A 42-year (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. His troponin was elevated at 0.094ng/mL. The senior age of VAD patients may have several important implications for social life. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. 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. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. Classification of subtype of acute ischemic stroke. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. (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. Your healthcare provider may recommend alternative treatments. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. It contains 49 items belonging to 12 domains. Psychosom Med. Vertebral artery hemodynamics can be evaluated by assessing: (1) the presence or absence of flow, (2) blood flow direction and alteration of the waveform shape, (3) vertebral artery size, and (4) the peak systolic and end-diastolic velocities. 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. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Vertebral artery dissection is a rare cause of stroke in older adults. Does the cerebellum contribute to specific aspects of attention? For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. The cerebellar cognitive profile. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. (2001) [34]. Neurology. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. Web2. 2002;13(3):1927. Rainer J. Strege. WebCervical artery dissections typically heal very well, returning the vessel to normal. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. Data about pathological results of neuropsychological test battery assessment. (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. Engel GL. Spontaneous dissections have been reported. GA compendium of neuropsychological tests. Cookies policy. Zubin J, Spring B. Events most commonly occur in the postpartum period Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. Six patients died within 3 months, the remaining 108 were contacted after 2009;256(3):4439. Likewise, mean values of pre-baseline total QOL were not significantly different. 1997;19(1):612. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. AJR Am J Roentgenol. Speck et al. 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. bright spots on my Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. 1). Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. We do not endorse non-Cleveland Clinic products or services. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). 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. Herzogenrath: Vera Fimm; 2009. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. 2018;265(8):18919. Am J Psychiatry. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. On rare occasions, this can lead to stroke. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. TOAST. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. 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. Stroke. Article 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. In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. 1983;67(6):36170. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. 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. 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%). Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. 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]. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. Google Scholar. Cervical artery dissection goes frequently undiagnosed. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. Afterwards we developed a multivariate regression model using variables that have proven statistically significant at the univariate analysis at a significant level of 5% (p<0.05). Bonita R, Beaglehole R. Recovery of motor function after stroke. Theyll use contrast dye and X-ray-guided imaging to look at blood flow through the artery itself along with the extent of the dissection or vessel injury in real-time. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. The other variables showed no significant differences. As the key finding, our subgroup analysis of these VAD patients showed significantly higher levels of posttraumatic stress symptoms (p=0.002) and of pre-baseline anxiety symptoms (p=0.006) being associated with patients with good functional outcome (mRS02) and bad QOL compared to those with good functional outcome (mRS 02) and good QOL. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. California Privacy Statement, 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. 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. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. Third, psychological condition was not examined at baseline. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. Factors affecting the quality of life after ischemic stroke: young versus old patients. It can affect blood flow, putting you at risk for life-threatening complications. more than one drug, a medium or high dosage or signs of sedative or cognitive side effects, or (6) concurrent or preexisting CNS morbidity or damage apart from white matter lesions (WML) and minor strokes without any disabling, in particular cognitive preexisting deficit. No further differences were found in the other domains. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. This difference was not statistically significant (p<0.05). Previous Aschenbrenner S, Tucha O, Lange KW. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. No individual persons personal details, images or videos are being used in this study. 2004;63(11):21325. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study, https://doi.org/10.1186/s12883-019-1541-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. While there were in groups D and I compared to group M frequent impairments in both global screening tests (MMSE, MoCA) and in single cognitive function tests of the neuropsychological test battery (Additionalfile1) and also in the resulting cognitive composite score (CCS), this difference reached statistical significance only in the MoCA assessment for group D compared to group M (Table2). Czechowsky et al. Arch Phys Med Rehabil. In contrast to the primary application of the English version to intensive care unit patients, the German version was recently validated for its use on a broader spectrum of patients [21]. The hospital anxiety and depression scale. