Neurological syndromes occurring in patients receiving synthetic steroids (oral contraceptives)

Abstract

Whether the combination of the above changes in the blood coagulability and vessel wall is capable of precipitating intravascular thrombosis remains a disputed question. Abnormalities in the vascular bed may prepare the ground for the development of thrombosis. This is suggested by the group of patients whose vascular headaches appeared to have recurred coincident with the course of medication and also by the observation that 3 of our 6 patients with brain infarction also had hypertension or a strong family history suggestive of vascular disease. The authors do not consider that the occurrence of the previously described neurological syndromes in women who were also taking progestational steroids proves a specific relationship between the 2 events. The absence of adequate statistical confirmation is obvious. In view of the large number of women presently using these drugs and the lack of good epidemiologic evaluation, it is not likely that this problem will be satisfactorily resolved in the near future. These cases are reported in the hope that others will look for similar possible relationships in their own clinical material and also to record 1 additional list of data which might relate to the pathogenesis of cerebrovascular disease. We suggest that progestational steroids be administered with caution under the following conditions: hypertension, history of recurrent vascular headaches, history of Raynaud''s or other vasospastic phenomena, history of occlusive arterial disease, and epilepsy. The development of any of the previously described symptoms during the course of administration of progestational steroids should be a stimulus to reconsider whether their use is necessary.