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Cerebrovasculäre Insulte bei jungen Frauen Ätiologische Analyse

Pathogene Rolle von Ovulationshemmern?

Cerebrovascular accidents in young women etiological analysis

Pathogenetic role of oral contraceptive drugs

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Summary

During a time period of 8 years 55 female patients between age 15 and 40 with cerebrovascular accidents (CVA) were seen by us. 19 were pregnant, 9 had migraine accompagnéc, 2 showed embolisms, 3 had a hematologic disorder, in 2 cases there was juvenile subcortical bleeding, 2 had a thrombosis of the internal carotid artery, and in 5 cases no specific etiological factor was found. The remaining 11 cases were young women taking the “pill” at the time of the CVA. Two other patients age 42 and 45 years, respectively, with a CVA were on the same medication, and in still 2 more females the medication had precipitated migraine accompagnée followed by cerebrovascular accident. One patient with a CVA during the first month of her pregnancy had taken an oral contraceptive for the 2 preceding years. Adding 4 more females seen after the manuscript of this paper was submitted we have by now observed a total of 20 patients in whom the pill may be implicated in the development of a CVA. The average age of the patients was 29 years. The drug regimens comprised 7 different brands which had bee taken for periods from 14 days to 36 months. In 17 cases hemiplegia was present, and in 2 others there was a global amnestic episode. On the basis of our observations and of 80 cases reported in the medical literature pathogenetic mechanisms of the “pill” are discussed. Statistic evidence supports the assumption that it may play a pathogenetic role, as does experimental work on the influence of contraceptives on blood clotting mechanisms and on histologic alterations of the vascular walls. Common features of the state of pregnancy and the administration of the “pill” are stressed.

Zusammenfassung

Aus dem Krankengut von 8 Jahren werden 55 Frauen im Alter zwischen 15 und 40 Jahren analysiert, die einen vasculären cerebralen Insult durchmachten. Bei 19 derselben trat der Insult im Rahmen einer Gravidität auf, bei 9 in Zusammenhang mit einer Migraine accompagnée, bei 2 durch eine Embolie, bei 3 im Rahmen einer Blutkrankheit, bei 2 lag eine juvenile subcorticale Blutung, bei 2 weiteren eine Carotisthrombose vor, und bei 5 war kein sicherer ätiologischer Faktor eruierbar. Demgegenüber standen 11 Fälle, die zur Zeit des Insultes Ovulationshemmer einnahmen. Hinzu kommen 2 weitere Frauen im Alter von 42 und 45 Jahren, die Ovulationshemmer nahmen, 2 bei denen durch die Einnahme von Ovulationshemmern eine Migraine accompagnée ausgelöst wurde, und eine weitere, die bis unmittelbar vor einer zweiten Schwangerschaft, in welcher ein Insult auftrat, 2 Jahre lang Ovulationshemmer eingenommen hatte. Fügt man 4 Fälle hinzu, bei welchen nach Abschluß dieser Arbeit unter Ovulationshemmern ein Insult sich ereignete, so verfügen wir insgesamt über 20 Beobachtungen, bei welchen die Einnahme von Ovulationshemmern pathogenetisch eine Rolle beim Zustandekommen eines vasculären cerebralen Insultes spielen könnte. Das Durchschnittsalter der Patientinnen beträgt 29 Jahre, die Dauer der Einnahme der Ovulationshemmer variiert zwischen 36 Monaten und 14 Tagen. Die Marke spielt keine Rolle. Zusätzliche pathogene Faktoren sind nur in vereinzelten Fällen vorhanden. Die Symptomatologie besteht außer in 2 Fällen mit einer amnestischen Episode in einer Hemiparese. An Hand der eigenen Beobachtungen sowie von 80 Fällen aus der Literatur wird der mögliche pathogenetische Mechanismus diskutiert. Es werden die Argumente, die für eine echte kausale Beziehung sprechen, im einzelnen angeführt.

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  1. Neurologische Klinik und Neuroradiologische Abteilung am Zentralen Strahleninstitut der Universität Bern, Switzerland

    Marco Mumenthaler, Peter Huber & Philippe Grandjean

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  1. Marco Mumenthaler
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  2. Peter Huber
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In gekürzter Form am 29. 4. 1970 vor der Berliner Gesellschaft für Psychiatrie und Neurologie vorgetragen.

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Mumenthaler, M., Huber, P. & Grandjean, P. Cerebrovasculäre Insulte bei jungen Frauen Ätiologische Analyse. Z. Neurol. 198, 46–64 (1970). https://doi.org/10.1007/BF00316135

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