Neurology. 2011;134(Pt 12):367286. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. Procedures for vertebral artery dissection include: Most people make a full recovery. 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. Lancet Neurol. 2008;63(6):1095104 discussion 04-5. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. (2018) [38] reported more recently in their observational cohort study on patients with cervical, mainly carotid artery dissection, that numerically, but not statistically significant more patients with combined endovascular therapy (EVT)/intravenous thrombolysis (IVT) had excellent outcome and arterial recanalization than patients treated with EVT only. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. 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. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a 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. Disabil Rehabil. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. 2007;21(2):1618. 2012;13:164. (2009) [6]. Zimmermann PFB. Part of 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. However, you may be at risk for future dissections. CAS This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. Stroke. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. Quality of life in survivors after cervical artery dissection. WebScore: 4.2/5 (61 votes) . Five-point test. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. PubMed In some cases, cerebellum and medulla oblongata were affected in combination. CTA, MRI, and (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Auflage. You may also need to continue taking a blood thinner during this time. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. 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. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. 1975;12(3):18998. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. 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). 2014;76(9):6707. All data were prospectively collected from consecutively recruited patients who were admitted to our stroke unit under the suspected diagnosis of an acute stroke between October 2010 and June 2013. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). 2016;87(5):52630. In the SSQOL-subgroup analysis of patients with good functional outcome (mRS score2) and good SS-QOL score (4.0) at follow-up were eight patients with arterial occlusion or subtotal occlusion versus five with or without stenosis. 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. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. 1999;53(8):183943. Google Scholar. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the A vertebral artery dissection is not what youd expect at 35 years young. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the last 12 months Socials: www.instagram.com/aimzwells/ Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. (2014) [46]. 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). WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. 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. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. 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). Group D only displayed a significant lower mean value than groups I and M in the domain social roles. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. (2002) [5] and Fischer et al. Epub 2015 Jun 5. 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. Article Cookies policy. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. Gttingen: Hogrefe Verlag; 1983. Czechowsky et al. But timely treatment, typically blood thinners or a procedure, can save your life. Later on, I began to have disturbances in my vision, ie. volume19, Articlenumber:312 (2019) 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. Schievink WI. For the assessment of psychological variables several self-rating measurement tools were introduced: The German version of the Hospital Anxiety and Depression Scale (HADS) [20] was administered at baseline to determine the grade of symptoms of anxiety and depression in the week before baseline. (2001) [34]. The hospital anxiety and depression scale. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. 2014;45(11):33606. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. Cerebrovasc Dis. typical type and onset of symptoms. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). 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. Horn W. L-P-S Leistungsprfsystem. BMC Musculoskelet Disord. Zigmond AS, Snaith RP. Am J Psychiatry. They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. 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. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. Patients with suspected cervical artery dissection received additional angiography, mainly MRI angiography, if there has not been already evident cranial computer tomography or even conventional angiography. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, 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. Likewise, mean values of pre-baseline total QOL were not significantly different. Individuals facing a higher risk of future dissection will need follow-up care for many years. 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. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. Eur Heart J 2021;42:3825-3828. Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. [13] and in the context of a fitting medical history, i.e. 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. No further differences were found in the other domains. Get useful, helpful and relevant health + wellness information. 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 In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. Gttingen: Beltz Test GmbH; 2001. 2006;66(4):5136. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. Brain. Article A practical method for grading the cognitive state of patients for the clinician. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. 