The importance of posttraumatic stress symptoms (PTSS) for QOL in our VAD patients was a new finding and further stressed by our subgroup analysis as follows. 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. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. Neurology. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. 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. 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). Thomas LC, Rivett DA, Attia JR, Levi CR. 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. A Spearmans rank correlation analysis was performed for outcome-relevant variables. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. Gttingen: Hogrefe Verlag; 2000. Williams LS, Weinberger M, Harris LE, Biller J. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. PubMed The study protocol was approved by the Local Ethics Committee of the University of Bremen. 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]. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. 2006;66(4):5136. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. Spontaneous dissection of the carotid and vertebral arteries. Events most commonly occur in the postpartum period This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. BMC Neurology VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. While the mean group values of MMSE around 28 out of 30 were within normal range, only the group of stroke mimics showed a normal mean value of 26.96 if scored by MoCA. Another 66years old patient with medulla oblongata infarction deceased due to nonspecific heart failure and was lost for follow-up; in group I one stroke and two myocardial infarcts occured; group M remained without any vascular event. Disabil Rehabil. 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. Administration, norms, and commentary. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. 1993;24(1):3541. 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). 2003;41(11):145260. Likewise, functional impairment measured by mRS at follow-up significantly correlated with reduced SS-QOL at follow-up in concordance with the results of the mixed cervical artery dissection series of Fischer et al. Practicing yoga where hyperextension of your neck occurs. (2002) [5] and Fischer et al. 2008;63(6):1095104 discussion 04-5. 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. https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. 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). Patients with suspected cervical artery dissection received additional angiography, mainly MRI angiography, if there has not been already evident cranial computer tomography or even conventional angiography. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. The hospital anxiety and depression scale. Magnetic resonance angiography is a sophisticated test thats not widely available. Arch Phys Med Rehabil. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. Stroke. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. Apart from severity of neurological disorders, as scored by mRS, and impaired neuropsychological performance at baseline, as measured by global cognitive screening in form of MMSE, elevated posttraumatic stress symptoms levels, as assessed by Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14), proved to be an independent predictor for reduced QOL at follow-up in group D patients after VAD according to multivariate regression analysis. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. 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. That is in particular striking regarding VAD. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Am J Psychiatry. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Thus, reduced neurocognition and neurostatus at baseline and increased scoring levels for stress symptoms at follow-up were predictive for reduced quality of life at follow-up in patients with VAD in this regression model. J Neurol. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. 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. Monitoring typically includes magnetic resonance angiography every three to six months. 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. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. 2001;344(12):898906. J Neurol. Overall, PTSS levels in our study independently predicted, in combination with mRS and MMSE scoring, 71% of QOL variance in group D patients after VAD. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Magnetic resonance angiography is the gold standard diagnostic test. Manage cookies/Do not sell my data we use in the preference centre. WebA vertebral artery dissection is not what youd expect at 35 years young. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. (1987) [33] and Wahlund et al. 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. 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. 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. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Vertebral artery dissection is a rare cause of stroke in older adults. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. FMD is usually a life-long condition. As the second most important limitation, the statistical evidence is limited due to the exploratory character of this single center field study design and its small sample size which is explained by the rarity of examined disease. The vertebral arteries have many small branches. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. Czechowsky D, Hill MD. Jokinen et al. Google Scholar. They finally hypothesized that the rate of incidence must be equal throughout life. 2009;256(3):4439. The use of the German version in this study was authorized by their authors (pers. Participants were examined for psychological, cognitive and neurological variables with special reference for functional outcome as well as quality of life 6months after the index event. Was performed for outcome-relevant variables of life after stroke: a brief screening tool for mild cognitive impairment Exercise patients... 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