Læknablaðið - 15.06.2011, Blaðsíða 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
1. van Gijn J, Kerr RS, Rinkel GJE. Subarachnoid
haemorrhage. Lancet 2007; 369: 306-18.
2. Linn FHH, Rinkel GJE, Algra A, van Gijn J. Incidence of
subarachnoid hemorrhage: role of region, year, and rate of
computed tomography: a meta-analysis. Stroke 1996; 27:
625-9.
3. Anderson C, Anderson N, Bonita R, et al. Epidemiology
of aneurysmal subarachnoid hemorrhage in Australia
and New Zealand: incidence and case fatality from the
Australasian Cooperative Research on Subarachnoid
Hemorrhage Study (ACROSS). Stroke 2000; 31:1843-50.
4. Brisman L, Song, J, Newell DW. Cerebral Aneurysms. N
Engl J Med 2006; 355:928-39.
5. Rinkel GJE, Djibuti M, Algra A, van Gijn J. Prevalence and
risk of rupture of intracranial aneurysms: a systematic
review. Stroke 1998; 29:251-6.
6. White PM, Wardlaw JM. Unruptured intracranial
aneurysms. J Neuroradiol. 2003; 30: 336-50.
7. Schievink WI. Intracranial aneurysms. N Engl J Med 1997;
336:28-40.
8. Feigin VL, Rinkel GJE, Lawes CM, et al. Risk factors for
subarachnoid hemorrhage: an updated systematic review
of epidemiological studies. Stroke 2005; 36:2773-80.
9. Ruigrok YM, Buskens E, Rinkel GJE. Attributable risk
of common and rare determinants of subarachnoid
hemorrhage. Stroke 2001; 32:1173-5.
10. Wang MC, Rubinstein D, Kindt GW, et al. Prevalence of
intracranial aneurysms in first-degree relatives of patients
with aneurysms. Neurosurg Focus 2000; 13:1-5.
11. Fann JR, Kukull WA, Katon WJ, Longstreth WT. Physical
activity and subarachnoid haemorrhage: a population
based case-control study. J Neurol Neurosurg Psychiatry
2000; 69: 768-72.
12. Anderson C, Ni Mhurchu C, Scott D, Bennett D, Jamrozik
K, Hankey G. Triggers of subarachnoid hemorrhage:
role of physical exertion, smoking, and alcohol in the
Australasian Cooperative Research on Subarachnoid
Hemorrhage Study (ACROSS). Stroke 2003; 34:1771-6.
13. Intemational Study of Unruptured Intracranial
Aneurysms Investigators. Unruptured intracranial
aneurysms: natural history, clinical outcome, and risks
of surgical and endovascular treatment. Lancet 2003; 362:
103-10.
14. Wijdicks EFM, Schievink WI. Perimesencephalic nonan-
eurysmal subarachnoid hemorrhage: first hint of a cause?.
Neurology 1997; 49:634-6.
15. Schwartz TH, Solomon RA. Perimesencephalic
nonaneurysmal subarachnoid hemorrhage: review of the
literature. Neurosurgery 1996; 39:433-40.
16. Rinkel GJE, Wijdicks EFM, Vermeulen M, Tans JTJ, Hasan
D, van Gijn J. Acute hydrocephalus in nonaneurysmal
perimesencephalic hemorrhage: evidence of CSF block at
the tentorial hiatus. Neurology 1992; 42:1805-7.
17. Schwartz TH, Farkas J. Quadrigeminal non-aneurys-
mal subarachnoid hemorrhage: a tme variant of
perimesencephalic subarachnoid hemorrhage: case report.
Clin Neurol Neurosurg 2003; 105:95-8.
18. Brilstra EH, Rinkel GJE, Algra A, van Gijn J. Rebleeding,
secondary ischemia, and timing of operation in patients
with subarachnoid hemorrhage. Neurology 2000; 55:1656-
60.
19. Caeiro L, Menger C, Ferro JM, Albuquerque R, Figueira
ML. Delirium in acute subarachnoid haemorrhage.
Cerebrovasc Dis 2005; 19: 31-8.
20. Pinto AN, Canhao P, Ferro JM. Seizures at the onset of
subarachnoid haemorrhage. J Neurol 1996; 243:161-4.
21. Cloft HJ, Joseph GJ, Dion JE. Risk of cerebral angiography
in patients with subarachnoid hemorrhage, cerebral
aneurysm, and arteriovenous malformation: a meta-
analysis. Stroke 1999; 30:317-20.
22. Vieco PT, Shuman WP, Alsofrom GF, Gross CE.
Detection of circle of Willis aneurysms in patients with
acute subarachnoid hemorrhage: a comparison of CT
angiography and digital subtraction angiography. AJR
Am J Roentgenol 1995; 165:425-30.
23. Huston J 3rd, Nichols DA, Luetmer PH, et al. Blinded
prospective evaluation of sensitivity of MR angiography
to known intracranial aneurysms: importance ofaneurysm
size. AJNR Am J Neuroradiol 1994; 15:1607-14.
