Orsakagreining heilablóðþurrðar á endurhæfinga- og taugadeild Borgarspítalans 1994

Einar M. Valdimarsson, Garðar Sigurðsson, Finnbogi Jakobsson

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: This is the first Icelandic study in which the etiology of cerebral ischemia is examined. The goal of the study was to examine how the etiology of cerebral infarcts and transient ischemic attacks was determined at the Department of Neurology and Rehabilitation Medicine at Reykjavik City Hospital and how the patients were treated. Material and methods: The study was retrospective and included 102 patients with cerebral infarcts and transient ischemic attacks that were admitted to the Department of Neurology and Rehabilitation Medicine at Reykjavik City Hospital in 1994. Patients with cerebral hemorrhage were excluded. The patients' mean age was 68.5 years (range 25-89) and the male:female ratio was 59:43. Cerebral computerized tomography was obtained from 98 (98%) patients. Carotid ultrasonography was done in 72 (72%) cases and carotid angiogram in 14 (14%) patients. Transthoracic echocardiography was done in 69 (69%) cases and transesophagal echocardiography in the 11 (11%) youngest patients. Results: Of the 102 patients, 79 (79%) had cerebral infarctions and 23 (23%) transient ischemic attacks. The probable cause of cerebral infarction was cardioembolic in 21 patients (27%), lacunar infarction in 16 patients (20%) and carotid artery disease in 13 patients (16%). In 37% of the cases the cause was unspecific. The etiology of transient ischemic attacks was carotid artery disease in four patients (17%), cardioembolic in two patients (9%) and lacunar in one patient (4%). In 70% of the cases the cause of transient ischemic attacks was undetermined. Nine of the 102 patients (9%) underwent carotid endarterectomy and 15 (15%) were treated with warfarin. Conclusion: A specific etiology was found in 2/3 of those with cerebral infarcts and in 1/3 of those with transient ischemic attacks. Determination of etiology led to specific preventive treatment in 1/4 of the patients.
Inngangur: Ekki hafa áður verið birtar niðurstöður rannsókna á Íslandi sem lýsa orsökum heilablóðþurrðar. Tilgangur rannsóknarinnar var að athuga hvernig orsakir heiladreps og skammvinnrar heilablóðþurrðar voru greindar á endurhæfinga- og taugadeild Borgarspítalans árið 1994, hverjar þær voru og hvernig brugðist var við þeim. Efniviður og aðferðir: Litið var afturskyggnt á sjúkraskrár allra sjúklinga sem lögðust inn á endurhæfinga- og taugadeild Borgarspítalans árið 1994 með greininguna heiladrep og skammvinn heilablóðþurrð, en heilablæðingar voru undanskildar. Meðalaldur hópsins var 68,5 ár (25-89 ára) og hlutfall karla og kvenna 59:43. Tölvusneiðmynd af höfði var framkvæmd hjá 98 (98%) einstaklingum. Ómun af hálsslagæð um var gerð hjá 72 (72%) og æðamyndataka hjá 14 (14%) einstaklingum. Ómun af hjarta í gegnum brjóstvegg var gerð hjá 69 (69%) en ómun af hjarta í gegnum vélinda hjá 11 (11%) yngstu einstaklingunum. Niðurstöður: Alls greindust 102 einstaklingar með heilablóðþurrð (cerebral ischemia), 79 (79%) greindust með heiladrep (cerebral infarction) og 23 (23%) með skammvinna heilablóðþurrð (transient cerebral ischemia). Einkenni frá næringarsvæði hægri hálsslagæðar höfðu 26 (26%), frá svæði vinstri hálsslagæðar 41 (41%), frá svæði hryggslagæðar 25 (25%), en óvist var um staðsetninguna hjá 10 (10%) einstaklingum. Orsakir heiladreps skiptust þannig: hálsæðasjúkdómur 13 (16%), hjartasjúkdómur 21 (27%), smáæðasjúkdómur (lacunar infarction) 16 (20%), ósértæk orsök hjá 29 (37%) einstaklingum. Orsakir skammvinnrar heilablóðþurrðar voru: hálsæðasjúkdómur fjór-ir (17%), hjartasjúkdómur tveir (9%), smáæðasjúkdómur einn (4%), og ósértæk orsök hjá 16 (70%) einstaklingum. Af 102 einstaklingum sem greindust með heiladrep og skamvinna heilablóðþurrð gengust níu (9%) undir aðgerð á hálsslagæð og 15 (15%) einstaklingar voru settir á blóðþynningu með warfaríni að aflokinni orsakagreiningu. Ályktanir: Sértæk orsök fannst hjá tveimur þriðju þeirra einstaklinga sem greindust með heiladrep og þriðjungi þeirra sem höfðu skammvinna heilablóðþurrð. Orsakagreining leiddi til sértækrar fyrirbyggjandi meðferðar hjá fjórðungi einstaklinga.
Original languageIcelandic
JournalLæknablaðið
Publication statusPublished - 1 Dec 1998

Other keywords

  • Heiladrep
  • Ómskoðun
  • Brain Ischemia
  • Cerebral Infarction
  • Carotid Stenosis
  • Brain Infarction
  • Ultrasonography

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