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  • Title: Paradoxical embolism associated with oral contraceptives: an underdiagnosed lesion?
    Author: de Swiet J.
    Journal: Postgrad Med J; 1979 Jun; 55(644):419-20. PubMed ID: 482190.
    Abstract:
    A case of cerebral embolism is described in which paradoxical features have been proved clinically, and which may explain some hitherto unaccountable reported cases, and suggests the value of prospective studies. A successful outcome of such a proved case, associated with oral contraceptives, does not appear to have been reported previously. In an effort to call attention to a lesion which is possibly provoked by ingestion of oral contraceptives, this case report of a 23-year-old woman, who had been taking Minovlar for 3 years admitted to the hospital after sudden onset of complete right-sided hemiplegia and total motor aphasia is presented. There was no clinical evidence of deep vein thrombosis or other cerebral, coronary, or other arterial occlusions due to embolism on admission. 1 week later, bilateral leg venography showed a normal left leg but the right leg showed nonfilling of the deep veins of the calf. In the process of a right-heart catherization, an atrial communication was crossed which proved to be a patent foramen ovale by pulmonary artery pressures and dilution indicator curves. Hence, a clinical diagnosis of paradoxical embolism was made on the grounds of combined evidence of deep vein thrombosis, electrocardiogram changes of acute cor pulmonale, which were entirely different from those known to accompany primary cerebrosvascular lesions, and catheter studies typical of embolism rather than thrombosis. This case prompted the authors to call for prospective studies to reveal paradoxical embolism in oral contraceptive users, rather than venous thrombosis.
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