Abstract Body: Background: Most patients with Cervical Artery Dissection (CeAD) have a good functional long-term (LT) outcome. Earlier studies suggest that outcomes are worse when psychological sequela and LT-quality of life (QoL) are considered. In CeAD-patients, we assessed LT-QoL, frequency of increased anxiety levels, post-traumatic stress disorder (PTSD, DSM-IV criteria), depression, fatigue, cognitive complaints and (ii)explored if baseline characteristics can identify patients at high risk of developing the aforementioned.
Methods: LT-follow-up (LT-FU, ie >=12 months after baseline) study including consecutive CeAD patients treated at the University Hospital Basel (CH). Patients with excellent 3-month outcome (ie mRS 0-1) and no prior formal diagnosis of psychiatric disorder were eligible for inclusion. Patients were asked to answer pre-defined, established (eg HADS depression scale, SF-36, Checklist Individual Strength) questionnaires.
Results: Data from 89 CeAD (56%, n=50 male) patients were analyzed. LT-FU was performed at a mean of 69.1 months (range 15-351 months) after baseline. At LT-FU, 36% (32/89) of participants reported feeling more anxious compared to before the CeAD. Threshold for formal diagnosis of anxiety was met by 14.6% (13/89) – ie 2x as high as the current global prevalence of anxiety in the general population. 11.2% of participants met the criteria for PTSD diagnosis – ie >5x the estimated 12-m-PTSD-prevalence in the general Swiss population. 19.1% (17/89) reported depression at any point between baseline and LT-FU, 48.3% (43/ 89), scored above thresholds for abnormal fatigue. Those who experienced heightened levels of anxiety experienced reduced QoL in 6/8 measured domains. Participants who met criteria for PTSD diagnosis scored lower on 4/8 QoL-domains. A higher degree of dissociation during index CeAD and a higher degree of cognitive complaints at LT-FU predicted heightened anxiety levels at LT-FU. Occlusion of the dissected artery, tinnitus at baseline and prior smoking predicted the presence of PTSD at LT-FU.
Conclusion: CeAD patients seem to be at increased LT risk for anxiety, depression and PTSD compared to the background population. These mental health outcomes concur with a decrease in QoL. Severity of vascular pathology and dissociation during the index event might predict psychological sequlae in these patients. Further, prospective, ideally interventional studies investigating psychological sequela in CeAD patients are warranted.