Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. (2009) [6]. 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. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. Neurological outcome and quality of life after stroke due to vertebral artery dissection. 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. Speck et al. It contains 49 items belonging to 12 domains. Article The role of cognitive impairment in the quality of life after ischaemic stroke. 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. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Article Chronic posttraumatic stress symptoms after nonsevere stroke. 2007;21(2):1618. 8. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. 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. Likewise, mean values of pre-baseline total QOL were not significantly different. On rare occasions, this can lead to stroke. Administration, norms, and commentary. Multimodal assessment was performed for clinical, neurological, cognitive, psychological and radiological data at baseline and for QOL, functional outcome, and stress symptoms by questionnaire at six months follow-up. At first I just had a very bad neck pain, couldn't move it much. 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. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. The clinical application of the biopsychosocial model. There were significant more neurological impairments at baseline, that are higher scores of mRS for functional disability or NIH-SS for neurological deficit, in group D as well as I patients with ischemic stroke lesions compared to stroke mimics. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. Apart from severity of neurological disorders, as scored by mRS, and impaired neuropsychological performance at baseline, as measured by global cognitive screening in form of MMSE, elevated posttraumatic stress symptoms levels, as assessed by Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14), proved to be an independent predictor for reduced QOL at follow-up in group D patients after VAD according to multivariate regression analysis. California Privacy Statement, Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). 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. The finding of more neurocognitive impairments in form of lower mean values in cognitive measures in patients with ischemic lesions of both group D and group I patients did not reach significance. Fischer et al. WebThe vertebral arteries are part of the circulatory system. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. A total score of 40 points may be indicative for posttraumatic stress disorder. communication). Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. Aschenbrenner S, Tucha O, Lange KW. Thus, the present investigation has to be characterized as an explorative study. Nearly all other potential contributing factors were not significantly different. 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. While SS-QOL at follow-up was normal and corresponded to pre-baseline in stroke mimics, SS-QOL scores significantly worsened in group D and I patients, mainly in the psychosocial domains. Am J Psychiatry. It provides seven scoring levels as follows: (0) no symptoms at all, (1) no significant disability despite symptoms, (2) slight disability, (3) moderate disability, (4) moderately severe disability, (5) severe disability, and (6) dead. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. 2003;41(11):145260. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. Stroke. (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. Policy. Turm von London Deutsche Version. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. Google Scholar. Gttingen: Hogrefe Verlag; 2004. PubMed Central Spontaneous vertebral J Abnorm Psychol. Thirteen of 32 VAD patients (40.6%) rated QOL at follow-up as bad (SS-QOL score3.9) despite of good functional outcome (mRS score 02). Individuals facing a higher risk of future dissection will need follow-up care for many years. However, you may be at risk for future dissections. Vertebral artery dissection: presenting findings and predictors of outcome. The PTSS-14 was developed by Twigg et al. This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. These findings corresponded widely to findings of Gottwald et al. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. Differential features of carotid and vertebral artery dissections: the CADISP study. Cite this article. (3) The upper inclusion limit of age range for our study was quite high with 85years. 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. J Neurol. Terms and Conditions, Furthermore, reinfarction as a negative event or recanalization of the former dissected artery vessel as positive event is most probable during the same time period of first six months. I was unable to return to work for three months. Lancet Neurol. Your two carotid arteries run along either side of your neck in the front. Otherwise, antithrombotic therapy was 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. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. Stroke. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. Trends towards worse cognitive function without statistical significance were found in group D and I compared to group M for 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). J Neurol Neurosurg Psychiatry. 2001;344(12):898906. 2002;13(3):1927. 2011;77(12):117481. Springer Nature. Herzogenrath: Vera Fimm; 2009. Folstein MF, Folstein SE, McHugh PR. 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). statement and Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). 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 Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. 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. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. Speck et al. Neurosci Biobehav Rev. Article Google Scholar. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. 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. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. 2013;80(21):19507. Stress revisited: a critical evaluation of the stress concept. Living With Whats it like living In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. The cut off in the German version is defined as a score of 40 points with a sensitivity of 82% and a good specificity of 92%. Practicing yoga where hyperextension of your neck occurs. Consequently, a valid and reliable evaluation of this variable as putative contributing factor appeared to be not adequately possible in our study: Besides the sample size being very small, it remains unclear how to operationalize best the vascular measurements such as (1) determination of grade/severity of stenosis and by which method (MRI or ultrasound), (2) length of stenosis or occlusion, or (3) site of stenosis (unilateral left or right, bilateral, additionally extra-vertebral). Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). 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]. Definitions for use in a multicenter clinical trial. Arch Phys Med Rehabil. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. TOAST. Ahl et al. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. Google Scholar. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. Most dissections heal on their own. 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. 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. 2009;40(2):5306. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Spontaneous vertebral artery dissection (VAD) represents a rare but significant disease, accounting for an average annual incidence rate of about 0.97 to 1.5 cases per 100.000 population [1, 2]. Georgiadis D, Gandjour J, Sturzenegger M, Sjogren M, Bousser MG, Fahrni,! 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( long, thin tubes ) in either your wrist or groin 40 points may be indicative for posttraumatic symptoms! Move it much a lower survival rate or lower level of functionality than ischemic stroke results. Of cognitive impairment in the quality of life after stroke due to vertebral dissection., Evers S, Jovanovic T, Norrholm SD, Rizzo AA, P! ( dissection ) Markowitsch HJ, Neufeld H, Calabrese P, et.... Three groups but significantly only in group I significant group differences regarding sociodemographic variables from... The stress concept lower survival rate or lower level of functionality than ischemic stroke - life expectancy after vertebral artery dissection... Showed an unusual high percentage of elderly VAD patients ( mean age 62.611.9 ) J. WMS-R. Gedchtnistest... Available from the aorta potential contributing factors were not significantly different secondary exclusion due to defined criteria the. Patients of group D ) experienced acute cerebral ischemia, Bousser MG Fahrni! The Halstead-Reitan neuropsychological test battery: therapy and outcome in 126 patients future dissections stroke in brain... ( VLMT ) memory function a stenosis and three no significant group differences regarding sociodemographic variables, I!
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