Læknablaðið - 15.03.2010, Blaðsíða 41

FRÆÐIGREINAR
SJÚKRATILFELLI OG YFIRLIT
Heimildir
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Giant cell arteritis - two cases with acute blindness
Giant cell arteritis is characterized primarily by
inflammation in certain large and medium-sized arteries.
The major risk factors are age, female gender and Northern
European descent.
In this report we describe two cases of acute vision loss
due to giant cell arteritis. In both cases the erythrocyte
sedimentation rate (ESR) was below 50 mm/hr and the
presenting complaint was foggy vision followed by acute
blindness. The cases are to some extent different, for
example in the former case the patient reported jaw
claudication and ophthalmologic evaluation was consistent
with anterior ischemic optic neuropathy. In the latter case
there was narrowing and box-carring of blood cells in
retinal arterioles, consistent with occlusion of the central
retinal artery. This patient had recently finished a 2-year
long treatment with glucocorticosteroids for polymyalgia
rheumatica.
The retina and the optic nerve do not survive for long
without perfusion. If giant cell arteritis causes blindness
in one eye there is significant risk for the other eye to go
blind if no treatment is given. Corticosteroids can spare
the other eye and suppress the underlying infiammatory
disease process as well. It is vital to confirm the diagnosis
of giant cell arteritis with a biopsy and start corticosteroid
treatment as soon as possible, even before the biopsy is
taken.
Elfarsson A, Gudbjomsson B, Stefansson E.
Giant cell arteritis - two cases with acute blindness. Icel Med J 2010; 96: kkkkfff.
Keywords: Giant cell arteritis, Corticosteroids, Headache, Acute blindness, Anterior ischemic optic neuropathy, Central retinal artery
occlusion.
Correspondence: Einar Stefánsson, einarste@landspitali.is
Barst: 18. ágúst 2009, - samþykkt til birtingar: 9. desember 2009
Hagsmunatengsl: Engin
LÆKNAblaðið 2010/96 189
ENGLISH SUMMARY