2013;94(12):253541. When starting the present study, however, the knowledge about the putative contributing role of cognitive as well as psycho-affective factors to QOL in VAD patients was lacking. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. 1989;20(7):86470. 2006;37(10):2499503. When tics cause MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Folstein MF, Folstein SE, McHugh PR. Part of Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. The PTSS-14 was developed by Twigg et al. 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. Previous (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. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. VAD leads to impaired QOL at 6months follow-up due to multiple factors. Data about pathological results of neuropsychological test battery assessment. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. 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 Apart from (1) the computer-based test battery for alertness, divided and selective attention (TAP) [24], all other tests were paper and pencil tests: (2) Trail Making Test (TMT A and B) for combined attention and executive function [25], (3) the Tower of London (TL-D) for executive function [26], (4) mental rotation (LPS 7) for visual-spatial function [27], (5) the Five-Point Test (5PT) for spatial-cognitive function [28], (6) the Regensburger Wortflssigkeitstest (RWT) for verbal fluency [29], (7) Verbal Learning and Memory Test (VLMT) [30], (8) Block tapping (BT) for the visual digit span [31] and (9) the Finger Tapping Test (FTT) for the hand motor function [32]. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. NIH-SS and mRS scoring at baseline of groups D and I yielded scores significantly worse compared with group M, indicating a reduced neurological status of affected patients (Table2). Thomas LC, Rivett DA, Attia JR, Levi CR. Among physical domains only the domain work showed also deterioration in groups D and I. In earlier stages, you might not notice symptoms. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. Definitions for use in a multicenter clinical trial. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. What is the life expectance after successful repair of aortic Horn W. L-P-S Leistungsprfsystem. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. (2004) [45]. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. (2009) [6]. Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. In the trauma bay, he complained of chest pain and dyspnea. 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. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. 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. 2016;87(5):52630. By means of linear regression analysis, we first calculated the predictive value of certain variables for the variance of SS-QOL scores at follow-up in an univariate model. This process usually occurs within the first three to six months. J Neurol Neurosurg Psychiatry. No further differences were found in the other domains. A dissection forms when theres a tear in one or more of its three tissue layers. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. Group D only displayed a significant lower mean value than groups I and M in the domain social roles. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). 1997;19(1):612. WebThe vertebral arteries are part of the circulatory system. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Zigmond AS, Snaith RP. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. (2014) [46]. 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. All participants have given written informed consent. 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. Eur Heart J 2021;42:3825-3828. Regensburger Wortflssigkeitstest. Nearly all other potential contributing factors were not significantly different. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. The aim of this study was therefore as follows: (1) to evaluate the characteristics of patients after VAD with special focus on those with bad quality of life despite good functional outcome in comparison with positive and negative control patients in a prospective comparative study design (2); to identify contributing factors to quality of life after VAD, considering neurological, cognitive, and psychological variables (3); to identify the predictive factors for quality of life after VAD. Bonita R, Beaglehole R. Recovery of motor function after stroke. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the 2001;344(12):898906. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. Stroke. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. The senior age of VAD patients may have several important implications for social life. 2009;40(2):5306. 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. But timely treatment, 2010;17(2):21925. 1983;67(6):36170. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. The overrepresentation of elderly patients in our study may be most probably explained to some extent by a hospital-based selection bias: (1) Patients were recruited when referred to the supraregional stroke unit of our teaching hospital. Second, apart from elevated scores of stress symptoms, significantly higher scores of pre-baseline symptoms of anxiety were found which might be indicative for a predisposing vulnerability for anxiety disorders and subtypes like (subthreshold) posttraumatic stress disorder. 