Læknaneminn - 01.04.1994, Blaðsíða 157

Samanburðarhópurmeð sambærilegarheilaskemmdir
en án geðslagsbreytinga hafði marktækt meiri rýrnun
áheilavefundirheilaberki ("subcortical atrophy") en
PSM-hópurinn (36).
Ættarsaga
Ættarsaga um þunglyndi eða örlyndi var marktækt
oftar til staðar hjá 9 PSM-sjúklingum (4/9) en hjá 31
PSD-sjúklingi (3/31) (39). Tilgáta Robinsons (39) er
sú að e.t.v. sé örlyndi eftir heilablóðfall svo sjaldgæft
sem raun ber vitni sakir þess að það krefjist útleysandi
þátta annarra en heilaskaða svo sem heilarýrnunar,
ættarsögu um geðhvörf eða lækkaðs krampaþröskuldar
í miðtaugakerfi til að koma fram.
Meingerð
Meingerð örlyndis eftir heilablóðfall er óþekkt.
Ymsartilgáturhafa þó verið settar fram. Shukla et al.
(37)hafat.a.m. taliðað umflogafyrirbæri væri að ræða
í limbískumsvæðunrbeggjaheilahvela. Robinson og
Starkstein (40) hafa talið að um tiltekið meingerðarferli
sé að ræða og gegni breytt virkni brauta milli
framheilabarkar og limbíska kerfísins, einkum hægra
megin, þar lykilhlutverki.
Meöferð
Ekki hafa verið gerðar neinar samanburðar-
rannsóknir á meðferð PSM-sjúklinga með örlyndis-
lyQumeða lyfleysu. Þau tilfelli semmenn hafafjallað
um í greinum hafa svarað vel hefðbundinni örlyndis-
meðferð (litíum, sefandi lyfjum s.s. haloperidol og
krampastillandi lyfjum s.s. karbamazepíni og
valpróati) (39). 0
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