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Oral contraception and cerebral thrombosis in a Jamaican.


 A case report of a 20-year old nulliparous woman who developed a stroke after taking the oral contraceptive (OC) pill Niroday (norethindrone 1 mg and mestranol .05mg) for 2 years is presented. The patient was admitted to the University Hospital in Jamaica after falling and losing power in the right arm and leg. She was a nonsmoker in good general health and had never previously been hospitalized. She was conscious with mild dysphasia when examined and complained of severe generalized headaches. There was grade 1 power in the right arm and leg, and an upper motor neurone right facial palsy. The left plantar response was down-going and the right equivocal. Fundoscopy was normal. Most clinical findings were normal, but a left Carotid angiogram showed complete occlusion of the middle cerebral artery at its origin and later films showed a good collateral circulation from the anterior cerebral vessels in particular. The patient was treated with a low dose aspirin and the OCs were discontinued. Physiotherapy was instituted and continued on an outpatient basis on her discharge 3 weeks after admission with grade 3 power in the right leg and grade 2 in the right arm. After careful exclusion of other known causes of stroke, the evidence, supported by data from the literature, points to the contraceptive pill as the causative factor in the development of the thrombotic stroke. The widespread use of OCs in the Caribbean should alert clinicians to the possibility of future cases, and women at risk should use other forms of contraception.
