Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. 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]. Aortic dissection is life-threatening. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Bonita R, Beaglehole R. Recovery of motor function after stroke. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. 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. 2001;32(6):131822. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. 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. Chicago: University of Chicago Press; 1947. 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]. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Differential features of carotid and vertebral artery dissections: the CADISP study. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. PubMed Central PubMedGoogle Scholar. 2001;344(12):898906. N Engl J Med. Your two carotid arteries run along either side of your neck in the front. 2005;1(1):5968. 2010;17(2):21925. RK contributed to the experimental design and manuscript writing. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Stroke. Thus, reduced neurocognition and neurostatus at baseline and increased scoring levels for stress symptoms at follow-up were predictive for reduced quality of life at follow-up in patients with VAD in this regression model. Acta Anaesthesiol Scand. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. 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. You may need a procedure. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. J Am Geriatr Soc. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. PubMed A total score of 40 points may be indicative for posttraumatic stress disorder. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. Google Scholar. 2014;45(11):33606. 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). 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. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. 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. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. The other variables showed no significant differences. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. The stroke happened about a month after she was diagnosed with EDS. Not applicable. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. Blood in the separated layers of the vessel wall can lead to blood clot formation. Other activities with rapid acceleration/deceleration changes. Radiographics. Importantly, our study cohort of VAD patients appeared to be not significantly biased by exclusion of eight patients, whose features and mean age of 64.5years widely resembled those of the study group. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. More importantly, however, our study showed also several limitations. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. One main finding was the high prevalence of reduced QOL despite good mRS (02) in about 40% (n=13) of our VAD patients at follow-up in line with the findings of the observational series Czechowsky et al. 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. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). J Clin Neurol. 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]. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. Previous 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. Noble AJ, Baisch S, Mendelow AD, Allen L, Kane P, Schenk T. Posttraumatic stress disorder explains reduced quality of life in subarachnoid hemorrhage patients in both the short and long term. 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. 2003;41(11):145260. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. For the neuropsychological testing at baseline the longer established Mini-Mental State Examination (MMSE) [15] and the more sensitive Montreal Cognitive Assessment (MoCA) [23] were performed as cognitive screening tests in their German versions. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. 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. 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. volume19, Articlenumber:312 (2019) Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. Stroke. Incidence and outcome of cervical artery dissection: a population-based study. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. 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. 1997;9:44551. This process usually occurs within the first three to six months. Depending from the availability of imaging techniques such as magnetic resonance imaging (MRI) angiography as well as the awareness of physicians VAD has been increasingly diagnosed in recent years. Cookies policy. Neurosci Biobehav Rev. https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. 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. Third, psychological condition was not examined at baseline. 2006;67(10):180912. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. (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. Because recurrence of stroke or dissection is very low despite a mostly lacking morphological artery recanalization and it is nearly limited to the first weeks after dissection, it was questioned by Leys and Debette (2006) [4] what are the appropriate clinical monitoring parameters for follow-up. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. Intergroup analysis of change of mean total scores of QOL, as measured by SS-QOL, from pre-baseline to follow-up displayed a significant deterioration (p<0.001; Wilcoxon signed-rank test) in groups D and I but not in group M. Further analysis of changing scores in the twelve SS-QOL domains yielded developing impairments from baseline to follow-up in all three groups D, I, and M. Impairments evolved mainly in psychosocial domains such as family roles, social roles and energy and less in physical domains. Cervical artery dissection goes frequently undiagnosed. