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Risafrumuæðabólga : tvö sjúkratilfelli með skyndiblindu

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Authors
Andri Elfarsson
Björn Guðbjörnsson
Einar Stefánsson
Issue Date
2010-03-01

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Giant cell arteritis : two cases with acute blindness
Citation
Læknablaðið 2010, 96(3):185-9
Abstract
Giant cell arteritis is characterized primarily by inflammation in certain large and medium-sized arteries. The major risk factors are age, female gender and Northern European descent. In this report we describe two cases of acute vision loss due to giant cell arteritis. In both cases the erythrocyte sedimentation rate (ESR) was below 50 mm/hr and the presenting complaint was foggy vision followed by acute blindness. The cases are to some extent different, for example in the former case the patient reported jaw claudication and ophthalmologic evaluation was consistent with anterior ischemic optic neuropathy. In the latter case there was narrowing and box-carring of blood cells in retinal arterioles, consistent with occlusion of the central retinal artery. This patient had recently finished a 2-year long treatment with glucocorticosteroids for polymyalgia rheumatica. The retina and the optic nerve do not survive for long without perfusion. If giant cell arteritis causes blindness in one eye there is significant risk for the other eye to go blind if no treatment is given. Corticosteroids can spare the other eye and suppress the underlying inflammatory disease process as well. It is vital to confirm the diagnosis of giant cell arteritis with a biopsy and start corticosteroid treatment as soon as possible, even before the biopsy is taken.
Risafrumuæðabólga einkennist af bólgubreytingum í ákveðnum stórum og meðalstórum slagæðum. Helstu áhættuþættir eru aldur, kvenkyn og norrænn uppruni. Í þessari grein er lýst tveimur tilfellum skyndiblindu af völdum risafrumuæðabólgu. Í báðum tilfellum mældist sökk undir 50 mm/klst og reyndist móðusýn fyrirboði blindu. Tilfellin eru ólík að mörgu leyti, til dæmis var í fyrra tilfellinu um að ræða kjálkaöng og lokun á æðum til fremsta hluta sjóntaugarinnar. Í seinna sjúkratilfellinu var lokun á aðalslagæðinni til sjónhimnu og hafði sá sjúklingur nýlokið tveggja ára barksterameðferð vegna fjölvöðvagigtar. Sjónhimna og sjóntaug lifa ekki af nema í stutta stund án blóðflæðis. Ef risafrumuæðabólga veldur blindu í öðru auga er hætta á að hitt augað missi sjón sé ekkert að gert. Barksterameðferð getur komið í veg fyrir blindu hins augans, auk þess að halda grunnsjúkdómnum niðri. Mikilvægt er að staðfesta risafrumuæðabólgu með vefjasýni og hefja barksterameðferð eins fljótt og kostur er, jafnvel áður en vefjasýni er tekið.
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http://www.laeknabladid.is
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Icelandic Journal Articles (Peer Reviewed)

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