Intracerebral hemorrhage associated with sildenafil use: a case report

Alpsan, M H; Bebek, Nerses; Ciftci, F.; Çoban, Oğuzhan; Bahar, S.; Tunçay, Rezzan

doi:10.1007/s00415-008-0618-z

Cited by 21 publications

(12 citation statements)

References 4 publications

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“…), intracranial neoplasms, cerebral venous thrombosis, infection and dysfunctional coagulopathy. Drug-induced intracerebral haemorrhages are related to anticoagulant thrombolytics, sympathomimetics, methamphetamines or cocaine (1,7). Cases of intracerebral hemorrhages in relation to sildenafil use are being increasingly reported recently (1, 3 ,4, 7, 11).…”

Section: Discussionmentioning

confidence: 99%

“…With the inhibition of PDE-5, the amount of cyclicguanosine monophosphatase (cGMP) in the vascular smooth muscle cells in the corpus cavernosum increases, leading to a relaxation of muscles and vasodilatation (1). Studies have shown that the NO-c-GMP pathway leads to cerebral vasodilatation with a similar mechanism (1, 4).…”

Section: Discussionmentioning

confidence: 99%

“…Although there are cases of subarachnoid haemorrhage and intracerebral hemorrhage caused by the use of sildenafil, there are few cases in the literature reporting intracerebral or subarachnoid hemorrhage associated with the use of sildenafil (1,7,8,11,10).…”

Section: Discussionmentioning

confidence: 99%

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Subarachnoid and intracerebral hemorrhage after alcohol ingestion and illicit use of sildenafil

Antar¹,

Sutpideler²,

Baran³

et al. 2014

Turkish Neurosurgery

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Sildenafil is a drug used in the treatment of male impotence. Few cases of spontaneous intracerebral hemorrhage following the use of sildenafil have been cited in the literature. A 42-year-old man was admitted to the emergency outpatient clinic of İstanbul Educational and Research Hospital after sudden loss of consciousness. He had ingested alcohol, taken 50mg sildenafil and had sexual intercourse. Non-contrast cranial tomography revealed an intracerebral hematoma with extension to the ventricles.Sildenafil is a selective phosphodiesterase-5 enzyme inhibitor. With the inhibition of PDE-5, the amount of cyclic-guanosine monophosphate (c-GMP) in the smooth vascular muscle cells in the corpus cavernosum increases, leading to a relaxation of muscles and vasodilatation. Studies have shown that the NO-c-GMP pathway leads to cerebral vasodilatation with a similar mechanism. The literature has shown that the effect of PDE-1 and PDE-2 on cerebral bleeding control is affected by sildenafil. This increased blood flow increases the risk of intracranial haemorrhage.Although data concerning the presentation of intracerebral hematoma in connection with the combined use of alcohol ingestion and use of sildenafil is inadequate, it can nevertheless be thought that the combined use increases the risk of spontaneous intracerebral hemorrhage and caution is in order concerning the matter. ÖZSildenafil erkek impotansının tedavisinde kullanılan bir ilaçtır. Sayısı az olsa da literatürde sildenafil kullanımı sonrasında spontan intraserebral hemoraji olguları bildirilmiştir. Kırk iki yaşında bir erkek hasta ani bilinç kaybı sonrasında İstanbul Eğitim ve Araştırma Hastanesinin acil polikliniğine başvurdu. Alkol alıp, 50mg sildenafil kullanmış ve cinsel ilişkide bulunmuştu. Kontrastsız kraniyal tomografi ventriküllere uzanan bir intraserebral hematom gösterdi.Sildenafil selektif bir fosfodiesteraz-5 enzim inhibitörüdür. PDE-5 inhibisyonu ile korpus kavernosumdaki düz vasküler kas hücrelerinde siklik guanozin monofosfat (c-GMP) miktarı artıp kaslarda gevşeme ve vazodilatasyona yol açar. Çalışmalar NO-c-GMP yolağının benzer bir mekanizmayla serebral vazodilatasyona yol açtığını göstermiştir. Literatür, PDE-1 ve PDE-2'nin serebral kanama kontrolü üzerindeki etkisinin sildenafilden etkilendiğini göstermiştir. Bu artmış kan akışı, intrakraniyal kanama riskini artırır.Kombine alkol alma ve sildenafil kullanmayla bağlantılı olarak intraserebral hematom ortaya çıkmasıyla ilgili veriler yetersiz olsa da kombine kullanımın spontan intraserebral kanama riskini artırdığı ve bu konuda dikkatli olmak gerektiğini düşünülebilir.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Subarachnoid and intracerebral hemorrhage after alcohol ingestion and illicit use of sildenafil

Antar¹,

Sutpideler²,

Baran³

et al. 2014

Turkish Neurosurgery

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“…Since the approval of these medications in 1998, several reports have tied their use to ICH [4,8,11,23,26,37,39]. Interestingly, not all adult cases were associated with sexual activity [26] and one case occurred in an infant being treated for pulmonary hypertension [37].…”

Section: Ich Of Other Etiologiesmentioning

confidence: 96%

Sexual activity as a trigger for intracranial hemorrhage

et al. 2015

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“…These adverse effects are mild, such as facial flushing, headache and nasal congestion. In addition, there are few case reports relating to the use of PDE-5i agents with serious complications, such as myocardial infarction, aortic dissection, stroke, ocular and auditory complications [4][5][6] . A meta-analysis has showed severe clinical adverse events of PDE-5i drugs are not more common than placebo 7 .…”

Section: Introductionmentioning

confidence: 99%