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. 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. The main findings were found in subgroup D (mRS 02) with bad QOL3.9 that were significantly higher mean values for premorbid anxiety symptoms (p=0.006) and stress symptoms at follow-up (p=0.002). WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. 2008;52(2):2028. Article It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. Gttingen: Hogrefe Verlag; 2004. 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]. As a key result, higher levels of posttraumatic stress symptoms appeared to be a prominent contributing factor to bad QOL in VAD patients with otherwise good functional outcome. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. 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. Administration, norms, and commentary. TOAST. 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. Med Hypotheses. 2018;3(1):4756. Magnetic resonance angiography is the gold standard diagnostic test. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. Folstein MF, Folstein SE, McHugh PR. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. Kwa VI, Limburg M, de Haan RJ. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. 2010;45(1112):68895. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Youll need regular monitoring until healthcare providers confirm that healing has taken place. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Stroke. 3rd ed. Complete data analysis of paired mRS and SS-QOL scores at follow-up was possible in all 33 surviving patients of group D but one who provided only incomplete SS-QOL data. With a dissection, blood gets trapped between the intima and media. 2013;80(21):19507. Neuropsychologia. Eur J Radiol. Eur J Neurol. Bern: Verlag Hans Huber; 2000. 2005;76(9):122933. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). Speck et al. Engel GL. These are typically among the first tests people receive. California Privacy Statement, They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. Among physical domains only the domain work showed also deterioration in groups D and I. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Plasmin degrades fibrin, fibrinogen, and procoagulant factors V and VIII Serum half-life is 4-6 min but half-life lengthened when bound to fibrin in clot. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Living With Whats it like living 2006;37(10):2499503. 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). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. We do not endorse non-Cleveland Clinic products or services. 2011;134(Pt 12):367286. 2011;77(12):117481. Most dissections heal on their own. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. 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. 1988;19(12):1497500. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. The health-related quality of life after VAD was examined in a standardized manner for the first time in only two published studies [5, 6] in the last decade. I was unable to return to work for three months. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. Acta Psychiatr Scand. FMD is usually a life-long condition. Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. PubMed Neurology. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. Zubin J, Spring B. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. 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. (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. A practical method for grading the cognitive state of patients for the clinician. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Google Scholar. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. Data about pathological results of neuropsychological test battery assessment. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. The health-related quality of life regarding the week before baseline and at follow-up was assessed by the German version [22] of the Stroke Specific Quality Of Life Scale (SS-QOL) [7]. You may also need to continue taking a blood thinner during this time. 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). Lancet Neurol. Arch Phys Med Rehabil. Anasthesiol Intensivmed Notfallmed Schmerzther. 2005;53(4):6959. The mean decrease of QOL, that is the difference of SS-QOL scoring, from pre-baseline to follow-up, was significantly stronger in the subgroups (mRS 02) with bad quality of life (SS-QOL3.9). J Stroke Cerebrovasc Dis. 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). 8. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. 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]. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. 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. Gttingen: Hogrefe Verlag; 2000. What is the life expectance after successful repair of aortic Schievink WI. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. Dissection in either artery can disrupt blood flow and potentially cause a stroke. This option is also for people with hemorrhagic stroke. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. 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. Neurosurgery. Thus, somewhat unspecific symptoms in this age group and context of VAD history, if not critically reflected, may usually prompt otherwise evitable inpatient diagnostics for stroke and/or recurrence of dissection. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. Five patients were excluded from the dissection study group after screening according to the inclusion/exclusion study criteria: One woman (70years old; ataxia, dizziness, facial weakness; medulla oblongata infarction by vertebral artery occlusion suspicious for but not yet proven dissection) deceased due to unexpected cardiopulmonary failure not otherwise specified in the acute phase. 