Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2019

Open Access 01-12-2019 | Stroke | Research article

Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study

Authors: Rainer J. Strege, Reinhard Kiefer, Manfred Herrmann

Published in: BMC Neurology | Issue 1/2019

Login to get access

Abstract

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.

Methods

In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. 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. 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 0–2). Predictors for QOL at follow-up were analyzed by regression model.

Results

88.2% of patients with VAD suffered from acute cerebral ischemia. Thirteen of 32 VAD patients (40.6%) rated QOL at follow-up as bad (SS-QOL score ≤ 3.9) despite of good functional outcome (mRS score 0–2). Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p = 0.002) in this subgroup. 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.

Conclusion

VAD leads to impaired QOL at 6 months follow-up due to multiple factors. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Clinical monitoring should address this topic to make timely treatment possible.
Appendix
Available only for authorised users
Literature
1.
Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. Incidence and outcome of cervical artery dissection: a population-based study. Neurology. 2006;67(10):1809–12.PubMedCrossRef
2.
Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001;344(12):898–906.PubMedCrossRef
3.
Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Vertebral artery dissection: presenting findings and predictors of outcome. Stroke. 2006;37(10):2499–503.PubMedCrossRef
4.
Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. Cerebrovasc Dis. 2006;22(2–3):215.PubMedCrossRef
5.
Czechowsky D, Hill MD. Neurological outcome and quality of life after stroke due to vertebral artery dissection. Cerebrovasc Dis. 2002;13(3):192–7.PubMedCrossRef
6.
Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. Quality of life in survivors after cervical artery dissection. J Neurol. 2009;256(3):443–9.PubMedCrossRef
7.
Williams LS, Weinberger M, Harris LE, Biller J. Measuring quality of life in a way that is meaningful to stroke patients. Neurology. 1999;53(8):1839–43.PubMedCrossRef
8.
9.
Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Arch Phys Med Rehabil. 2013;94(12):2535–41.PubMedCrossRef
10.
Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. Factors affecting the quality of life after ischemic stroke: young versus old patients. J Clin Neurol. 2005;1(1):59–68.PubMedPubMedCentralCrossRef
11.
Kwa VI, Limburg M, de Haan RJ. The role of cognitive impairment in the quality of life after ischaemic stroke. J Neurol. 1996;243(8):599–604.PubMedCrossRef
12.
Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry. 1980;137(5):535–44.PubMedCrossRef
13.
Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Radiographics. 2008;28(6):1711–28.PubMedCrossRef
14.
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment. Stroke. 1993;24(1):35–41.PubMedCrossRef
15.
Folstein MF, Folstein SE, McHugh PR. "mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRefPubMed
16.
Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. Cervical artery dissection: trauma and other potential mechanical trigger events. Neurology. 2013;80(21):1950–7.PubMedCrossRef
17.
Thomas LC, Rivett DA, Attia JR, Levi CR. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. BMC Musculoskelet Disord. 2012;13:164.PubMedPubMedCentralCrossRef
18.
Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–70.PubMedCrossRef
19.
Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. 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). Eur J Neurol. 2010;17(2):219–25.PubMedCrossRef
20.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.CrossRefPubMed
21.
Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. Anasthesiol Intensivmed Notfallmed Schmerzther. 2010;45(11–12):688–95.PubMedCrossRef
22.
Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Neurorehabil Neural Repair. 2007;21(2):161–8.PubMedCrossRef
23.
Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.CrossRefPubMed
24.
Zimmermann PFB. Testbatterie zur Aufmerksamkeitsprüfung (TAP) Version 2.2. Herzogenrath: Vera Fimm; 2009.
25.
Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. Tucson: Neuropsychological Press; 1985.
26.
Tucha O, Lange KW. Turm von London – Deutsche Version. Göttingen: Hogrefe Verlag; 2004.
27.
Horn W. L-P-S Leistungsprüfsystem. 2. Auflage. Göttingen: Hogrefe Verlag; 1983.
28.
Strauss E, Sherman EMS, Spreen O. Five-point test. GA compendium of neuropsychological tests. Administration, norms, and commentary. 3rd ed. New York: Oxford University Press; 2006.
29.
Aschenbrenner S, Tucha O, Lange KW. Regensburger Wortflüssigkeitstest. Göttingen: Hogrefe Verlag; 2000.
30.
Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfähigkeitstest (VLMT). Göttingen: Beltz Test GmbH; 2001.
31.
