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. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. Aortic dissection is life-threatening. While SS-QOL at follow-up was normal and corresponded to pre-baseline in stroke mimics, SS-QOL scores significantly worsened in group D and I patients, mainly in the psychosocial domains. 1999;53(8):183943. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. Individuals facing a higher risk of future dissection will need follow-up care for many years. J Neurol. (1987) [33] and Wahlund et al. Knecht et al. Ischemic stroke was found in only 33.9%. 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. Czechowsky et al. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. Psychological self assessment for symptoms of depression (HADS-D/D), symptoms of anxiety (HADS-D/A), and posttraumatic stress symptoms (PTSS-14) showed significantly positive correlations in all groups. The senior age of VAD patients may have several important implications for social life. However, you may be at risk for future dissections. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. AJR Am J Roentgenol. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. Chronic posttraumatic stress symptoms after nonsevere stroke. They carry blood to the brain and spinal cord, which are part of the nervous system. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. TOAST. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. 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. 2016;87(5):52630. Stroke. 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]. 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]. 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. MH contributed to the experimental design, data analyses and manuscript writing. Psychol Assess. Inpatient rehabilitation for several weeks was performed in 48.5% patients of group D, 60.5% of group I and in only one patient (4%) of group M. A change of employment at baseline to unemployment at follow-up was reported in 3 patients (9.4%) in group D, 5 patients (13.5%) in group I and 2 patients in group M. Figure2 displays group-related change of mRS scoring between baseline and follow-up: Mean mRS scores of about 2 at baseline were significantly higher (p<0.05) in group D and I in comparison to group M, reflecting a reduced functional status. 2006;22(23):215. 2004;251(10):12428. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. Procedures for vertebral artery dissection include: Most people make a full recovery. (2009) [40] reported that severe periventricular white matter disease was significantly associated with poor functional outcome at 3months after ischemic stroke, independently of other factors. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. But its still a dangerous situation. Among physical domains only the domain work showed also deterioration in groups D and I. You may need a procedure. 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. These are typically among the first tests people receive. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. In contrast to younger people who are supported by their also young family as well as the health system to achieve occupational reintegration as fast as possible, elderly people may be limited by less easy access to rehabilitation facilities, less support by potentially also disabled caregivers and, probably most important, by potential comorbidities and/or neurovascular risk factors. Cite this article. (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. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. All authors read and approved the final manuscript. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. But timely treatment, This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. 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. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Google Scholar. Vertebral artery hemodynamics can be evaluated by assessing: (1) the presence or absence of flow, (2) blood flow direction and alteration of the waveform shape, (3) vertebral artery size, and (4) the peak systolic and end-diastolic velocities. 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). When tics cause Schievink WI. The study protocol was approved by the Local Ethics Committee of the University of Bremen. GA compendium of neuropsychological tests. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. 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. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. Bern: Verlag Hans Huber; 2000. The multivariate analysis of 126 patients with carotid and vertebral artery dissections in a retrospective study design showed that the variables stroke and arterial occlusion were independent factors associated with a poor outcome [37]. 2008;63(6):1095104 discussion 04-5. J Stroke Cerebrovasc Dis. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. Aschenbrenner S, Tucha O, Lange KW. 2011;35(5):1291301. Am J Psychiatry. 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). Thus, the present investigation has to be characterized as an explorative study. Spontaneous vertebral Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. 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. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. The German version of the Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) [21] was used at follow-up to determine posttraumatic stress symptoms. bright spots on my Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. (2014) [46], mean age 44.8years. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Stress revisited: a critical evaluation of the stress concept. WebScore: 4.2/5 (61 votes) . Cookies policy. 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. 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. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Psychosom Med. 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. 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]. 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. Google Scholar. Kissela et al. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. A Spearmans rank correlation analysis was performed for outcome-relevant variables. 1997;19(1):612. 2003;250(10):117984. Neurology. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. 2013;80(6):78790. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. Their high PTSD prevalence might be overestimated because physically less affected people voluntarily participating in their study might have tended to mention more mental problems when asked by self-rating PDS. Other activities with rapid acceleration/deceleration changes. (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. 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. Speck et al. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Folstein MF, Folstein SE, McHugh PR. In addition to routine work a semiquantitative visual grading of white matter lesions (WML) from grade 0=no lesions to grade III=severe and diffuse white matter lesions was performed in each patient according to the criteria defined by Fazekas et al. J Neurol Neurosurg Psychiatry. Furthermore, some recently published data suggested for the first time a role of VAD-accompanied atherosclerosis as additional putative contributing factor to functional outcome at three months in posterior circulation stroke (PCS) patients [39]. 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). "mini-mental state". WebCervical artery dissections typically heal very well, returning the vessel to normal. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. 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. 2017;88(14):131320. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. 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. 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. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. 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