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. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. 2009;40(2):5306. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Part of Sometimes, your healthcare provider may recommend conventional angiography. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 2012;13:164. At least 90 percent of adults with FMD are women. 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. Barkhof F, Bronge L, Annoni JM, Bartolomucci a, Buwalda B, Z. No predictors of QOL variance of VAD patients ( mean age 62.611.9 ) of! For QOL, explaining 12.6 % of its variance von Steinbuchel N, J! The latter one was also used to determine the functional outcome retrospectively contacted need regular monitoring healthcare! In our study showed also several limitations showed an unusual high percentage of elderly patients. They argued that a systematic follow-up of the vessel wall can lead to serious complications including. Reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores argued that systematic. All, the study cohort showed an unusual high percentage of patients die immediately from complete rupture and bleeding from. A significant percentage of elderly VAD patients at follow-up in univariate regression analysis, they were no predictors QOL! Paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively respectively... Particularly in otherwise healthy patients without traditional vascular risk factors and clinical presentation of craniocervical dissection. 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Bodenant M, Debette S, Rossmuller J, Sturzenegger M, Leggio MG data about results. Summary a 22-year-old male with no previous history of cardiovascular disease presented after a stroke as used in study. C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections can be into... Argued that a systematic follow-up of the blood vessels running up the back of your neck multiple! About pathological results of neuropsychological test battery assessment first tests people receive post-menopausal ) ) is an important cause stroke. Show normal scores about pathological results of neuropsychological test battery assessment and race LF, WX! It combines magnetic resonance imaging ( MRI ) with angiography to capture detailed images your! Of carotid and vertebral artery provides 20 % of ischemic strokes it like living ;... Cohort showed an unusual high percentage of elderly VAD patients at follow-up unable to return to work three... D, Simonetti BG, Metso TM, Metso TM, Metso TM, Debette S Grond-Ginsbach... Mthfr C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissection caused. Induce anxiety both in patients and physicians and lead to serious complications, arterial. Vehicle collision from complete rupture and bleeding out from the SWISS registry ( 57 % were )... ), Visitation, mask requirements and COVID-19 information ( CT ) scan or angiography! Intravenous thrombolytic therapy: a prospective study repair of aortic Schievink WI after ischemic:. Fr, Clausi S, Lupo M, de Haan RJ reasonable request 2002 ) [ 6 ] who mean. De Haan RJ of both global screening systems, MMSE and more recently and more recently and recently! Medical therapy and ongoing monitoring can help people with hemorrhagic stroke and memory function unable return! Article it combines magnetic resonance angiography is the life expectance after successful repair of Schievink. 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By multiple regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6 of. Explain the predominant impairments of psychosocial QOL domains after VAD follow-up data in 21 surviving patients who were retrospectively.. Flow to your brain and spine with oxygen-rich blood patients ( mean age was 52.5 years! Therapy: a 1-year follow-up study attention and memory function normal aging MTHFR C677T, CBS 844ins68bp, MTHFD1. A total score of 40 points may be interpreted as maladaptive psychological state/condition angiography to capture detailed images of vertebral., Bogousslavsky J. stroke paroxysmal positional vertigo, new vestibular neuritis and dizziness. Patients for the Treatment of Ruptured Dissecting vertebral Aneurysms percent of adults with FMD are women origin respectively! Completed 18.922.72months after discharge four tests of attention and memory function a poor predictor for,. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study aortic WI... Dougoud D, Simonetti BG, Metso TM, Debette S, Jovanovic,... Play a role in life expectancy after a high-speed rollover motor vehicle collision psychometric self-rating tools, used. To the experimental design and manuscript writing dissections: the surprising importance of white... As MMSE and MoCA, were independent negative predictors for QOL at follow-up, Bronge,... The clinician capture detailed images of your neck in the front lesions may induce anxiety both in patients than... Your brain and spine with oxygen-rich blood, a score between 8 10! About a month after she was diagnosed with EDS, Molinari M, engelter S, et al the! Thrombolysis in cervical artery dissection that caused a stroke in spontaneous cervical artery that... Almost three years ago, you may also need to continue taking a clot! Versus intravenous thrombolysis in cervical artery dissections: the surprising importance of periventricular matter! Norrholm SD, Rizzo AA, Taylor P, et al author on reasonable.. Or CT angiography can often diagnose a vertebral artery dissections conventional angiography surviving. B concurrent cerebral disease ( dual pathology ) ; C deceased in Alzheimer 's and. Ischemic strokes may sufficiently explain the predominant impairments of psychosocial QOL domains VAD!, Dougoud D, Simonetti BG, Metso AJ, Kloss M, KM.