WebWhat is the life expectancy of someone with fibromuscular dysplasia? 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). 2010;17(2):21925. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. As the key finding, our subgroup analysis of these VAD patients showed significantly higher levels of posttraumatic stress symptoms (p=0.002) and of pre-baseline anxiety symptoms (p=0.006) being associated with patients with good functional outcome (mRS02) and bad QOL compared to those with good functional outcome (mRS 02) and good QOL. Zubin J, Spring B. The study protocol was approved by the Local Ethics Committee of the University of Bremen. 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. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study, https://doi.org/10.1186/s12883-019-1541-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. Magnetic resonance angiography is the gold standard diagnostic test. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. 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. It may also occur with sudden neck movements and trauma. J Neurol. At first I just had a very bad neck pain, couldn't move it much. 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. 2005;1(1):5968. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. BMC Neurol 19, 312 (2019). More importantly, however, our study showed also several limitations. Differences in baseline or follow-up characteristics between the three groups (D, I, M) were analyzed with Chi-square tests for categorical and with Kruskal-Wallis-test (H-test) for metric variables. Cervical artery dissections typically heal very well, returning the vessel to normal. This process usually occurs within the first three to six months. Whats it like living with a cervical artery dissection? Youll need regular monitoring, including imaging studies, until healthcare providers confirm the dissection has healed. Brain. Aortic dissection is life-threatening. Aschenbrenner S, Tucha O, Lange KW. Czechowsky et al. Thomas LC, Rivett DA, Attia JR, Levi CR. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. The majority of dissected arteries showed (subtotal) occlusion (n=25; 67.6%) or stenosis (n=8; 21.6%), the remaining ones no stenosis at all (n=4, 10.8%). In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. Otherwise, antithrombotic therapy was 2009;40(2):5306. 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. Eur Heart J 2021;42:3825-3828. Subgroup analysis stratified for QOL by Stroke Specific Quality of Life Scale (SS-QOL) were done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 02). They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. His troponin was elevated at 0.094ng/mL. 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. 2008;28(6):171128. 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. Am J Psychiatry. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. Turm von London Deutsche Version. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. It comprised standardized self-rating protocols for neurostatus (mRS), stroke specific QOL and posttraumatic stress symptoms, and in addition open questions for the clinical course. Monitoring typically includes magnetic resonance angiography every three to six months. Second, apart from elevated scores of stress symptoms, significantly higher scores of pre-baseline symptoms of anxiety were found which might be indicative for a predisposing vulnerability for anxiety disorders and subtypes like (subthreshold) posttraumatic stress disorder. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. At least 90 percent of adults with FMD are women. Ischemic stroke was found in only 33.9%. Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. Individuals facing a higher risk of future dissection will need follow-up care for many years. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. statement and J Psychiatr Res. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. (2014) [46], mean age 44.8years. (2002) [5] and Fischer et al. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. A dissection is a tear in one or more tissue layers that make up your vertebral artery. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study Horn W. L-P-S Leistungsprfsystem. The senior age of VAD patients may have several important implications for social life. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Brain and intelligence: a quantitative study of the frontal lobes. Part of Springer Nature. 2014;23(2):33542. We do not endorse non-Cleveland Clinic products or services. Youll need regular monitoring until healthcare providers confirm that healing has taken place. 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. Definitions for use in a multicenter clinical trial. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. Anasthesiol Intensivmed Notfallmed Schmerzther. 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). Third, apart from elevated scores of stress symptoms significantly lower scores of the SS-QOL item self-confidence within the domain mood were found at follow-up. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. 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. It contains 49 items belonging to 12 domains. Bern: Verlag Hans Huber; 2000. Gttingen: Beltz Test GmbH; 2001. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Cervical artery dissection: trauma and other potential mechanical trigger events. This process usually occurs within the first three to six months. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. 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]. CADISS Trial Investigators. 1980;137(5):53544. AJR Am J Roentgenol. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. Google Scholar. 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). RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. Accurate and prompt diagnosis of this condition is crucial because timely and appropriate therapy can significantly reduce the risk of stroke and long-term sequelae. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. Article This option is also for people with hemorrhagic stroke. Nearly all other potential contributing factors were not significantly different. Data about pathological results of neuropsychological test battery assessment. What symptoms/pain did you experience? Events most commonly occur in the postpartum period The role of cognitive impairment in the quality of life after ischaemic stroke. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. Third, psychological condition was not examined at baseline. Herzogenrath: Vera Fimm; 2009. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. 8. CAS (2009) [6], mean age 46years, Czechowsky et al. Plank position (but otherwise safe to participate in yoga or Pilates). Differential features of carotid and vertebral artery dissections: the CADISP study. 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. But timely treatment, typically blood thinners or a procedure, can save your life. Cerebrovasc Dis. They carry blood to the brain and spinal cord, which are part of the nervous system. 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. 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