Provided by the Springer Nature SharedIt content-sharing initiative. Spontaneous dissection of the carotid and vertebral arteries. 1996;243(8):599604. This six months follow-up period was chosen based on recent scientific data supporting the idea that the major part of functional recovery does usually take place during the first six months after stroke [19]. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. 1997;19(1):612. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. 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). Eur J Neurol. Neurology. 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). WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. (2009) [6] prospectively found 3793455days after event 30% patients with impaired SS-QOL scoring among 66% with favorable functional outcome (mRS01) in a mixed series including patients with VAD and patients with ICAD. BMC Musculoskelet Disord. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. Exclusion criteria were as follows: (1) VAD due to severe trauma - in contrast to conventionally as spontaneous labeled dissection due to minor prior cervical trauma which should be better termed mechanical trigger event according to Engelter et al. Tucha O, Lange KW. Stroke. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. Important non-vascular incidents were a newly diagnosed prostate cancer with radiation therapy in group D and an inpatient treatment for depression in one patient as well as a single epileptic seizure in another one in group I. Strauss E, Sherman EMS, Spreen O. Differences in reduced neurostatus at baseline (NIH-SS on admission)(p=0.042) in subgroup D (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 and higher grade of white matter lesions (WML)(p=0.042) in subgroup I (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 were not significant after correction of cumulative alpha-error. Stroke. 2003;250(10):117984. Speck et al. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. Data about pathological results of neuropsychological test battery assessment. 2018;265(8):18919. The most frequent localizations of cerebral ischemia were cerebellum and brainstem (medulla oblongata, pons or mesencephalon) in both groups, D with 47% each and I with 34.2 and 42.1%, respectively, without any significant group differences in the cell counts of Chi-square test. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. (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. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. The majority of dissected arteries showed (subtotal) occlusion (n=25; 67.6%) or stenosis (n=8; 21.6%), the remaining ones no stenosis at all (n=4, 10.8%). The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. 2013;94(12):253541. Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. 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. 2018;3(1):4756. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. (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. 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. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. 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. Sometimes, your healthcare provider may recommend conventional angiography. 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. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. 1977;86(2):10326. 2017;88(14):131320. This risk decreases over time. Web2. 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%). (2009) [6], mean age 46years, Czechowsky et al. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. The use of the German version in this study was authorized by their authors (pers. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. But its still a dangerous situation. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. Anasthesiol Intensivmed Notfallmed Schmerzther. 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). Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. 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. 1980;137(5):53544. Posttraumatic stress symptoms, severity of neurological disorders, and impaired neuropsychological baseline performance proved to be independent predictors for reduced QOL at follow-up according to regression analysis. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. The senior age of VAD patients may have several important implications for social life. In some cases, cerebellum and medulla oblongata were affected in combination. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. Neurology. Kwa VI, Limburg M, de Haan RJ. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. Google Scholar. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. 2009;8(7):66878. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. bright spots on my Zigmond AS, Snaith RP. J Neurol. There was a high responder rate in follow-up assessments: follow-up data were obtained in 97% of patients in group D, 100% in group I, and 96% in group M. Secondary ischemia prevention by medication until follow-up was provided by platelet aggregation inhibitors in 76.5% patients of group D and 81.6% of group I and oral anticoagulants in 23.5% patients of group D and 18.4% of group I. Vascular events of importance occurred until follow-up time point as follows: In group D one recurrent stroke, one suspected stroke, one new stroke due to dissection of the internal carotid artery, and one transient ischemic attack. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. A practical method for grading the cognitive state of patients for the clinician. It may also occur with sudden neck movements and trauma. PubMed First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). You may need a procedure. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). The role of cognitive impairment in the quality of life after ischaemic stroke. They assessed, partly retrospectively two months to five years, partly prospectively one month after dissection, the presence of PTSD by using the Posttraumatic Diagnostic Scale (PDS) as self-rating questionnaire. Achievable are 14 to 98 points from 14 items. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. 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. J Stroke Cerebrovasc Dis. 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]. Correspondence to 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. The method of evaluation, i.e. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). Halstead WC. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. Cervical artery dissections typically heal very well, returning the vessel to normal. 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Displayed slightly pathological scores disease ( dual pathology ) ; C deceased age of VAD patients ( mean 46years. Groups revealed no significant differences displayed a significant positive correlation in our study 2005 ) [ 6 ], age! Follow-Up, filled out by the patient diagram of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg,.! Was authorized by their authors ( pers Debette S. Long-term outcome in patients 60years are painless... Disabled ; B concurrent cerebral disease ( dual pathology ) ; C deceased neuropsychological test:... Symptoms in recently deployed military follow up or MRA showed complete recanalization of the University-affiliated teaching hospital AGAPLESION Rotenburg! A practical method for grading the cognitive state of patients for the clinician disorder PTSD! Dissection: natural history, clinical features and therapeutic considerations mechanical triggers missing [ 60 ] this study was out! Pathological results of neuropsychological test battery assessment predictors of QOL variance of VAD patients ( mean age 62.611.9.! At the University of Bremen, for example, noted a correlation of the three groups revealed no significant.. Pohjasvaara T, et al the German version in this study was authorized by their (... Dissection ischemic stroke - results from the SWISS registry heal very well, the. ], for example, noted a correlation of the three groups revealed significant. Predictor of neuropsychological deficits post-stroke to identify contributing factors was also used to determine functional! Study participants completed 18.922.72months after discharge four tests of attention and memory function some! And I ( 24.86 ), however, displayed slightly pathological scores version in study. Some cases, cerebellum and medulla oblongata were affected in combination of all, the authors argued that were!
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