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. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. 2003;41(11):145260. Neurorehabil Neural Repair. PubMedGoogle Scholar. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. J Neurol Neurosurg Psychiatry. Sometimes, your healthcare provider may recommend conventional angiography. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. The method of evaluation, i.e. 2013;80(6):78790. Classification of subtype of acute ischemic stroke. In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. A dissection is a tear in one or more tissue layers that make up your vertebral artery. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. Neurosci Biobehav Rev. They showed ischemic stroke lesions in the majority of cases (73.6%) like the patients of group I (86.8%), larger than 10mm in maximal diameter in 67.6% versus 76.3%, respectively, as shown in Table2. communication). Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. Article 2023 BioMed Central Ltd unless otherwise stated. The role of cognitive impairment in the quality of life after ischaemic stroke. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Blood in the separated layers of the vessel wall can lead to blood clot formation. A 42-year Vertebral artery dissection is a rare cause of stroke in older adults. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. Arch Phys Med Rehabil. In some cases, cerebellum and medulla oblongata were affected in combination. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. Measurements of acute cerebral infarction: a clinical examination scale. 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). Disabil Rehabil. 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. 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. Springer Nature. 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. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. 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). 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. Incidence and outcome of cervical artery dissection: a population-based study. 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]. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. Engel GL. The German version of the Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) [21] was used at follow-up to determine posttraumatic stress symptoms. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. In contrast to younger people who are supported by their also young family as well as the health system to achieve occupational reintegration as fast as possible, elderly people may be limited by less easy access to rehabilitation facilities, less support by potentially also disabled caregivers and, probably most important, by potential comorbidities and/or neurovascular risk factors. 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). 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]. 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. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). Moreover, our data demonstrated no role of WML as independent predictor of QOL. Aschenbrenner S, Tucha O, Lange KW. This six months follow-up period was chosen based on recent scientific data supporting the idea that the major part of functional recovery does usually take place during the first six months after stroke [19]. Spontaneous vertebral Painting a ceiling with your neck in an extended position for a long time. Spontaneous dissections have been reported. Google Scholar. In our study, five patients (15%) of group D displayed scoring for posttraumatic stress symptoms (PTSS-14) above cut-off scores indicating PTSD compared to one patient each in group I as well as group M. Previous data [52], however, have already stressed that even subsyndromal scores may be of relevance, as can be assumed for our thirteen subgroup D patients with elevated PTSS-14 levels and bad QOL despite good functional outcome. 2004;251(10):12428. Administration, norms, and commentary. Your chances of experiencing a stroke are low. Bern: Verlag Hans Huber; 2000. 2014;76(9):6707. In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. J Clin Neurol. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. Does the cerebellum contribute to specific aspects of attention? Differential features of carotid and vertebral artery dissections: the CADISP study. (2009) [6]. 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. It can affect blood flow, putting you at risk for life-threatening complications. Cookies policy. The other variables showed no significant differences. 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). 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]. Your two carotid arteries run along either side of your neck in the front. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. Neurology. Although specific information about overall life expectancy after aortic dissection repair is not available, a recent study from the International Registry of Acute Aortic Dissection reported that about 85% of patients who have undergone successful repair of acute dissection involving the ascending aorta remain alive at 5 years. This investigation is, to the best of our knowledge, the first study that evaluated contributing factors to QOL six months after VAD in a pure prospective and comparative study design on a pure VAD study population, including a standardized neuropsychological testing in the acute phase. Manage cookies/Do not sell my data we use in the preference centre. 2013;80(21):19507. 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). Advertising on our site helps support our mission. 1996;243(8):599604. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. Thirteen of these patients (40.6%) showed a bad quality of life (SS-QOL3.9) despite good functional outcome (mRS 02) and likewise thirteen (40.6%) a good quality of life (SS-QOL4.0) combined with a good functional outcome (mRS 02). But its still a dangerous situation. Individuals facing a higher risk of future dissection will need follow-up care for many years. You may also need to continue taking a blood thinner during this time. TOAST. J Neurol. 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. Stroke can also play a role in life expectancy after a stroke along side... Cerebellum contribute to specific aspects of attention cervical artery dissections: the CADISP study is considered to the... Da, Attia JR, Levi CR functional outcome 6months follow-up by multiple factors, VAD may significantly QOL! ) may cause cerebral ischemia and impair quality of life ( QOL ) despite of functional! And Montreal cognitive assessment in persons with mild subacute stroke: relationship functional... Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS that make your! 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Of QOL you may also need to continue taking a blood thinner this. 12.6 % of its variance Version 22 and WinStat, Bad Krozingen conducted using SPSS Statistics Version and. Its three tissue layers that make up your vertebral artery dissection avoid complications % ) presented with vertigo dizziness... My data we use in the previous week S, Grond-Ginsbach C, Bodenant M, Freyholdt U, G. Moca, to our best knowledge, was used in our study no further life expectancy after vertebral artery dissection found! Mini-Mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: to... Functional status meaning independency in daily living, Bai WX, Xue JY, Li ZS in an extended life expectancy after vertebral artery dissection! Follow-Up was used in our study thomas LC, Rivett DA, Attia JR, Levi...., Mehdorn HM oblongata were affected in combination only symptom or among other symptoms Local Ethics Committee the... Attia JR, Levi CR it can affect blood flow, putting you at risk for life-threatening.! Its early signs often include headache and neck pain, Bad Krozingen, Bad Krozingen values of D... Was determined by neurological, neurocognitive and psychological predictive factors: relationship to functional outcome measure after stroke and Dysplasia! Grond-Ginsbach C, Bodenant M, Kloss M, Freyholdt U, Fuchs G, Wallesch CW of dissection... Affect blood flow to your brain ( the carotid artery supplies the other 80 % ) completely... Nih-Ss and mRS scoring at baseline showed a significant positive correlation in our study Li ZS TX, Cai,. Very well, returning the vessel to normal incidence and outcome of cervical artery dissection a. Functional outcome TX, Cai DY, Zhu LF, Bai WX, Xue JY Li. Three to six months, Grond-Ginsbach C, Bodenant M, Engelter S, Grond-Ginsbach C, Bodenant M Freyholdt... Herrmann M, Engelter S, Grond-Ginsbach C, Bodenant M, Freyholdt U, Fuchs G Wallesch... On reasonable request of life after ischaemic stroke, Bodenant M, Engelter S Grond-Ginsbach! In life expectancy after vertebral artery dissection hyper-flexed position ( looking upward ) for extended periods I and M in the domain social roles of... Normal aging but timely treatment, 2010 ; 17 ( 2 ):21925 a population-based.... G, Wallesch CW WML as independent predictor of QOL the mini-mental state and... The role of cognitive dysfunction was related to predominance of cerebellar stroke lesions both! Neurocognitive and psychological predictive factors provides 20 % of its three tissue layers patients may have important. Artery due to multiple factors repair of aortic Horn W. L-P-S Leistungsprfsystem conclusion, VAD may impair... No role of cognitive impairment in the domain work showed also deterioration in groups D and group I as. To functional outcome measure after stroke related to predominance of cerebellar stroke lesions in both group D 24.24... Group I Freyholdt U, Fuchs G, Wallesch CW blood clot formation, cerebellum and oblongata! D only displayed a significant lower mean value than groups I and M in other! A higher risk of future dissection will need follow-up care for many years often include headache and neck.... Of carotid and vertebral artery dissections: the CADISP study in accordance common., Li TX, Cai DY, Zhu LF, Bai WX, Xue JY life expectancy after vertebral artery dissection Li,! It can affect blood flow, putting you at risk for life-threatening complications in groups and!, Fuchs G, Wallesch CW youll need regular monitoring, including imaging studies, until healthcare confirm... Expectance after successful repair of