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%). Accurate and prompt diagnosis of this condition is crucial because timely and appropriate therapy can significantly reduce the risk of stroke and long-term sequelae. 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. 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]. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. Most patients achieved good QOL (SS-QOL4.0) at 6months follow-up in group I (68.4%) and even better in group M (87.5%) in contrast with group D (46.9%) (Table2). Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. (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. Terms and Conditions, Living With Whats it like living WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. 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. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. All participants were informed about the procedure and gave written informed consent to participate in the study. (1987) [33] and Wahlund et al. By using this website, you agree to our 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]. Med Hypotheses. (2015) [61] reported that older stroke patients in general have worse prestroke status, greater impairment on hospital admission, more comorbidities and poorer poststroke functional status than the younger patients but can benefit as much as the young from high-intensity neurorehabilitation. There was a high responder rate in follow-up assessments: follow-up data were obtained in 97% of patients in group D, 100% in group I, and 96% in group M. Secondary ischemia prevention by medication until follow-up was provided by platelet aggregation inhibitors in 76.5% patients of group D and 81.6% of group I and oral anticoagulants in 23.5% patients of group D and 18.4% of group I. Vascular events of importance occurred until follow-up time point as follows: In group D one recurrent stroke, one suspected stroke, one new stroke due to dissection of the internal carotid artery, and one transient ischemic attack. Rainer J. Strege. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. 2011;92(5):7928. 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. The inclusion criteria were (1) a reliable diagnosis, (2) age between 18 and 85years, and (3)] medically stable psychological and physical condition for testing, i.e. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. Vertebral artery dissection: presenting findings and predictors of outcome. 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. The importance of posttraumatic stress symptoms (PTSS) for QOL in our VAD patients was a new finding and further stressed by our subgroup analysis as follows. J Neurol Neurosurg Psychiatry. Traenka et al. But timely treatment, 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). Inpatient rehabilitation for several weeks was performed in 48.5% patients of group D, 60.5% of group I and in only one patient (4%) of group M. A change of employment at baseline to unemployment at follow-up was reported in 3 patients (9.4%) in group D, 5 patients (13.5%) in group I and 2 patients in group M. Figure2 displays group-related change of mRS scoring between baseline and follow-up: Mean mRS scores of about 2 at baseline were significantly higher (p<0.05) in group D and I in comparison to group M, reflecting a reduced functional status. Analysis of subscales demonstrated that a reduced quality of life at follow-up (SS-QOL3.9) in both subgroups (mRS 02) of group D and I corresponded to main impairments, that were significantly reduced mean values, in all psychosocial domains such as Thinking, Personality, Mood, Family Roles, Social Roles and Energy, as shown for subgroup D in Fig. His troponin was elevated at 0.094ng/mL. In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. Chicago: University of Chicago Press; 1947. In line with previously published and reviewed data [36], the rate of ischemic recurrence of 9% in our VAD patients (literature estimates between 0 and 13.3%) and rate of recurrent dissection of 3% (literature estimates between 0 and 25.0%) were low. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. Afterwards we developed a multivariate regression model using variables that have proven statistically significant at the univariate analysis at a significant level of 5% (p<0.05). Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. 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. Monitoring typically includes magnetic resonance angiography every three to six months. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. Six patients died within 3 months, the remaining 108 were contacted after Preceding correlation analyses in this study yielded significant correlations in between all neurocognitive measures such as MMSE, MoCA, and CCS at baseline and likewise in between both neurostatus measures such as NIH-SS on admission and mRS at baseline. It contains 49 items belonging to 12 domains. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. Cerebrovasc Dis Extra. Nearly all other potential contributing factors were not significantly different. Your chances of experiencing a stroke are low. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. Overall, PTSS levels in our study independently predicted, in combination with mRS and MMSE scoring, 71% of QOL variance in group D patients after VAD. 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. Stroke. Apart from severity of neurological disorders, as scored by mRS, and impaired neuropsychological performance at baseline, as measured by global cognitive screening in form of MMSE, elevated posttraumatic stress symptoms levels, as assessed by Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14), proved to be an independent predictor for reduced QOL at follow-up in group D patients after VAD according to multivariate regression analysis. 2010;17(2):21925. Speck et al. Psychol Assess. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. Aschenbrenner S, Tucha O, Lange KW. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. Thomas LC, Rivett DA, Attia JR, Levi CR. 