Stress revisited: a critical evaluation of the stress concept. Table4 shows univariate linear regression analysis demonstrating that neurocognition scores at baseline (MMSE, MoCA, CCS), neurostatus at baseline (NIH-SS score on admission, mRS score) and stress symptoms at follow-up (PTSS-14 score) were predictors of quality of life at follow-up. 2010;17(2):21925. 2011;77(12):117481. 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. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. It can affect blood flow, putting you at risk for life-threatening complications. 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. Auflage. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). 2014;45(11):33606. But timely treatment, MMSE and MoCA inversely cross-correlated with NIH-SS scores in group D with weak significance, MoCA scoring with NIH-SS also significantly in group I, and MMSE scoring with NIH-SS only non-significantly in group I. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. Vertebral artery dissection is a rare cause of stroke in older adults. Google Scholar. Correspondence to You can still exercise but should avoid the following: Vertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. The overrepresentation of elderly patients in our study may be most probably explained to some extent by a hospital-based selection bias: (1) Patients were recruited when referred to the supraregional stroke unit of our teaching hospital. Zubin J, Spring B. 88.2% of patients with VAD suffered from acute cerebral ischemia. Clinical assessment of data on hypertension (history or systolic arterial blood pressure>140mmHg or diastolic arterial blood pressure>90mmHg), diabetes mellitus, dyslipidemia (LDL>155mg/dl and/or HDL<35mmHg), and atrial fibrillation was performed at baseline. 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. 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. Get useful, helpful and relevant health + wellness information. 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. 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. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a 2008;63(6):1095104 discussion 04-5. They included benign paroxysmal positional vertigo in 40%, vestibular neuritis in 24%, vestibulocochlear irritation in 4%, Schwannoma in 4%, suspected somatoform dizziness in 8% and nonspecific dizziness of unknown origin in 16%. A dissection is a tear in one or more tissue layers that make up your vertebral artery. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. It has been already earlier demonstrated in both patients with stroke and patients with Parkinsons disease that the type of psychosocial alterations, psychosocial adaptation and coping strategies seem to be of much greater impact than the degree of physical impairment [56]. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. J Neurol Neurosurg Psychiatry. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. 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). National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. Events most commonly occur in the postpartum period BMC Musculoskelet Disord. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. Living With Whats it like living Neurosurgery. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Magnetic resonance angiography is a sophisticated test thats not widely available. 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. 2006;37(10):2499503. Psychosom Med. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). The mRS is considered to be the worldwide most established functional outcome measure after 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%). (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. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. 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. J Am Geriatr Soc. 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. Cervical artery dissection goes frequently undiagnosed. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). WebA vertebral artery dissection is not what youd expect at 35 years young. 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). Cookies policy. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. The stroke happened about a month after she was diagnosed with EDS. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Thomas LC, Rivett DA, Attia JR, Levi CR. This option is also for people with hemorrhagic stroke. Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. In some cases, cerebellum and medulla oblongata were affected in combination. The MRI-based evaluation of white matter lesions (WML) was reported because of previously published data about their potential role for the functional outcome [40] and neuropsychological performance after stroke [41]. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. 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. 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. J Abnorm Psychol. 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]. 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. These are typically among the first tests people receive. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. Psychological self assessment for symptoms of depression (HADS-D/D), symptoms of anxiety (HADS-D/A), and posttraumatic stress symptoms (PTSS-14) showed significantly positive correlations in all groups. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. (2004) [45]. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. 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. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. 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. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. RK contributed to the experimental design and manuscript writing. All data were prospectively collected from consecutively recruited patients who were admitted to our stroke unit under the suspected diagnosis of an acute stroke between October 2010 and June 2013. In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. In this context the following aspects seem to be worthy to note: First, elevated scores of stress symptoms were also found in patients without any stroke lesion in our study in line with other study results [50]. Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. Thus, the present investigation has to be characterized as an explorative study. 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. This difference was not statistically significant (p<0.05). Stroke. Predictors for QOL at follow-up were analyzed by regression model. Herzogenrath: Vera Fimm; 2009. Your healthcare provider may recommend alternative treatments. Quality of life in survivors after cervical artery dissection. The following are key points to remember from this Viewpoint article on physical activity and exercise in patients with spontaneous coronary artery dissection (SCAD) and fibromuscular Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. 2014;76(9):6707. They showed ischemic stroke lesions in the majority of cases (73.6%) like the patients of group I (86.8%), larger than 10mm in maximal diameter in 67.6% versus 76.3%, respectively, as shown in Table2. Provided by the Springer Nature SharedIt content-sharing initiative. Neurological outcome and quality of life after stroke due to vertebral artery dissection. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. At least 90 percent of adults with FMD are women. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. 2006;67(10):180912. 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]. Web2. WebThe vertebral arteries are part of the circulatory system. 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. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. All participants have given written informed consent. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Data about pathological results of neuropsychological test battery assessment. J Neurol. From October 1, 2010, to June 31, 2013, 42 consecutive patients with spontaneous first-time vertebral artery dissection (VAD), who were admitted to our hospital under the suspected diagnosis of an acute stroke, were registered and screened for this study. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. 2009;8(7):66878. 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. The challenging main consequence from our study regarding this older age group of VAD patients might be therefore for the treating physician to make the right decision: When to consider (re-)dissection stroke and when to consider neuropsychiatric sequelae, for example. It contains 49 items belonging to 12 domains. (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. (2009) [6], mean age 46years, Czechowsky et al. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. J Stroke Cerebrovasc Dis. Accurate and prompt diagnosis of this condition is crucial because timely and appropriate therapy can significantly reduce the risk of stroke and long-term sequelae. Three cohorts of consecutive patients were included in the study for the purpose of comparison: group D (dissection) as the main group comprised patients with first-time spontaneous vertebral artery dissection (VAD) of at least one vertebral artery, group I (ischemia) as a positive control group consisted of patients with acute cerebral ischemia such as stroke or transient ischemic attack (TIA) of the posterior circulation due to any other cause than dissection, and group M (mimics) was chosen as a negative control group of stroke mimics of the posterior circulation. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. I was unable to return to work for three months. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Speck et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. 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]. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. 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