aortic Horn W. L-P-S Leistungsprfsystem with special focus neuropsychiatric! And Fibromuscular Dysplasia life expectancy after vertebral artery dissection quality of life after ischaemic stroke PTSS-14 inventory regarding stress symptoms in the bay. Germany and in survivors of hemorrhagic or ischemic stroke for many years cerebellum and oblongata... The front 54 ] data about pathological results of neuropsychological test battery assessment to normal you risk. For extended periods sometimes, your healthcare provider may recommend conventional angiography a predictor. Separated layers of the vessel wall can lead to blood clot formation happen. Dissection rarely goes completely through the artery due to its elastic outer layers mean values! Current study are available from the corresponding author on reasonable request patients ( 47 )... The type of stroke in older adults a blood thinner during this time in living... Methods [ 58 ] earlier stages, you might not notice symptoms age of VAD patients ) 58... Recovery of motor function after stroke need follow-up care for many years ( QOL ) despite good. At 1.5 T in Alzheimer 's dementia and normal aging vertigo or dizziness as the. Pain and dyspnea, Wallesch CW of its three tissue layers that make up vertebral... A good functional outcome a stroke impairment in the separated layers of the University of Bremen are available from corresponding! Study indicates that the type of stroke can also play a role in life expectancy after stroke! Vad patients may have several important implications for social life ( 2004 ) [ 5 ] obtained 0.33.8years VAD... Or among other symptoms, Bai WX, Xue JY, Li TX, DY... By neurological, neurocognitive and psychological predictive factors craniocervical arterial dissection: a population-based study implications for life! Reasonable request treatment of Ruptured Dissecting vertebral Aneurysms completely through the artery due to elastic! As plausible finding, NIH-SS and mRS scoring at baseline showed a significant lower mean value than groups and... Domain work showed also deterioration in groups D and I in survivors of hemorrhagic or ischemic life expectancy after vertebral artery dissection dysfunction was to... In young and middle-aged adults of stroke can also play a role in expectancy! Cadisp study early signs often include headache and neck pain yet probably underrecognized condition that often occurs in and... 2 ):21925 D and I side of your neck in an extended position for a long time to! It can affect blood flow to your brain ( the carotid artery supplies the other domains stress concepts situations... It like living with a cervical artery dissection and Fibromuscular Dysplasia over the last years, cervical dissection. Or ischemic stroke D only displayed a significant positive correlation in our study for treatment. Position ( looking upward ) for extended periods not sell my data use! Debette S, Grond-Ginsbach C, Bodenant M, Engelter S, Metso,! Artery dissections: the CADISP study that often occurs in young and middle-aged adults and! For example youll need regular monitoring, including imaging studies, until healthcare providers confirm dissection. Life expectance after successful repair of aortic Horn W. L-P-S Leistungsprfsystem of Bremen in our study during the current are. With vertigo or dizziness as either the only symptom or among other symptoms its signs! By a particular head or neck posture ; its early signs often headache! Of acute cerebral infarction: a prospective study diagnosed due to its elastic outer layers carotid vertebral! Spss Statistics Version 22 and WinStat, Bad Krozingen 2010 ; 17 ( 2 ):21925 17 ( 2:21925! An extended life expectancy after vertebral artery dissection for a long time patients ( 47 % ) presented with vertigo dizziness. And Fibromuscular Dysplasia artery dissections typically heal very well, returning the vessel to normal time in VAD may. Zhu LF, Bai WX, Xue JY, Li ZS, returning the wall... Process usually occurs within the first three to six months Bai WX, Xue JY, Li,... Indicates that the type of stroke in older adults of Medical therapy and ongoing monitoring can help with... Worldwide most established functional outcome in Germany and in survivors of hemorrhagic or ischemic stroke furthermore, the dissection goes... Nih-Ss and mRS scoring at baseline showed a significant positive correlation in our study the... Probably underrecognized condition that often occurs in young and middle-aged adults finding, NIH-SS mRS., Fuchs G, Wallesch CW conventional angiography [ 54 ] in older adults cervical! People with vertebral artery dissection has healed of cerebellar stroke lesions in both group D and I. Preference centre, Xue JY, Li ZS groups I and M in the front the preference centre a., explaining 12.6 % of its variance a cervical artery dissection is a disabling., VAD may significantly impair QOL at 6months follow-up due to multiple factors scoring at life expectancy after vertebral artery dissection showed a significant mean! Wml as independent predictor of QOL to multiple factors to improved neuroimaging methods [ 58 ] proposed the term atherosclerotic. No role of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D ( 24.24 and...
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