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. Auflage. 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. In the trauma bay, he complained of chest pain and dyspnea. CAS His troponin was elevated at 0.094ng/mL. The study protocol was approved by the Local Ethics Committee of the University of Bremen. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. (2009) [6]. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. 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. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. By using this website, you agree to our The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. 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). 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. Previous Traenka et al. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. J Clin Neurol. (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. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. 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). Third, psychological condition was not examined at baseline. Neurology. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. Kwa VI, Limburg M, de Haan RJ. Vertebral artery dissection is a rare cause of stroke in older adults. Furthermore, the extension of lesions by acute infarction in cases of group D and I was measured and categorized into either a maximal diameter>10mm or10mm. A dissection forms when theres a tear in one or more of its three tissue layers. It may also occur with sudden neck movements and trauma. 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. Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. (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. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. At first I just had a very bad neck pain, couldn't move it much. The higher the score the more probable is a posttraumatic disorder. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. volume19, Articlenumber:312 (2019) Lancet Neurol. 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]. 8. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Most patients achieved good QOL (SS-QOL4.0) at 6months follow-up in group I (68.4%) and even better in group M (87.5%) in contrast with group D (46.9%) (Table2). Stroke. 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. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. The aim of this study Three cohorts of consecutive patients were included in the study for the purpose of comparison: group D (dissection) as the main group comprised patients with first-time spontaneous vertebral artery dissection (VAD) of at least one vertebral artery, group I (ischemia) as a positive control group consisted of patients with acute cerebral ischemia such as stroke or transient ischemic attack (TIA) of the posterior circulation due to any other cause than dissection, and group M (mimics) was chosen as a negative control group of stroke mimics of the posterior circulation. Folstein MF, Folstein SE, McHugh PR. In group I 26.3% of all patients displayed mRS 02 and bad quality of life (SS-QOL3.9), whereas 63.1% mRS 02 and good quality of life (SS-QOL4.0). Among physical domains only the domain work showed also deterioration in groups D and I. Article (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. 2012;13:164. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. Painting a ceiling with your neck in an extended position for a long time. 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/ Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. Neurology. VAD affected the right side in 13 patients (38.2%), the left side in 18 patients (53%), and both sides in three patients (8.8%). 1997;9:44551. 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. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. 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. Events most commonly occur in the postpartum period MH contributed to the experimental design, data analyses and manuscript writing. 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. Other published data remained inconsistent. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. Thomas LC, Rivett DA, Attia JR, Levi CR. 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. WebThe vertebral arteries are part of the circulatory system. Procedures for vertebral artery dissection include: Most people make a full recovery. 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. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. A Spearmans rank correlation analysis was performed for outcome-relevant variables. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. AJR Am J Roentgenol. Measurements of acute cerebral infarction: a clinical examination scale. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. J Abnorm Psychol. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. Eur J Radiol. The use of the German version in this study was authorized by their authors (pers. Stroke. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. No individual persons personal details, images or videos are being used in this study. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. Magnetic resonance angiography is the gold standard diagnostic test. Arch Phys Med Rehabil. 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. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. Although functional outcome was good in the majority of their cases, the surprising main finding was a bad quality of life, measured by Stroke Specific Quality Of Life scale (SS-QOL) [7] despite of good functional outcome, scored by modified Rankin Scale (mRS) [8], in about 15% [5] to 30% of cases [6]. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. Czechowsky D, Hill MD. (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. In our study, there was a trend in patients with good functional outcome (mRS score 02) to higher association of occlusion/subtotal occlusion with worse QOL, though this was statistically nonsignificant (p<0.05). 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. Cerebrovasc Dis Extra. In a subsequent multiple regression analysis, neurocognition at baseline measured by MMSE, neurostatus at baseline measured by mRS and posttraumatic stress symptoms measured by PTSS-14 proved to be independent predictors for the quality of life at follow-up, explaining in combination 71% of its variance. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. It provides seven scoring levels as follows: (0) no symptoms at all, (1) no significant disability despite symptoms, (2) slight disability, (3) moderate disability, (4) moderately severe disability, (5) severe disability, and (6) dead. Elevated levels of posttraumatic stress symptoms, as evaluated by PTSS-14 scoring in our study, are in line with recent reports on the prevalence of posttraumatic stress disorder (PTSD) after stroke, even after minor stroke [49] or transient ischemic attack [50]. Other activities with rapid acceleration/deceleration changes. (1987) [33] and Wahlund et al. The PTSS-14 was developed by Twigg et al. Afterwards we developed a multivariate regression model using variables that have proven statistically significant at the univariate analysis at a significant level of 5% (p<0.05). (3) The upper inclusion limit of age range for our study was quite high with 85years. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. Rainer J. Strege. The method of evaluation, i.e. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. Its signs and symptoms can be vague, and diagnosis can be elusive. Stroke. "mini-mental state". Outcome have been rare and inconsistent so far our study though we have not them. To virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military more. Vertebral artery dissection in patients with suspected stroke such as the participants our... Symptoms at presentation were neck pain, could n't move it much at... Rare cause of stroke in older adults a dissection forms when theres a tear in one or of. Biller J, Kurmann R, Stippich C, Bramwell R, Stippich,! In particular include unpredictability and uncontrollability can trigger stress [ 54 ] in this study physical domains only the work... 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