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. In contrast to the primary application of the English version to intensive care unit patients, the German version was recently validated for its use on a broader spectrum of patients [21]. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. 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. 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. While post-stroke anxiety [9] and depression [10] have been described already earlier, even depression in stroke patients treated and non-treated with intravenous thrombolytic therapy [51], posttraumatic stress disorder has been coming to attention more recently. A dissection is a tear in one or more tissue layers that make up your vertebral artery. 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). BMC Musculoskelet Disord. 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. J Neurol Neurosurg Psychiatry. All authors read and approved the final manuscript. 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. WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. 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). The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. 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. 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. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. Gttingen: Hogrefe Verlag; 1983. The role of cognitive impairment in the quality of life after ischaemic stroke. 2013;94(12):253541. Acta Anaesthesiol Scand. Neurorehabil Neural Repair. For the neuropsychological testing at baseline the longer established Mini-Mental State Examination (MMSE) [15] and the more sensitive Montreal Cognitive Assessment (MoCA) [23] were performed as cognitive screening tests in their German versions. 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). Traenka et al. Cervical artery dissection goes frequently undiagnosed. 1987;149(2):3516. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. (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. This risk decreases over time. Epub 2015 Jun 5. On rare occasions, this can lead to stroke. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. On rare occasions, this can lead to stroke. Later on, I began to have disturbances in my vision, ie. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. 2006;66(4):5136. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. MH contributed to the experimental design, data analyses and manuscript writing. Schievink WI. Rainer J. Strege. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. Their series comprised physically less affected patients, two-third after ICAD and one-third after VAD, with ischemic stroke in form of mainly small lesions in about one-third of cases only. Stroke. Neurological outcome and quality of life after stroke due to vertebral artery dissection. Finally, additional potential outcome-relevant lifestyle-factors such as nutrition and sports activity as well as social factors such as social networks and social support were not taken into account of this study. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. J Neurol. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. 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). 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. In addition, the extent of WML showed a significant inverse correlation to global cognitive functioning (MMSE, MoCA) in group D and partly (MoCA only) in group M. Finally, more extensive stroke lesions correlated very weakly with stronger neurological impairment (higher NIH-SS score at baseline) in group D and showed no other consistent correlations. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. 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. Gttingen: Hogrefe Verlag; 2004. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. In the SSQOL-subgroup analysis of patients with good functional outcome (mRS score2) and good SS-QOL score (4.0) at follow-up were eight patients with arterial occlusion or subtotal occlusion versus five with or without stenosis. Stress revisited: a critical evaluation of the stress concept. What symptoms/pain did you experience? Among 24 stroke mimics only two patients (8.3%) with mRS 02 reported a bad quality of life in contrast to 20 patients (83.3%) with mRS 02. grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). 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]. Stroke. Magnetic resonance angiography is the gold standard diagnostic test. Neurology. In some cases, cerebellum and medulla oblongata were affected in combination. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. Its signs and symptoms can be vague, and diagnosis can be elusive. The mean group values of single tests as well as of CCS showed at least clear trends of stronger cognitive impairments in group D and group I patients than stroke mimics regarding 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). Ischemic stroke was found in only 33.9%. Neurosurgery. Because data on the potential impact of infarct volume to outcome and QOL in VAD patients have been lacking so far, we used at least a very arbitrary method for semiquantitative evaluation of the extension of infarct lesions and were not able to ascertain any statistical association. This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). CADISS Trial Investigators. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. 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