Læknablaðið - 15.06.2011, Side 21

Y F I R L I T
á unga aldri, ef margir æðagúlar eru til staðar eða ef fleiri
f fjölskyldunni eru með sjúkdóminn. Hafa verður í huga að
regluleg skimun getur ekki komið í veg fyrir allar blæðingar
þar sem æðagúlar geta myndast og rofnað á skemmri tíma en
fimm árum.'H
Skimun ættingja
Almennt er ekki mælt með skimun ef eingöngu einn ættingi
í fyrsta ættlið hefur fengið SIB (það þyrfti að skima yfir 300
einstaklinga til að koma í veg fyrir eitt dauðsfall).1 Undantekningar
eru gerðar ef systkini þess sem blætt hefur er undir 40 ára aidri
eða ef nákominn ættingi hefur miklar áhyggjur af því að hann hafi
æðagúl. Skimun er réttlætanleg hjá einstaklingi ef tveir eða fleiri
ættingjar í fyrsta ættlið hafa fengið SIB og einnig í fjölskyldum
þar sem blöðrunýmasjúkdómur er ættgengur.1 Skimun ætti að
íhuga hjá eineggja tvíbura ef hinn hefur orðið fyrir SIB.
Órofinn æðagúll fundinn óvænt
Ef æðagúll finnst fyrir tilviljun við myndrannsókn sem fram-
kvæmd er af öðrum ástæðum þarf að meta hvort betra sé að
fylgjast með æðagúlnum með reglulegum myndatökum eða
framkvæma aðgerð. Við áhættumat þarf að taka tillit til aldurs
(yngra fólk á fleiri ár fram undan), einnig þarf að hafa í huga
að hætta á rofi eykst með aldrinum.45 Önnur atriði sem þarf
að vega og meta eru: stærð æðagúls (aukin hætta er á rofi
með aukinni stærð), staðsetning (aukin hætta á rofi ef gúll-
inn er í aftari heilablóðveitunni), form gúlsins, kyn (konur eru
í aukinni hættu), aðrir sjúkdómar og fjölskyldusaga. Þar sem
ákvarðanatakan getur verið flókin er nauðsynlegt að hafa samráð
við taugaskurðlækni í þessum efnum.
Höfundar þakka Aroni Björnssyni heila- og taugaskurðlækni
kærlega fyrir yfirlestur greinarinnar og gagnlegar ábendingar.
Heimildir
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