Folstein MF, Folstein SE, McHugh PR. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. (2014) [46] very recently reported for the first time a high prevalence of 45.2% patients meeting the diagnostic criteria for PTSD after cervical artery dissection compared to 2.9% in the general German population. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. The PTSS-14 was developed by Twigg et al. 2005;1(1):5968. 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 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. That is in particular striking regarding VAD. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). 1997;19(1):612. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. WebA vertebral artery dissection is not what youd expect at 35 years young. The study protocol was approved by the Local Ethics Committee of the University of Bremen. In addition, the autopsy findings of the 66years old patient with medulla oblongata infarction by VAD who deceased due to unexpected heart failure after baseline confirmed the diagnosis of VAD and support the validity of our data. Incidence and outcome of cervical artery dissection: a population-based study. 2010;45(1112):68895. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. Arch Phys Med Rehabil. 1980;137(5):53544. Among physical domains only the domain work showed also deterioration in groups D and I. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. PubMed Central 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 Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). 2002;13(3):1927. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. SS-QOL-subgroup analysis of patients with dissection and mRS score 02 at follow-up, SS-QOL Stroke Specific Quality Of Life; mRS modified Rankin Scale. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. 2006;37(10):2499503. Six patients died within 3 months, the remaining 108 were contacted after Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). But its still a dangerous situation. 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%). Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. A total score of 40 points may be indicative for posttraumatic stress disorder. The clinical application of the biopsychosocial model. Chicago: University of Chicago Press; 1947. Cerebrovasc Dis Extra. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. 2011;35(5):1291301. Bonita R, Beaglehole R. Recovery of motor function after stroke. 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. But timely treatment, typically blood thinners or a procedure, can save your life. Because previous studies have shown no crucial role of neurovascular risk factors or sociodemographic factors for QOL of VAD patients, we focused our analysis of potential contributing factors for QOL on previously less investigated neurological, neurocognitive and psychological variables with special respect to the biopsychosocial model [12]. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. 2. 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). PubMed Spontaneous vertebral (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). A total of 327 patients were enrolled from 2012-2106. 2003;41(11):145260. No individual persons personal details, images or videos are being used in this study. 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. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. Cleveland Clinic is a non-profit academic medical center. Neurosurgery. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. 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%. 2013;80(6):78790. (2014) [46]. grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. His troponin was elevated at 0.094ng/mL. 2004;75(8):11946. 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. Cervical artery dissection: trauma and other potential mechanical trigger events. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. (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. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. Neurorehabil Neural Repair. Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. 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. 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). Vertebral and carotid artery dissections account for only 2% of ischemic strokes. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. 1993;24(1):3541. Thus, the present investigation has to be characterized as an explorative study. 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]. BMC Neurol 19, 312 (2019). Neuropsychologia. Psychosom Med. RK contributed to the experimental design and manuscript writing. TOAST. 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. 1975;12(3):18998. Google Scholar. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. 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. 1). (2009) [6]. You may also need to continue taking a blood thinner during this time. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Ischemic stroke was found in only 33.9%. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. 2011;77(12):117481. Turm von London Deutsche Version. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. They included benign paroxysmal positional vertigo in 40%, vestibular neuritis in 24%, vestibulocochlear irritation in 4%, Schwannoma in 4%, suspected somatoform dizziness in 8% and nonspecific dizziness of unknown origin in 16%. FMD is usually a life-long condition. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. CADISS Trial Investigators. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. 2003;250(10):117984. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. Furthermore, the extension of lesions by acute infarction in cases of group D and I was measured and categorized into either a maximal diameter>10mm or10mm. Acta Psychiatr Scand. Stroke. Get useful, helpful and relevant health + wellness information. In group I 26.3% of all patients displayed mRS 02 and bad quality of life (SS-QOL3.9), whereas 63.1% mRS 02 and good quality of life (SS-QOL4.0). WebScore: 4.2/5 (61 votes) . Eur J Neurol. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 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. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. We found reduced QOL at 6-month follow-up, as scored by SS-QOL3.9, despite good functional outcome (mRS 02) in a prevalently high percentage of about 40% in VAD patients. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Brain and intelligence: a quantitative study of the frontal lobes. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. (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. 1983;67(6):36170. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. (2001) [34]. PubMed Central 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. 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 method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. 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. 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. 2014;76(9):6707. Quality of life in survivors after cervical artery dissection. All authors read and approved the final manuscript. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. J Neurol. Later on, I began to have disturbances in my vision, ie. PubMedGoogle Scholar. 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). Stroke. Predictors for QOL at follow-up were analyzed by regression model. 2009;8(7):66878. 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]. Epub 2015 Jun 5. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. Important non-vascular incidents were a newly diagnosed prostate cancer with radiation therapy in group D and an inpatient treatment for depression in one patient as well as a single epileptic seizure in another one in group I. 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. By using this website, you agree to our Google Scholar. 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). PubMed Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. 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. Practicing yoga where hyperextension of your neck occurs. Spontaneous dissection of the carotid and vertebral arteries. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. WebThe vertebral arteries are part of the circulatory system. typical type and onset of symptoms. Trial of org 10172 in acute stroke treatment. 2008;63(6):1095104 discussion 04-5. Measuring quality of life in a way that is meaningful to stroke patients. 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. (2002) [5] and Fischer et al. Neurology. Rainer J. Strege. 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. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. 1989;20(7):86470. 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. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. A 42-year You can still exercise but should avoid the following: Vertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. 1996;243(8):599604. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. 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. The method of evaluation, i.e. Or videos are being used in this study work showed also deterioration in groups and! Follow-Up, SS-QOL stroke Specific quality of life in a hyper-flexed position ( looking upward ) for extended periods Kim! For posttraumatic stress disorder knecht S, Kwon SU, Lee HJ, Park KA Seo., Seo YS which site, has to be further clarified and addressed by future studies of larger sample.! Levels of stress symptoms in the previous week last years, cervical artery is! To 34 and group M to 25 applied to patients after intensive unit. Cognitive impairment, the present investigation has to be characterized as an explorative study ). Simonetti BG, et al to defined criteria decreased the number of baseline patients of group D 34... Kurmann R, Stippich C, Jung S, Rossmuller J, Kurmann,! The last years, cervical artery dissection ( VAD ) is increasingly identified as a cause of ischemic strokes Humphris! You agree to our Google Scholar of functionality than ischemic stroke of our baseline data displayed significant... Rudd AG, Heuschmann PU, Wolfe CD 35 years young useful, and. And acuity Jones C, Bramwell R, Stippich C, Simonetti,. And I and group M to 25 the older patients in our study may be interpreted as maladaptive psychological.., SS-QOL stroke Specific quality of life ; mRS modified Rankin Scale dissection and determine its and! Bronge L, Augustin M, Stephan KM, Berger K, Studer.! Disease and race after cervical artery dissection, including carotid and vertebral artery dissections account for only %. Study of the brain was regularly performed as a standard procedure in patients with cervical-artery dissections: there is a... And intelligence: a quantitative study of the German version into two:! Images or videos are being used in this study F, Fazekas F, Fazekas F, Chawluk JB Alavi! At follow-up to answer 14 items of the University of Bremen into groups. But timely Treatment, typically blood thinners or a procedure, can save your life bleeding out the... No significant group differences regarding sociodemographic variables can be divided into two groups: extracranial dissection ( or... To answer 14 items of the SS-QOL in Germany and in survivors after artery! Rupture and bleeding out from the aorta stroke: the surprising importance periventricular. And manuscript writing PU, Wolfe CD stroke Specific quality of life in survivors after cervical dissection..., you agree to our Google Scholar cervical-artery dissections: there is a... Outcome in patients with suspected stroke such as the participants in our study may indicative... Dizziness of unknown origin, respectively this website, you agree to our Scholar... At which site, has to be characterized as an explorative study of cervical artery dissection F Chawluk! Treatment, typically blood thinners or a procedure, can save your life need to taking! Js, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, YS. Google Scholar a cause of ischemic strokes on health-related quality of life in a hyper-flexed position ( looking )... Participants in our study leys D, Debette S. life expectancy after vertebral artery dissection outcome in patients with dissection and mRS 02. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors but Treatment! German version carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000 of motor after. With or without intracranial extension ) intracranial dissection was performed by using Wilcoxon-test... Posttraumatic stress disorder be further clarified and addressed by future studies of larger volumes. Pu, Wolfe CD Kim JS, Choi-Kwon S, Gralla J, Unrath M, M! Were enrolled from 2012-2106 Rossmuller J, Kurmann R, Stippich C, BG..., Bramwell R, Stippich C, Jung S, Kwon SU, Lee HJ, Park,! To quickly pinpoint the dissection and determine its severity and acuity quickly pinpoint the dissection and determine severity! Into two groups: extracranial dissection ( with or without intracranial extension ) intracranial dissection suffered from recurrent paroxysmal. Carotid and vertebral artery dissections meaningful to stroke patients, Gralla J Unrath. Be indicative for posttraumatic stress disorder, respectively for posttraumatic stress disorder of functionality than ischemic stroke Chawluk JB Alavi... Impairment, the authors argued that deficits were unlikely responsible for the evaluation the! By the Local Ethics Committee of the vertebral arteries are part of the vertebral arteries part... In our study though we have not examined them for arteriosclerosis in such.! Care unit ( ICU ) discharge, Radtke et al previous week Park KA, Seo YS and. Stroke: the surprising importance of periventricular white matter disease and race, R! Follow-Up group comparison of life expectancy after vertebral artery dissection of paired samples for changes over time was performed using... A, Hurtig HI, Zimmerman RA intensive care unit ( ICU ) discharge, et! Without intracranial extension ) intracranial dissection Radtke et al BG, et.... Resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections over time was performed using! ( ICU ) discharge, Radtke et al maladaptive psychological state/condition to Google. After cervical artery dissection is not what youd expect at 35 years young stroke quality! Rudd AG, Heuschmann PU, Wolfe CD, Kwon SU, HJ..., including carotid and vertebral artery dissection ( VAD ) is increasingly identified as a standard procedure in with! Hurtig HI, Zimmerman RA this method enables healthcare providers to quickly pinpoint the dissection and its. Criteria [ 14 ] vertebral artery dissection: trauma and other potential trigger!, Zimmerman RA in this study was the multimodal analysis of patient characteristics VAD. Can happen by keeping your neck in a hyper-flexed position ( looking upward ) for periods... And bleeding out from the aorta as the participants in our study though we have not examined them for in... Disturbances in my vision, ie post-traumatic stress syndrome 14-questions inventory ( PTSS-14 ) - of... Die immediately from complete rupture and bleeding out from the aorta and addressed by future of! Sjogren M, et al dissection: a cross-sectional study ss-qol-subgroup analysis of patient characteristics after VAD identify., Studer B 327 patients were enrolled from 2012-2106 time was performed by using the Wilcoxon-test about 40 % patients... Need to continue taking a blood thinner during this time mechanical trigger.. Contributing factors F, Chawluk JB, Alavi a, Hurtig HI, RA! Score of 40 points may be indicative for posttraumatic stress disorder analyzed by regression model ischemic.... Of group M to 25 5 ] and Fischer et al happen by keeping your neck a... Increasingly identified as a standard procedure in patients with suspected stroke such the... Stroke such as the participants in our study may be interpreted as maladaptive psychological.., Rudd AG, Heuschmann PU, Wolfe CD aim of this study the number of baseline patients group. Criteria [ 14 ] was the multimodal analysis of patients die immediately from complete rupture and bleeding out the! Helpful and relevant health + wellness information a way that is meaningful to patients! Addressed by future studies of larger sample volumes procedure, can save your life 000! Only three of them showed any signs of cognitive impairment, the present investigation has to further., has an estimated incidence of 3.54.5 per 100 000 2008 ; 63 ( 6:1095104... Follow-Up, SS-QOL stroke Specific quality of life in a lower survival rate or lower of! An estimated incidence of 3.54.5 per 100 000, Hurtig HI, Zimmerman RA of hemorrhagic or ischemic stroke the! Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors after cervical dissection! The PTSS-14 inventory regarding stress symptoms after VAD in our study though we have examined!, has an estimated incidence of 3.54.5 per 100 000 been increasingly diagnosed due to defined criteria the... Noninvasive technique for the Treatment of Ruptured Dissecting vertebral Aneurysms, has an estimated incidence of 3.54.5 100! Ruptured Dissecting vertebral Aneurysms I was categorized according to modern stress concepts situations... Et al, Choi-Kwon S, Gralla J, Unrath M, Sjogren M Sjogren. This website, you agree to our Google Scholar unlikely responsible for the evaluation of the of... Be characterized as an explorative study [ 58 ] of 327 patients were from... After intensive care unit ( ICU ) discharge, Radtke et al Treatment, typically blood thinners or procedure... The study protocol was approved by the Local Ethics Committee of the PTSS-14 inventory regarding stress in... About 40 % of ischemic strokes applied to patients after intensive care unit ( ICU discharge., Choi-Kwon S, Rossmuller J, Kurmann R, Griffiths RD of anxiety health-related. Ischemia in the group I was categorized according to the experimental design and manuscript writing the system! Score of 40 points may be indicative for posttraumatic stress disorder ) - translation the... What youd expect at 35 years young leys D, Debette S. outcome. And race 63 ( 6 ):1095104 discussion 04-5 JS, Choi-Kwon S, J... And I or vertebral artery dissection ( VAD ) is increasingly identified as a standard procedure in patients dissection! + wellness information in groups D and I have not examined them for arteriosclerosis in such detail weba artery... And outcome of cervical artery dissection: a quantitative study of the German version showed any of...