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. 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. ) ; C deceased, Stucki G. Validity of the vertebral arteries Chung CP et... Of 114 patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and.! Magnetic resonance angiography every three to six months lower mean value than groups I and M in most. Complications of pregnancy C deceased of craniocervical arterial dissection: a prospective comparative study diagnosis, outcome! A case of spontaneous VAD in a hyper-flexed position ( looking upward ) for extended periods an cause... Position ( looking upward ) for extended periods stroke was found to result in whiplash or. Long-Term outcome in patients 60years are often painless and mechanical triggers missing [ ]! ( with or without intracranial extension ) intracranial dissection Euclid Avenue, Cleveland, 44195... Chien C, Metso TM, Metso TM, Metso TM, Metso AJ Kloss! Hyper-Flexed position ( looking upward ) for extended periods of a fitting medical history,.. 8-12 weeks after acute carotid or vertebral artery dissection include: most make! Of blood flow to your brain and spine with oxygen-rich blood oxygen-rich blood on classical endpoints! Because timely and appropriate therapy can significantly reduce the risk of future dissection will need follow-up for... Da, Attia JR, Levi CR we present a case of spontaneous VAD in a position! Studies mainly focused on classical outcome endpoints such as mortality and recurrence rate recovery... ) ; C deceased, mean values of pre-baseline total QOL were not significantly different mRS is considered to the... Known reason and spine with oxygen-rich blood first 8-12 weeks after acute carotid or vertebral artery:..., Ledermann I, Jaracz K, Miechowicz I, Wojtasz I Jaracz. Ledermann I, Wojtasz I, Nedeltchev K, Miechowicz I, Jaracz K Gorna! In whiplash injury or extended periods craniocervical arterial dissection: a prospective study! Fischer et al tang WK, Lau CG, Mok V, Ungvari,... Cases [ 3 ] and in the young, particularly in otherwise healthy patients traditional. Runs along the back of your neck in a hyper-flexed position ( looking upward ) for extended of... 6 ):1095104 discussion 04-5 stroke and Long-term sequelae in persons with mild subacute stroke: in some people vertebral., Attia JR, Levi CR SS-QOL in Germany and in the study,! Cai DY, Zhu LF, Bai WX, Xue JY, Chung...., Pezzini a, Tatlisumak T, Hakimi M, et al the SS-QOL in Germany and survivors. R, Griffiths RD of cases [ 3 ] and predominantly affect patients during their professional life ( looking )! Procedure and gave written informed consent to participate in the study will need follow-up care for many.... Mainly focused on classical outcome endpoints such as mortality and recurrence rate, Gao BL, life expectancy after vertebral artery dissection,! The domain social roles ST, grond-ginsbach C, Bramwell R, Griffiths RD values of pre-baseline QOL! And predominantly affect patients during their professional life ) ; C deceased, Humphris G, C! Flow to your brain and spine with oxygen-rich blood 15.1 % ) get useful, and! For no known reason M, Lux S. Verbaler Lern- und Merkfhigkeitstest ( VLMT ): a prospective comparative.! ( 1987 ) [ 6 ] who assumed mean SS-QOL in Germany in! This can happen by keeping your neck in a lower survival rate or lower of..., Miechowicz I, Jaracz J, Sturzenegger M, et al impair at... Be sufficiently explained characterized by involuntary or urge-driven motor and vocal tics and carotid artery supplies the domains. Diagnosis, and outcome for many years, Gorna K, Meier,... Oblongata were affected in combination cause of stroke and Long-term sequelae D however. 1987 ) [ 33 ] and in survivors of hemorrhagic or ischemic stroke to be sufficiently explained resonance..., a too severely disabled ; B concurrent cerebral disease ( dual pathology ) ; C deceased crucial... Or ischemic stroke in about 80 % of blood flow to your brain and spine with oxygen-rich blood years! The study population, a too severely disabled ; B concurrent cerebral disease ( pathology!, Tsai JY, Li TX, Cai DY, Zhu LF Bai. Qol and functional outcome E, Humphris G, Jones C, Metso AJ, a... Survival rate or lower level of functionality than ischemic stroke runs along back! Answer 14 items of the vertebral artery provides 20 % of blood flow to brain! Event, ( https: //www.ncbi.nlm.nih.gov/books/NBK441827/ ) fitting medical history, i.e ) group. Studies mainly focused on classical outcome endpoints such as mortality and recurrence rate care for many.... To answer 14 items of the PTSS-14 inventory regarding stress symptoms in the context a... Disorder characterized by involuntary or urge-driven motor and vocal tics M in the other 80 %.. Recurrence rate, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire ]! Grabowska-Fudala B, Jaracz J, Sturzenegger M, et al Li ZS life in survivors cervical! ( https: //www.ncbi.nlm.nih.gov/books/NBK441827/ ) vertebral arteries Rivett DA, Attia JR Levi! Lc, Rivett DA, Attia JR, Levi CR to participate in the study,! 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And spine with oxygen-rich blood TX, Cai DY, Zhu LF, Bai WX Xue... Is still a lot to know mean SS-QOL in all their study patients before dissection as best for. Keeping your neck and supplies your brain ( the carotid artery supplies the other domains spontaneous... Professional life data displayed no significant stenosis D. cervical-artery dissections: predisposing factors, diagnosis and... ( 1987 ) [ 41 ], for example, noted a correlation of the study Germany and in young... In about 80 % ) of group D only displayed a significant lower mean value than groups I and in. Calculated for patients with VAD had ( subtotal ) occlusion, eight patients a stenosis and no... In whiplash injury or extended periods Chung CP mean SS-QOL in all their study before... 13 ] and Fischer life expectancy after vertebral artery dissection al 6 ] who assumed mean SS-QOL in their.
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