Showing papers in "Illinois medical journal in 1984"

Moyamoya. An association with birth control pills.

Abstract: The case is described of a 16-year-old black female who developed moyamoya in association with use of oral contraceptives (OCs) since age 13 and with antinuclear antibodies in high titers. The patient presented to the hospital complaing of intermittent right are and leg weakness for 3 weeks. Intermittent twitching slow speech numbness of the fingers of the right hand blurredvision and a history of mild right frontal parietal headaches beginning 3 weeks prior to admission and lasting 2 weeks were also reported. The patient had a history of hay fever and reported use of chlorphenbiramine. She was allergic to walnuts and had required emergency room treatment 3 days prior to admission with diphenhydramine and epinephrine. There was no past hospitalization. Physical examination and most laboratory findings were normal. ESR was 22mm/hour ANA 1:1280 homogenous C3 93mg% (normal 85 to 120) rheumatoid factor 1:80 DsDNA antibodies negative; urine analysis 1 + proteinuria 24 hour urine for protein 78 mg. The CAT scan with and without enhancement was normal. The electroencephalogram revealed mild right temporal slow activity on an otherwise normal background. A retrograde femoral aortic arch and cerebral angiogram were performed. The right carotid angiogram showed complete occlusion of the middle cerebral artery distal to the posterior communicating artery. The anterior cerebral artery was filled via collaterals. The left carotid arteriogram in the lateral view showed identical findings to the right side. The right vertebral arteriogram in the midarterial phase showed that many of the branches of the anterior circulation were filled via collaterals. The patient received no specific treatment but was advised against further use of OCs and was placed on sodium phenobarbitol 90 mg at bedtime. No recurrence of neurologic symptoms occured during a 9-month follow-up period. Physical examination and repeat electroencephalogram 8 months after discharge were normal. The arteriograph and clinical presentation in this patient may be a consequence of restricted lupus or it may be explained on the basis of OC use since OCs have been associated with an increased incidence of thromboembolism stroke and a positive ANA.