Intracranial haemorrhage in association with pseudoephedrine overdose.

Loizou, L A; Hamilton, Jessica; Tsementzis, S A

doi:10.1136/jnnp.45.5.471

Cited by 52 publications

(14 citation statements)

References 15 publications

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“…1 -3 More recently, intracranial haemorrhage has been seen following the use of phenylpropanolamine' 16 and as a complication of pseudoephedrine overdose. 7 Reports have also implicated the chronic abuse of nasal decongestant sprays 8 and abuse of ephedrine. 9 These drugs are used as decongestants, stimulants and appetite suppressants, and are readily available without prescription.…”

Section: Discussionmentioning

confidence: 99%

“…9 These drugs are used as decongestants, stimulants and appetite suppressants, and are readily available without prescription. Angiography has again demonstrated beading; 7 …”

Section: Discussionmentioning

confidence: 99%

“…7 The appearance of beading is non-specific, and has been noted in meningitis and encephalitis, 10 and following aneurysmal subarachnoid haemorrhage." In adult rhesus monkeys, transient angiographic changes were seen within ten minutes of intravenous administration of methamphetamine.…”

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confidence: 99%

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Intracerebral haemorrhage and angiographic beading following ingestion of catecholaminergics.

Stoessl¹,

Young²,

Feasby³

1985

Stroke

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SUMMARY We report two cases of serious intracerebral haemorrhage occurring in young women following their first use of oral medications containing catecholaminergic agents (phenylpropanolamine in combination with ephedrine or pseudoephedrine). Both women were previously well, and there was no evidence for systemic vasculitis, coagulopathy, aneurysm or arteriovenous malformation. Angiography in both cases, performed approximately forty hours following drug ingestion, revealed the beading pattern typical of that seen in previously reported cases of presumed amphetamine-induced "vasculitis." We believe that this arteriographic abnormality is non-specific and should not be construed as necessarily indicative of arteritis.

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Section: Discussionmentioning

confidence: 99%

“…9 These drugs are used as decongestants, stimulants and appetite suppressants, and are readily available without prescription. Angiography has again demonstrated beading; 7 …”

Section: Discussionmentioning

confidence: 99%

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Intracerebral haemorrhage and angiographic beading following ingestion of catecholaminergics.

Stoessl¹,

Young²,

Feasby³

1985

Stroke

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“…Indeed, lobar ICH is the result of other heterogeneous causes, including arteriovenous malformation, cavernous angioma, aneurysm, brain tumors, especially those of metastatic origin (2,3), the use of anticoagulant or fibrinolytic agents, cerebral amyloid angiopathy and vasculitis (2). Furthermore, the frequency of lobar ICH complicated by amphetamines (4), pseudoephedrine (5), and cocaine (6) has increased recently. Other relatively rare causes may include moyamoya disease (7), disseminated intravascular coagulation or sepsis (8), cerebral venous thrombosis (9) and leptomeningeal anastomosis after the occlusion of major cerebral artery (10).…”

Section: Introductionmentioning

confidence: 99%

Clinical and Radiographic Features of Lobar Cerebral Hemorrhage: Hypertensive Versus Non-hypertensive Cases

et al. 2003

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ObjectivesThe underlying cause of lobar intracerebral hemorrhage (ICH) is often difficult to determine, since these vascular abnormalities are not necessarily visualized in radiographic studies. Wesought to determine the clinical features of hypertensive and nonhypertensive lobar ICH, and further predict the presence or absence of vascular abnormalities in terms of clinical features and radiographic abnormalities.Patients and Methods Eighty-one patients with lobar ICH were retrospectively assigned to either hypertensive or non-hypertensive groups based on their blood pressure levels during the chronic phase or a history of antihypertensive medication. The clinical and radiographic features of these two groups were compared.Results Forty-nine patients (60%) were hypertensive, and the other thirty-two (40%) were non-hypertensive.In the non-hypertensive group, amyloid angiopathy (n= 6), aneurysms (n=5), arteriovenous malformation (n=4), use of anticoagulants (n=2), liver cirrhosis (n=2) and thrombasthenia (n=l) were found as underlying causes.There were no significant differences between these two groups in the frequencies of stroke risk factors except for hypertension, clinical features and initial neurological findings. On the contrary, subarachnoid extension of the hematomaon CT was significantly more frequent in the non-hypertensive lobar ICH group than in the hypertensive group (p<0.001). The patients with subarachnoid extension were morelikely to have vascular abnormality than those without subarachnoid extension (p<0.01). Conclusion Subarachnoid extension of the hematoma on CTstrongly indicates a non-hypertensive cause, and more specifically, it suggests lobar ICH caused by vascular abnormalities.

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“…Although most were related to PPA, stroke can also occur with the use of other sympathomimetics, particularly pseudoephedrine. We found 39 cases reported in the literature: 31 associated with the use of PPA 2-10,19 -21,25-40 ; 4 with pseudoephedrine, ephedrine, and ephedra alkaloid derivatives 16,[41][42][43] ; 2 with phentermine 44,45 ; and 2 with sympathomimetics used by the nasal route (oxymetazoline and fenoxazoline). 46,47 PPA use is associated largely with the occurrence of intracranial hemorrhage 21,26,27 and only occasionally with development of an ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Editorial Comment—Over-the-Counter Cold Remedies and Stroke

Brust

2003

Stroke

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Background and Purpose-Phenylpropanolamine (PPA) and pseudoephedrine are sympathomimetics contained in over-the-counter cold preparations. A case-control study linked PPA use with hemorrhagic stroke in women. Twenty-two patients with stroke associated with use of these drugs are described. Methods-In a consecutive stroke registry since 1988, 22 patients had stroke associated with over-the-counter sympathomimetics. Sympathomimetic dosage and type, time interval until stroke onset, and neuroimaging findings are described. Results-Ten male and 12 female patients were included. Intracerebral hemorrhage occurred in 17 patients, subarachnoid hemorrhage in 4, and ischemic stroke in 1. Stroke was associated with PPA use in 16 patients (dose 75 to 675 mg), with pseudoephedrine in 4 (dose 60 to 300 mg), and with others administered by the nasal route in 2 (oxymetazoline and phenylephrine). Stroke occurred after a single dose in 17 patients and after daily use during several days in 5. The interval between drug exposure and clinical onset varied from 30 minutes to 24 hours. Stroke occurred after recommended doses of PPA (50 to 75 mg) in 32% and pseudoephedrine (60 mg) in 50% of patients. Eight patients had acute hypertension at stroke onset. Cerebral angiography was normal in 8 cases and showed diffuse vasospasm or beading in 10 patients. Conclusions-Stroke related to over-the-counter sympathomimetics was associated with acute hypertension and/or vasospasm or angiitis mechanisms, most related to the use of PPA; however, stroke also occurred with the use of other sympathomimetics, particularly pseudoephedrine. Although stroke complications occurred when doses were used that were higher than recommended doses, apparently there is also a stroke risk when these agents are taken properly.

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Intracranial haemorrhage in association with pseudoephedrine overdose.

Cited by 52 publications

References 15 publications

Intracerebral haemorrhage and angiographic beading following ingestion of catecholaminergics.

Intracerebral haemorrhage and angiographic beading following ingestion of catecholaminergics.

Clinical and Radiographic Features of Lobar Cerebral Hemorrhage: Hypertensive Versus Non-hypertensive Cases

Editorial Comment—Over-the-Counter Cold Remedies and Stroke

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