Claris Law Legal Blogging Community

Editor: Robert Blanchard
Profession: Attorney at Law

Category: Ortho Evra Medical Information

Many women who may have suffered a stroke wihile on birth control may not know the distinction between a bleeding (hemorhaggic) stroke and a blockage (ischemic) stroke. Strokes from Ortho Evra and other birth control products are normally ischemic (a blood clot stops blood from reaching areas of the brain) and hemorhaggic stroke invole bleeding into the brain and are not generaly caused by birth control. Here is some good information on hemorhaggic strokes:

Subarachnoid hemorrhage (SAH) implies the presence of blood within the subarachnoid space from some pathologic process. SAH occurs in various clinical contexts, the most common being head trauma. The common medical use of the term SAH refers to the nontraumatic types of hemorrhages, usually from rupture of a berry aneurysm or arteriovenous malformation (AVM). The scope of this article is limited to these nontraumatic hemorrhages.

SAH comprises half of spontaneous atraumatic intracranial hemorrhages, the other half consist of bleeding that occurs within the brain parenchyma. Intracranial hemorrhage as a whole comprises 20% of all strokes. SAH is a devastating condition with high morbidity and mortality, and, in the United States, it is associated with an annual cost of $1.75 billion. The silver lining is that the condition often presents with a so-called "warning leak" that leaves the patient neurologically intact. Diagnosis and intervention during this stage of the disease is associated with an excellent outcome. Consequently, clinicians must be on the lookout for clinical presentations that suggest a leaking aneursym or malformation.
Risk factors include cigarette smoking and heavy alcohol consumption. Although hypertension has been identified as a risk factor for aneurysm formation, the data with respect to rupture are conflicting. However, certain hypertensive states, such as those induced by use of cocaine and other stimulants such as amphetamines, clearly promote aneurysm growth and rupture earlier than would be predicted by the available data.

The annual incidence of nontraumatic aneurysmal SAH is 6-25 per 100,000. More than 30,000 Americans suffer ruptured intracranial aneurysms each year. Incidence increases with age and peaks at age 50 years. Approximately 80% of cases of SAH occur in people aged 40-65 years, with 15% occurring in people aged 20-40 years. Only 5% of cases of SAH occur in people younger than 20 years. An estimated 10-15% of patients die before reaching the hospital. Mortality rate reaches as high as 40% within the first week. About half die in the first 6 months. Mortality and morbidity rates increase with age and poorer overall health of the patient. Advances in the management of SAH have resulted in a relative reduction in mortality rate that exceeds 25%. In patients with a suspected grade I or II SAH, ED care essentially is limited to diagnosis and supportive therapy. Early identification of sentinel headaches is key to reduced mortality and morbidity rates. In patients with a grade III, IV, or V SAH (ie, altered neurologic examination), ED care is more extensive. Endotracheal intubation of obtunded patients protects from aspiration caused by depressed airway protective reflexes. Patients with signs of herniation must be hyperventilated to decrease intracranial pressure (ICP). Osmotic agents, such as mannitol, which reduces ICP 50% in 30 minutes, peaks after 90 minutes, and lasts 4 hours should be used. Loop diuretics, such as Lasix, also decreases ICP. IV steroid therapy to control brain edema is controversial and debated. Antihypertensive agents should be used judiciously. Supplemental oxygen should be used for all patients with CNS impairment and the head of the bed should be elevated to facilitate intracranial venous drainage. Seizures should be managed in the standard fashion. Calcium channel blockers decrease the incidence and severity of cerebral vasospasm. Use of antifibrinolytics (antibleeding drugs), such as epsilon aminocaproic acid (Amicar), is controversial. Although they competitively inhibit plasminogen activation and have been reported to reduce the incidence of rebleeding, other reports warn of their detrimental vasospastic effect and increased occurrence of hydrocephalus.