Härting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedächtnistest – revidierte Fassung. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. Bern: Verlag Hans Huber; 2000.
32.
Halstead WC. Brain and intelligence: a quantitative study of the frontal lobes. Chicago: University of Chicago Press; 1947.
33.
Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol. 1987;149(2):351–6.PubMedCrossRef
34.
Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 2001;32(6):1318–22.PubMedCrossRef
35.
Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. J Neurol. 2004;251(10):1242–8.PubMedCrossRef
36.
Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 2009;8(7):668–78.PubMedCrossRef
37.
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. J Neurol. 2003;250(10):1179–84.PubMedCrossRef
38.
Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. Eur Stroke J. 2018;3(1):47–56.PubMedPubMedCentralCrossRef
39.
Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. Cerebrovasc Dis Extra. 2017;7(3):165–72.PubMedPubMedCentralCrossRef
40.
Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. Stroke. 2009;40(2):530–6.PubMedCrossRef
41.
Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. J Neurol Neurosurg Psychiatry. 2005;76(9):1229–33.PubMedPubMedCentralCrossRef
42.
Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. Arch Phys Med Rehabil. 2011;92(5):792–8.PubMedCrossRef
43.
Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. Does the cerebellum contribute to specific aspects of attention? Neuropsychologia. 2003;41(11):1452–60.PubMedCrossRef
44.
Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. The cerebellar cognitive profile. Brain. 2011;134(Pt 12):3672–86.PubMedCrossRef
45.
Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. Neurology. 2004;63(11):2132–5.PubMedCrossRef
46.
Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. J Stroke Cerebrovasc Dis. 2014;23(2):335–42.PubMedCrossRef
47.
Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. Acta Anaesthesiol Scand. 2008;52(2):202–8.PubMedCrossRef
48.
Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychol Assess. 1997;9:445–51.CrossRef
49.
Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Chronic posttraumatic stress symptoms after nonsevere stroke. Neurology. 2006;66(4):513–6.PubMedCrossRef
50.
Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Stroke. 2014;45(11):3360–6.PubMedCrossRef
51.
Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. J Neurol. 2018;265(8):1891–9.PubMedPubMedCentralCrossRef
52.
Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. Psychosom Med. 2014;76(9):670–7.PubMedCrossRef
53.
Zubin J, Spring B. Vulnerability--a new view of schizophrenia. J Abnorm Psychol. 1977;86(2):103–26.PubMedCrossRef
54.
Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. Stress revisited: a critical evaluation of the stress concept. Neurosci Biobehav Rev. 2011;35(5):1291–301.PubMedCrossRef
55.
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. Neurosurgery. 2008;63(6):1095–104 discussion 04-5.PubMedCrossRef
56.
Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. Disabil Rehabil. 1997;19(1):6–12.PubMedCrossRef
57.
Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Differential features of carotid and vertebral artery dissections: the CADISP study. Neurology. 2011;77(12):1174–81.PubMedCrossRef
58.
Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. J Neurol Neurosurg Psychiatry. 2004;75(8):1194–6.PubMedPubMedCentralCrossRef
59.
Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. Cervical artery dissection goes frequently undiagnosed. Med Hypotheses. 2013;80(6):787–90.PubMedCrossRef
60.
Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. Neurology. 2017;88(14):1313–20.PubMedCrossRef
61.
Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. J Neurol Neurosurg Psychiatry. 2016;87(5):526–30.PubMedCrossRef
Metadata
Title
Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study
Authors
Rainer J. Strege
Reinhard Kiefer
Manfred Herrmann
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2019
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-019-1541-x

Other articles of this Issue 1/2019

BMC Neurology 1/2019 Go to the issue

Case report

Late-onset riboflavin-responsive multiple acyl-CoA dehydrogenase deficiency (MADD): case reports and epidemiology of ETFDH gene mutations

Research article

Vitamin D deficiency as a risk factor for dementia and Alzheimer’s disease: an updated meta-analysis

Research article

Interaction between COX-1 and COX-2 increases susceptibility to ischemic stroke in a Chinese population

Case report

Intimal flap detected by three-dimensional curved multiplanar reconstruction image in isolated posterior inferior cerebellar artery dissection: a report of two cases

Study protocol

Optimizing early enteral nutrition in severe stroke (OPENS): protocol for a multicentre randomized controlled trial

Research article

The bucket test differentiates patients with MRI confirmed brainstem/cerebellar lesions from patients having migraine and dizziness alone