Hemorrhagic stroke after naphazoline exposition: case report

Abstract

-Ten percent of all strokes are due to spontaneous cerebral hemorrhages. They are associated to drugs (licit and illicit) in 9.5% of all cases in young adults. This is a case report of a 44-year-old man, without previous morbidities, who presented a sudden onset headache and arterial hypertension 24 hours after use of naphazoline as nasal decongestant. Cranial tomography showed right thalamus hemorrhage. Cerebral angiography showed no aneurisms, vascular malformations or vasculitis. No other risk factors were found during investigation in this patient and the stroke was attributed to naphazoline exposition.KEY WORDS: hemorrhagic stroke, naphazoline, sympathomimetic drug.Acidente vascular encefálico hemorrágico após exposição à nafazolina: relato de caso RESUMO -Dez por cento de todos os eventos vasculares encefálicos são devido às hemorragias intracerebrais espontâneas, associados a drogas (lícitas e ilícitas) em 9,5% de todos os casos em adultos jovens. Relatamos o caso de um homem de 44 anos de idade, sem doenças prévias, que apresentou cefaléia súbita e hipertensão arterial 24 horas após o uso de congestionante nasal contendo nafazolina. A tomografia de crânio evidenciou hemorragia talâmica. Durante a investigação não foram encontrados outros fatores de risco e a hemorragia foi atribuída à exposição à nafazolina. PALAVRAS-CHAVE: doença vascular encefálica hemorrágica, nafazolina, droga simpaticomimética.Cerebrovascular diseases occur more frequently in elderly people. Peak incidence is between 7 th and 8 th decades 1,2 . Before age 55, incidence is 10% 3,4 and before 45 it falls to 3.9% 5 .Ten percent of all cerebrovascular events are due to hemorrhage 6 . Its estimated incidence in United States of America is 0.3/100000 in younger than 35 years old 7 . Main etiologies are vascular malformations, arterial hypertension and exposition to drugs (amphetamines, sympathomimetics and illicit drugs) 8,9 . In young adults, drugs are associated to 9.5% of ischemic and hemorrhagic stroke 10 .We report a case of exposition to sympathomimetic drug naphazoline followed by thalamic hemorrhage. CASEA 44 year-old previously healthy man, with no history of arterial hypertension, was admitted to the emergency department of Hospital de Clinicas, Federal University of Parana, complaining of headache and left arm weakness. Five days before he had had some flu-like symptoms and naphazoline nasal decongestant was prescribed. In the following day he had a sudden onset headache associated to nausea and vomiting. He then looked for medical attention. Blood pressure was 190/120 mmHg and captopril 50 mg as a single dose was prescribed. A couple of days latter he developed left hemiparesia that made him seek for our emergency department. There was no previous history of thrombotic disorders and there were no familiar stroke cases.On physical examination vital signs were normal including blood pressure (120/70 mmHg), with no positive signs on cardiopulmonary and abdominal examination. Neurological examination revealed an oriented ...

Topical nasal decongestants: Comparative characteristics and a review of side effects

“…По мимо восстановления носового дыхания эти препа раты не оказывают никакого действия на другие симптомы ринита: они не уменьшают количество чиханий, а экспериментальные исследования на животных показывают, что при лечении вазокон стрикторами количество выделений из носа даже увеличивается [17]. [18,19], и даже приводить к ишемиче ским и геморрагическим инсультам головного мозга [20,21].…”

Activated fly ash catalyzed facile synthesis of novel spiro imidazolidine derivatives as potential antibacterial and antifungal agents

“…The present study describes the use of 6-carbethoxy-3,5-diarylcyclohex-2-enone 23 as a key intermediate with three versative functional groups i.e., ketone, olefin, and ester for the synthesis of imidazolidine derivatives. Owing to our interest in synthesis of fascinating biologically active hybrid heterocyclic compounds [24][25][26] and as part of our research program, herein we planned to design a spiro imidazolidine derivatives bearing a cyclohexene substituent on the carbon between the nitrogen centers to give a new series of spiro imidazolidine heterocycles because most bio-active imidazolidine derivatives bear a substituent (aryl or alkyl group) on the carbon between the nitrogen centers [18][19][20][21] .…”

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Synthesis, spectral analysis, and in vitro microbiological evaluation of ethyl 7,9-diaryl-1, 4-diazaspiro[4.5]dec-9-ene-6- carboxylates as a new class of antibacterial and antifungal agents

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“…The present study describes the use of ethyl 4,6-diaryl-2-oxocyclohex-3-ene-1-carboxylates [21], intermediates with three versatile functional groups, i.e., ketone, olefin, and ester, for the synthesis of imidazoline derivatives. In continuation of our earlier work on the synthesis of structurally diverse biologically active hybrid heterocyclic ring systems and as part of our ongoing research program [22][23][24][25][26], we plan to design imidazoline derivatives bearing a cyclohexene substituent bound by a spiro-linkage to the carbon atom between the nitrogen centers to obtain a new series of heterocycles, namely, ethyl 7,9-diaryl-1,4-diazaspiro [4.5]dec-9-ene-6-carboxylates since most of the bioactive imidazoline derivatives bear a substituent (aryl or alkyl group) on this carbon center [11][12][13]. In order to evaluate the effect of the structure on the biological activity of the target compounds, we chose different substituents at the phenyl rings of the starting reactants.…”