Læknaneminn - 01.04.1994, Qupperneq 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
HEIMILDIR
1. Coakley D. Stroke and other neurological
emergencies in old age. Acute geriatric medicine
1980, bls. 59-80. London: Croom Helm Ltd.
2. Wade DT, Hewer LJ, Skilbeck CE, David RM.
Stroke: a critical approach to diagnosis, treatment
and management. London 1985 : Chapman and Hall.
3. Starkstein SE og Robinson RG. Affective disorders
and cerebral vascular disease. British Joumal of
Psychiatry 1989; 154: 170-182.
4. Folstein F, Marlbergar R, McHugh R. Mood disorder
as a specific complication of stroke. Joumal of
Neurology and Neurosurgery 1977; 40: 1018-1020.
5. Kraepelin E. Manic depressive insanity and paranoia.
Edinburgh 1921: E. and S. Livingstone.
6. Bleuler EP. Textbook of Psychiatry. New York 1951:
Dover Publications.
7. Meyer A. The anatomical facts and clinical varieties
of traumatic insanity. American Journal of Insanity
1904; 60: 373.
8. Babinski J. Réflexes de défance. Brain 1922;45: 149-
84.
9. Ross ED, Gordon WA, Hibbard M et al. The
dexamethasone suppression test, poststroke
depression and the validity of DSM-lII-based
diagnostic criteria. American Joumal of Psychiatry
1986; 143: 1200-1201.
10. Kertesz A, Black SE, Nicholson L et al. The
sensitivity and specificity of MRI in stroke.
Neurology 1987; 37: 1580-1585.
11. Lipsey JR, Spencer WC, Rabins PV, et al .
Phenomenological comparison of post-stroke
depression and fimctional depression. American
Journal ofPsychiatry 1986; 142: 318-323.
12. Morris PLP, Robinson RG, Andrzejewski P, et al.
Association of depression with 10-year poststroke
mortality. American Joumal of Psychiatry 1993;
150, 1: 124-129.
13. Starkstein SE, Robinson RG, Berthier ML, et al.
Depressive disorders following posterior circulation
compared with middle cerebral artery infarcts. Brain
1988; 111: 375-387.
14. Dam H. Depression in patients with stroke. Focus on
depression, marshefti 1993.
15. Parikh RM, Robinson RG, Lipsey JR, et al. (1990).
The impact of poststroke depression on recovery in
activities of daily living over a 2-year follow-up.
Archives of Neurology, 47, 785-789.
16. Starkstein SE, Robinson RG og Price TR.
Comparison of patients with and without post-stroke
major depression matched for size and location of
lesion. Archives of General Psychiatry 1988; 45:
247-52.
17. Robinson RG, Bolla-Wilson K, Kaplan E, et al.
Depression influences intellectual impairment in
stroke patients. British Joumal of Psychiatry 1986;
148: 541-547.
18. Starkstein SE og Robinson RG. Aphasia and
depression. Aphasiology 1988; 2: 1-20.
19. Robinson RG, Starr LB, Kubos KL, et al. A two year
longitudinal study of post-stroke mood disorder:
ftndings during the initial evaluation. Stroke 1983;
14: 736-741.
20. Robinson RG, Starr LB, Lipsey JR et al. A two-year
longitudinal study of post-stroke mood disorders:
dynamic changes over the first six months of follow-
up. Stroke 1984; 15: 510-517.
21. Robinson RG, Starr LB, Lipsey JR et al. A two-year
longitudinal study of post-stroke mood disorders: in-
LÆKNANEMINN I 1994 47. árg.
143