24. Roos YBWEM, de Haan RJ, Beenen LFM, Groen RJM,
Albrecht KW, Vermeulen M. Complications and outcome
in patients with aneurysmal subarachnoid haemorrhage:
a prospective hospital based cohort study in The
Netherlands. J Neurol Neurosurg Psychiatry 2000; 68:337-
41.
25. Ohkuma H, Tsurutani H, Suzuki S. Incidence and
significance of early aneurysmal rebleeding before
neurosurgical or neurological management. Stroke 2001;
32:1176-80.
26. Molyneux AJ, Kerr RS, Yu LM, et al. Intemational
subarachnoid aneurysm trial (ISAT) of neurosurgical
clipping versus endovascular coiling in 2143 patients
with ruptured intracranial aneurysms: a randomised
comparison of effects on survival, dependency, seizures,
rebleeding, subgroups, and aneurysm occlusion. Lancet
2005; 366: 809-17.
27. Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid
hemorrhage. N Engl J Med 2006; 354: 387-96.
28. Rabinstein AA, Weigand S, Atkinson JL, Wijdicks
EFM. Pattems of cerebral infarction in aneurysmal
subarachnoid hemorrhage. Stroke 2005; 36:992-7.
29. Hijdra A, van Gijn J, Stefanko S, van Dongen
KJ, Vermeulen M, van Crevel H. Delayed cerebral
ischemia after aneurysmal subarachnoid hemorrhage:
clinicoanatomic correlations. Neurology 1986; 36:329-33.
30. Hop JW, Rinkel GJE, Algra A, van Gijn J. Initial loss of
consciousness and risk of delayed cerebral ischemia after
aneurysmal subarachnoid hemorrhage. Stroke 1999; 30:
2268-71.
31. Lysakowski C, Walder B, Costanza MC, Tramér MR.
Transcranial Doppler versus angiography in patients
with vasospasm due to a ruptured cerebral aneurysm: a
systematic review. Stroke 2001; 32:2292-8.
32. Phan TG, Huston J, Campeau NG, Wijdicks EFM,
Atkinson JL, Fulgham JR. Value of diffusion-weighted
imaging in patients with a nonlocalizing examination and
vasospasm from subarachnoid hemorrhage. Cerebrovasc
Dis 2003; 15:177-81.
33. Pickard JD, Murray GD, Illingworth R, et al. Effect of
oral nimodipine on cerebral infarction and outcome after
subarachnoid haemorrhage: British aneurysm nimodipine
trial. BMJ 1989; 298: 636-42.
34. Van den Bergh WM on behalf of the MASH study
group. Magnesium sulfate in aneurysmal subarachnoid
hemorrhage: a randomized controlled trial. Stroke 2005;
36:1011-5.
35. Rinkel GJE, Feigin VL, Algra A, van Gijn J. Circulatory
volume expansion therapy for aneurysmal subarachnoid
haemorrhage. Cochrane Database Syst Rev 2004; 4:
CD000483.
36. Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES.
Ventriculostomy-related infections: a critical review of the
literature. Neurosurgery 2002; 51:170-81.
37. Huang J, Van Gelder JM. The probability of sudden death
from rupture of intracranial aneurysms: a meta-analysis.
Neurosurgery 2002; 51:1101-5.
38. Stegmayr B, Eriksson M, Asplund K. Declining mortality
from subarachnoid hemorrhage: changes in incidence and
case fatality from 1985 through 2000. Stroke 2004; 35:2059-
63.
39) Buczacki SJ, Kirkpatrick PJ, Seeley HM, Hutchinson PJ.
Late epilepsy following open surgery for aneurysmal
subarachnoid haemorrhage. J Neurol Neurosurg Psyc-
hiatry 2004; 75:1620-2.
40. Hackett ML, Anderson CS for the ACROSS Group. Health
outcomes 1 year after subarachnoid hemorrhage: an
intemational population-based study. Neurology 2000; 55:
658-62.
41. Mayer SA, Kreiter KT, Copeland D, et al. Global and
domain-specific cognitive impairment and outcome after
subarachnoid hemorrhage. Neurology 2002; 59:1750-8.
42. Powell J, Kitchen N, Heslin J, Greenwood R. Psychosocial
outcomes at three and nine months after good neurological
recovery from aneurysmal subarachnoid haemorrhage:
predictors and prognosis. J Neurol Neurosurg Psychiatry
2002; 72: 772-81.
43. Powell J, Kitchen N, Heslin J, Greenwood R. Psychosocial
outcomes at 18 months after good neurological recovery
from aneurysmal subarachnoid haemorrhage. J Neurol
Neurosurg Psychiatry 2004; 75:1119-24.
44. Wermer MJH, Kool H, Albrecht KW, Rinkel GJE.
Aneurysm Screening after Treatment for Ruptured
Aneurysms Study Group. Subarachnoid hemorrhage
treated with clipping: long-term effects on employment,
relationships, personality, and mood. Neurosurgery 2007;
60:91-8.
45. Schievink WI, Limburg M, Dreissen JJ, Peeters FL, ter
Berg HW. Screening for unruptured familial intracranial
aneurysms: subarachnoid hemorrhage 2 years after angio-
graphy negative for aneurysms. Neurosurgery 1991; 29:
434-7.
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