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. 2017;7(3):16572. Adding one additional base point in all individuals our self-constructed cognitive composite score (CCS) showed a range from score 1=normal to 10=completely pathological. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Aortic dissection is life-threatening. The functional outcome, however, seems to be usually good in the majority of cases but there is still a lack of knowledge about the natural history of VAD and uncertainty concerning the appropriate follow-up management. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Neurology. 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 A better understanding of clinical courses and their affecting variables with special respect to the biopsychosocial model [12] seemed to be of great importance for the neurorehabilitation of such VAD patients in the future. 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]. 2001;32(6):131822. You may also need to continue taking a blood thinner during this time. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. Zigmond AS, Snaith RP. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. J Neurol. (2004) [45]. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. 2013;80(21):19507. 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. Achievable are 14 to 98 points from 14 items. BMC Neurology Nearly all other potential contributing factors were not significantly different. Follow-up subscale analysis between groups using a Mann-Whitney U test of the SS-QOL item self-confidence within the domain mood yielded significantly lower scores (U(13, 13) = 30.5; p<0.01) for VAD patients with bad QOL (SS-QOL3.9) versus good and also significantly lower scores (U(9, 25) = 24.5; p<0.001) for group I patients with bad versus good QOL. Although MMSE and MoCA significantly correlated to our cognitive composite score (CCS), further analysis of neurocognitive domain deficits by neuropsychological test battery yielded only some trends of mean group values, without statistical significance. 2003;41(11):145260. Psychol Assess. A practical method for grading the cognitive state of patients for the clinician. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. The clinical application of the biopsychosocial model. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. Regarding premorbid psychological profiles, no significant group differences of the mean values of scoring systems (HADS-A/D) for symptoms of anxiety or depression in the week before baseline were found. With a dissection, blood gets trapped between the intima and media. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. [13] and in the context of a fitting medical history, i.e. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. Apart from the presence of ischemic stroke lesions in groups D and I, socio-demographic and clinical data of the three groups were without significant differences, as shown in Table1. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. (2013) [59] hypothesized that cervical artery dissection goes frequently undiagnosed, particularly in patients with subtle symptoms, which is true for VAD [3, 57], and dependently from the awareness of the responsible physician. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. BMC Neurol 19, 312 (2019). Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. CADISS Trial Investigators. Both conditions fit if someone is suffering from a spontaneous artery dissection as well as subarachnoid hemorrhage in contrast to ischemic stroke caused by vascular risk factors which can be treated. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 2011;77(12):117481. 1980;137(5):53544. Vertebral artery dissection (VAD) is a rare cause of stroke in the general population; however, represents one of the more common causes of stroke in patients younger than 45 years of age. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). Article However, incidental minor trauma It generates 12 domain-related scores and a total score. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. Practicing yoga where hyperextension of your neck occurs. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. 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. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. PubMed The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. Painting a ceiling with your neck in an extended position for a long time. The subgroup of patients with good functional outcome (mRS score2) and bad SS-QOL score (3.9) comprised ten patients with arterial occlusion or subtotal occlusion versus three with or without stenosis. Gttingen: Hogrefe Verlag; 2000. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. The role of cognitive impairment in the quality of life after ischaemic stroke. J Neurol Neurosurg Psychiatry. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. All participants have given written informed consent. Strauss E, Sherman EMS, Spreen O. Not applicable. Regensburger Wortflssigkeitstest. In addition, the extent of WML showed a significant inverse correlation to global cognitive functioning (MMSE, MoCA) in group D and partly (MoCA only) in group M. Finally, more extensive stroke lesions correlated very weakly with stronger neurological impairment (higher NIH-SS score at baseline) in group D and showed no other consistent correlations. For more extensive testing, a neuropsychological test battery was used with cognitive tasks of nine cognitive domains with possible reference to cognitive functions of the anatomical structures of the posterior circulation, in particular the cerebellum. MH contributed to the experimental design, data analyses and manuscript writing. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. Gttingen: Hogrefe Verlag; 2004. Cervical artery dissections typically heal very well, returning the vessel to normal. This process usually occurs within the first three to six months. Whats it like living with a cervical artery dissection? Youll need regular monitoring, including imaging studies, until healthcare providers confirm the dissection has healed. 2010;45(1112):68895. I was unable to return to work for three months. New York: Oxford University Press; 2006. VAD leads to impaired QOL at 6months follow-up due to multiple factors. 2006;37(10):2499503. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. The PTSS-14 was developed by Twigg et al. volume19, Articlenumber:312 (2019) Eur Heart J 2021;42:3825-3828. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. 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. (2004) [58] showed in their study that a significant number of cervical artery dissection can occur in the older age group and can be diagnosed if considered. Procedures for vertebral artery dissection include: Most people make a full recovery. Individuals facing a higher risk of future dissection will need follow-up care for many years. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. 1975;12(3):18998. 2003;250(10):117984. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. 2017;88(14):131320. Its signs and symptoms can be vague, and diagnosis can be elusive. 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. CTA, MRI, and (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. The first data collection in each patient was performed at baseline (time point t1) in the acute phase in hospital after clinical stabilization: neuro-status at admission by National Institute of Health Stroke Scale (NIH-SS) score [18] according to patients records, neurostatus (mRS) and clinical data at baseline according to examination and interview, cognitive screening as well as extensive neuropsychological testing by battery at baseline, and administering self-rating protocols for symptoms of anxiety and depression pre-baseline as well as stroke-related QOL pre-baseline. RK contributed to the experimental design and manuscript writing. 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. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. 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). Williams LS, Weinberger M, Harris LE, Biller J. Article Jokinen et al. Google Scholar. 8. (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. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. Subgroup analysis stratified for QOL by Stroke Specific Quality of Life Scale (SS-QOL) were done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 02). 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. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. 2006;66(4):5136. N Engl J Med. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. Neurorehabil Neural Repair. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. 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. On rare occasions, this can lead to stroke. Speck et al. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. A vertebral artery dissection is not what youd expect at 35 years young. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the last 12 months Socials: www.instagram.com/aimzwells/ Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. 1997;9:44551. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. 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. It was only asked for affective symptoms of anxiety and depression pre-baseline and at follow-up there has been only exploration for stress symptoms but not for symptoms of anxiety and depression. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. Ahl et al. The use of the German version in this study was authorized by their authors (pers. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). 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 Neurol Neurosurg Psychiatry. 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). In case of significant difference, a subsequent analysis between two group pairs was performed: For categorical variables the Chi-square test or Fishers exact test, if appropriate, and for metric variables the Mann-Whitney U-test was used with Bonferroni-correction of cumulative alpha-error. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. Chicago: University of Chicago Press; 1947. Predictors for QOL at follow-up were analyzed by regression model. Its more common in people younger than 45. Neurosurgery. Our data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD, in particular in patients with reduced QOL despite good functional outcome. J Abnorm Psychol. They deliver oxygen-rich blood to your brain and spine. Terms and Conditions, Measuring quality of life in a way that is meaningful to stroke patients. 2013;94(12):253541. Gttingen: Beltz Test GmbH; 2001. Vertebral artery dissection: presenting findings and predictors of outcome. At least 90 percent of adults with FMD are women. Living With Whats it like living A dissection forms when theres a tear in one or more of its three tissue layers. (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. ( the carotid artery dissection, also called a dissection, occurs when a tear life expectancy after vertebral artery dissection in one of interior! Deficits were unlikely responsible for the reduced QOL therapy and clinical treatment, our data favor a multidimensional monitoring VAD! Can lead to stroke patients work for three months PTSD was the multimodal analysis of patient characteristics VAD. Running up the back of your neck in a way that is meaningful to stroke facing..., Kloss M, Ludemann P, et al blood thinner during this time disrupts! As pre-baseline symptoms of anxiety and depression were not significantly different third of patients mental in. Headache, visual disturbance, or focal extremity weakness only symptoms at presentation were neck pain therapy significantly! 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