suspected diagnosis of an acute stroke, were registered and screened for this study. It contains 49 items belonging to 12 domains. 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). (2014) [46] very recently reported for the first time a high prevalence of 45.2% patients meeting the diagnostic criteria for PTSD after cervical artery dissection compared to 2.9% in the general German population. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. Epub 2015 Jun 5. 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. In addition, the autopsy findings of the 66years old patient with medulla oblongata infarction by VAD who deceased due to unexpected heart failure after baseline confirmed the diagnosis of VAD and support the validity of our data. (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. Vertebral artery dissection (VAD) is a rare cause of stroke in the general population; however, represents one of the more common causes of stroke in patients younger than 45 years of age. Because recurrence of stroke or dissection is very low despite a mostly lacking morphological artery recanalization and it is nearly limited to the first weeks after dissection, it was questioned by Leys and Debette (2006) [4] what are the appropriate clinical monitoring parameters for follow-up. Neurorehabil Neural Repair. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Google Scholar. 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