PubMed Does the cerebellum contribute to specific aspects of attention? They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. Every pathological result, that is a value below one standard deviation, in one of the nine above mentioned cognitive function test domains was transposed to a cognitive composite score for each individual for the purpose of interindividual comparison. His troponin was elevated at 0.094ng/mL. 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). 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). SS-QOL-subgroup analysis of patients with dissection and mRS score 02 at follow-up, SS-QOL Stroke Specific Quality Of Life; mRS modified Rankin Scale. PubMedGoogle Scholar. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. Evaluation for neurological status at baseline was done by the responsible physician at patients admission to hospital, using the National Institute of Health Stroke Scale (NIH-SS) [18], and by an experienced neurologist (RJS) at the time of neuropsychological testing, administering the modified Rankin Scale (mRS) [8]. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Cerebrovasc Dis Extra. (2014) [46]. Neurology. 1975;12(3):18998. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). The higher the score the more probable is a posttraumatic disorder. Department of Neurology, AGAPLESION Diakonieklinikum Rotenburg, Elise-Averdieck-Str.17, 27356, Rotenburg, Germany, Center for Cognitive Sciences, Department of Neuropsychology and Behavioral Neurobiology, University of Bremen, Hochschulring 18, D-28359, Bremen, Germany, You can also search for this author in (3) The upper inclusion limit of age range for our study was quite high with 85years. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. Turm von London Deutsche Version. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. But its still a dangerous situation. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. 2001;344(12):898906. Spontaneous dissection of the carotid and vertebral arteries. 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. Achievable are 14 to 98 points from 14 items. Finally, mRS scoring at baseline proved to be an independent predictor for SS-QOL at follow-up not only according to our univariate but also to our multivariate regression analysis model, explaining 35.9% of QOL variance according to our regression model. 2017;7(3):16572. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. (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. 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. 2009;8(7):66878. Apart from the limits of our measurement method, we assumed that the neuroanatomical function of the affected stroke area was much more important than the extension. 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]. Neurorehabil Neural Repair. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. The multivariate analysis of 126 patients with carotid and vertebral artery dissections in a retrospective study design showed that the variables stroke and arterial occlusion were independent factors associated with a poor outcome [37]. Not applicable. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. Cookies policy. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Auflage. 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. 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. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. Zimmermann PFB. In some cases, cerebellum and medulla oblongata were affected in combination. 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. Preceding correlation analyses in this study yielded significant correlations in between all neurocognitive measures such as MMSE, MoCA, and CCS at baseline and likewise in between both neurostatus measures such as NIH-SS on admission and mRS at baseline. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). 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. Stroke. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. By using this website, you agree to our The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. Fourth, maladaptive coping strategies were significant predictors for and associated with posttraumatic stress disorder in patients with cervical artery dissection in the study of Speck et al. The stroke happened about a month after she was diagnosed with EDS. 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. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. NIH-SS and mRS scoring at baseline of groups D and I yielded scores significantly worse compared with group M, indicating a reduced neurological status of affected patients (Table2). WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. Google Scholar. Another woman (47years old; locked in-syndrome due to pontine infarction by basilar artery occlusion due to vertebral artery dissection) and a man (77years old; dizziness, nausea, vomiting, headache, ataxia, facial weakness, dysarthria, dysphagia; combined medulla oblongata and cerebellar infarction) without a sufficient ability to speak for participating in neuropsychological testing. Knecht et al. Individuals facing a higher risk of future dissection will need follow-up care for many years. Two more men (46 and 56years old; one with bilateral embolic cerebellar and occipital brain infarctions by VAD plus ocular down-beat syndrome, unilateral motor dysfunction, dizziness, and headache; the other one with dizziness and ataxia due to suspected cerebral ischemia by VAD) wanted to cut their inpatient treatment short and not to participate but showed also contraindications in form of concurrent diseases: one developed bronchial carcinoma 4months later and brain metastases 8months later, then deceased, the other suffered from alcoholism and had a history of former bronchial carcinoma and prophylactic brain irradiation. These include vertebral and carotid arteries. 37 patients fulfilled the inclusion criteria and were included into the study as group D. In addition, 38 patients with acute stroke or TIA of the posterior circulation were included as comparison group I and 27 stroke mimics of the posterior circulation as comparison group M (Fig. Other sites of ischemia were occipital lobe in 17.6% of group D and 34.2% of group I, furthermore thalamus in 5.3% of group I. Ischemic stroke was found in only 33.9%. Magnetic resonance angiography is the gold standard diagnostic test. WebThe vertebral arteries are part of the circulatory system. Gttingen: Hogrefe Verlag; 1983. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. 1980;137(5):53544. Neurology. Clinical monitoring should address this topic to make timely treatment possible. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. Provided by the Springer Nature SharedIt content-sharing initiative. Article 2008;52(2):2028. When tics cause Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. Third, psychological condition was not examined at baseline. Cerebrovasc Dis. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. Performed by using the Wilcoxon-test koolhaas JM, Bartolomucci a, Buwalda B de. Artery dissections can be divided into two groups: extracranial dissection ( with or without intracranial )! 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