Læknablaðið - 01.07.2015, Blaðsíða 26

366 LÆKNAblaðið 2015/101
fram á áhrif meðferðarinnar á alvarlega fylgikvilla svo sem blóð-
þurrðardrep eða blæðingu.5 Ákjósanleg meðferðarlengd er ekki
þekkt en lyfið er oftast gefið í 4-12 vikur.5
Í flestum tilfellum eru horfur mjög góðar og ganga einkenni
oftast yfir á innan við þremur vikum.5 Þrengingar í æðum eru
oftast gengnar yfir 12 vikum eftir upphaf einkenna og er því mælt
með því að endurtaka myndgreiningu að þeim tíma liðnum.7 Brott-
fallseinkenni geta þó verið viðvarandi hafi orðið drep á heilavef.
Sjúklingar sem fá blóðþurrðarslag jafna sig flestir af einkennum
sínum á nokkrum vikum og hafa fáir varanleg einkenni.7 Afar
sjaldgæft er að æðaþrengingarnar taki sig upp aftur.5
Af ofansögðu er ljóst að sjúkrasaga stúlkunnar er ekki alls-
kostar dæmigerð fyrir HASH. Heilkennið tekur þó til víðs hóps
sjúkdóma og falla ekki öll tilfelli undir greiningarskilmerki.
Greiningarskilmerkin hafa lítið verið rannsökuð og er ekki ljóst
hversu mörg skilyrði tilfelli þarf að uppfylla til að flokkast sem
HASH. Eins og áður sagði finnst engin orsök fyrir blóðþurrðar-
slagi hjá um fjórðungi barna og er hugsanlegt að hluti þeirra til-
fella skýrist af ógreindu HASH.
Y F i R l i T S G R E i n
Heimildir
1. Lyle CA, Bernard TJ, Goldenberg NA. Childhood arterial
ischemic stroke: A review of etiologies, antithrombotic
treatments, prognostic factors, and priorities for future
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Risk factors and etiologies. Curr Neurol Neurosci Rep
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3. Lopez-Vicente M, Ortega-Gutierrez S, Amlie-Lefond
C, Torbey MT. Diagnosis and management of pediatric
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4. Provenzale JM, Sarikaya B. Comparison of test per-
formance characteristics of mri, mr angiography, and ct
angiography in the diagnosis of carotid and vertebral
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Am J Roentgenol 2009; 193: 1167-74.
5. Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D.
Reversible cerebral vasoconstriction syndrome, part 1:
Epidemiology, pathogenesis, and clinical course. AJNR
Am J Neuroradiol 2015.
6. Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB.
Narrative review: Reversible cerebral vasoconstriction
syndromes. Ann Int Med 2007; 146: 34-44.
7. Ducros A, Hajj-Ali RA, Singhal AB, Wang SJ. Reversible
cerebral vasoconstriction syndrome. JAMA 2014; 71: 368.
8. Ducros A, Boukobza M, Porcher R, Sarov M, Valade D,
Bousser MG. The clinical and radiological spectrum of
reversible cerebral vasoconstriction syndrome. A pro-
spective series of 67 patients. Brain 2007;130: 3091-101.
9. Wolff V, Armspach JP, Lauer V, Rouyer O, Ducros A,
Marescaux C, et al. Ischaemic strokes with reversible
vasoconstriction and without thunderclap headache: A
variant of the reversible cerebral vasoconstriction syn-
drome? Cerebrovasc Dis (Basel) 2014; 39: 31-8.
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11. Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D.
Reversible cerebral vasoconstriction syndrome, part 2:
Diagnostic work-up, imaging evaluation, and differential
diagnosis. AJNR Am J Neuroradiol 2015
ENgLISH SUMMArY
During soccer practice a fifteen year old girl experienced a sudden
onset of pain in the left side of her neck and collapsed. Upon arrival at
the emergency room she had right hemiparesis and expressive aphasia.
on CT angiography a left carotid arterial dissection was suspected.
Symptoms improved during the first threedays but worsened again on
the fourth and a CT scan showed an ischemic area in the brain. Conven-
tional angiography showed decreased perfusion in the left middle cere-
bral artery but no evidence of dissection or thrombus. The most likely
diagnosis was thought to be reverse cerebral vasoconstriction syndrome
and the girl was treated with calcium channel inhibitors. Here we report
the case and review the literature.
acute ischemic stroke in female adolescent - Case report
Anna Stefansdottir1, Askell Löve2, Soley Gudrun Thrainsdottir3, Petur Ludvigsson1,4
1University of Iceland, 2Department of Radiology, Landspitali University Hospital 3Department of Neurology, Landspitali University Hospital, 4Children’s hospital, Landspitali University
Hospital
key words: Reversible cerebral vasoconstriction syndrome, pediatric stroke, expressive aphasia, hemiparesis.
Correspondence: Pétur Lúðvígsson, peturl@landspitali.is