Does the cerebellum contribute to specific aspects of attention? 2. (2014) [46]. Despite obvious overrepresentation of elderly VAD patients and the need for confirmation of our results by larger studies, the main findings are in line with all three younger aged study cohorts that were previously examined for health related QOL after cervical artery dissection as discussed above: (1) Significant percentage of patients with bad QOL (SS-QOL scoring) despite good functional outcome (mRS sccoring) - Fischer et al. One main finding was the high prevalence of reduced QOL despite good mRS (02) in about 40% (n=13) of our VAD patients at follow-up in line with the findings of the observational series Czechowsky et al. Apart from (1) the computer-based test battery for alertness, divided and selective attention (TAP) [24], all other tests were paper and pencil tests: (2) Trail Making Test (TMT A and B) for combined attention and executive function [25], (3) the Tower of London (TL-D) for executive function [26], (4) mental rotation (LPS 7) for visual-spatial function [27], (5) the Five-Point Test (5PT) for spatial-cognitive function [28], (6) the Regensburger Wortflssigkeitstest (RWT) for verbal fluency [29], (7) Verbal Learning and Memory Test (VLMT) [30], (8) Block tapping (BT) for the visual digit span [31] and (9) the Finger Tapping Test (FTT) for the hand motor function [32]. Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR). CADISS Trial Investigators. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. 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. (2009) [6]. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Google Scholar. At follow-up assessment, group M showed the best distribution of mRS scores in direction to better ones and group D the worst with a significant higher mean score of mRS. Group-related changing in mRS scoring between time points t1 (baseline) and t2 (6months follow-up), group D patients with dissection; group I patients with ischemia without dissection; group M stroke mimics; mRS modified Rankin Scale; n. s. not significant, * significant difference. Incidence and outcome of cervical artery dissection: a population-based study. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. 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%). Comparison of cognitive baseline profiles of the three groups revealed no significant differences. 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. 1980;137(5):53544. Google Scholar. Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. Lancet Neurol. 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. 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. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. Cookies policy. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. J Abnorm Psychol. 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. (1987) [33] and Wahlund et al. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. 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. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. 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. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. (2009) [6]. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. (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. 2008;28(6):171128. 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]. Kwa VI, Limburg M, de Haan RJ. WebThe vertebral arteries are part of the circulatory system. Gttingen: Hogrefe Verlag; 1983. (2015) [61] reported that older stroke patients in general have worse prestroke status, greater impairment on hospital admission, more comorbidities and poorer poststroke functional status than the younger patients but can benefit as much as the young from high-intensity neurorehabilitation. Thirteen of these patients (40.6%) showed a bad quality of life (SS-QOL3.9) despite good functional outcome (mRS 02) and likewise thirteen (40.6%) a good quality of life (SS-QOL4.0) combined with a good functional outcome (mRS 02). Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. Ischemic stroke was found in only 33.9%. The aim of this study was therefore as follows: (1) to evaluate the characteristics of patients after VAD with special focus on those with bad quality of life despite good functional outcome in comparison with positive and negative control patients in a prospective comparative study design (2); to identify contributing factors to quality of life after VAD, considering neurological, cognitive, and psychological variables (3); to identify the predictive factors for quality of life after VAD. MH contributed to the experimental design, data analyses and manuscript writing. 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. 1988;19(12):1497500. The clinical application of the biopsychosocial model. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the 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. 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. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). 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. (2018) [38] reported more recently in their observational cohort study on patients with cervical, mainly carotid artery dissection, that numerically, but not statistically significant more patients with combined endovascular therapy (EVT)/intravenous thrombolysis (IVT) had excellent outcome and arterial recanalization than patients treated with EVT only. BMC Musculoskelet Disord. We do not endorse non-Cleveland Clinic products or services. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. Privacy CAS No individual persons personal details, images or videos are being used in this study. (2009) [6], mean age 46years, Czechowsky et al. volume19, Articlenumber:312 (2019) 1977;86(2):10326. Cervical artery dissection: trauma and other potential mechanical trigger events. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. 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. 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]. Although specific information about overall life expectancy after aortic dissection repair is not available, a recent study from the International Registry of Acute Aortic Dissection reported that about 85% of patients who have undergone successful repair of acute dissection involving the ascending aorta remain alive at 5 years. 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