Top

Published in:

01-01-2016 | Clinical Article - Vascular

Sexual activity as a trigger for intracranial hemorrhage

Authors: Paul M. Foreman, Christoph J. Griessenauer, Magdy H. Selim, David Eric C. Searls, Adnan Safdar, Ekkehard M. Kasper, Christopher S. Ogilvy, Ajith J. Thomas

Published in: Acta Neurochirurgica | Issue 1/2016

Abstract

Background

Intracranial hemorrhage (ICH) has been reported in association with sexual activity. A case-series of patients with ICH following sexual activity is presented to further elucidate the role of the physiologic sexual response as a trigger of ICH.

Method

A retrospective review of the medical record was performed, identifying patients presenting with ICH temporally related to sexual activity. Clinical and radiographic data were collected and reported.

Results

Sixteen patients presented with non-traumatic ICH temporally related to sexual activity. Eight (50 %) patients presented with aneurysmal subarachnoid hemorrhage, four (25 %) with angiogram-negative subarachnoid hemorrhage, two (12.5 %) with a ruptured arteriovenous malformation, and two (12.5 %) with an intracerebral basal ganglia hemorrhage. Overall average age was 49.9 (range, 28–74) years. Sexual activity involved male–female intercourse in 14 (87.5 %) patients and masturbation in 2 (12.5 %) patients.

Conclusions

Sexual-activity-related ICH is rare and includes various etiologies. The human sexual response in associated with dramatic increases in arterial blood pressure, which likely underlies the association.

Akkawi NM, Agosti C, Borroni B, Rozzini L, Magoni M, Vignolo LA, Padovani A (2002) Jugular valve incompetence: a study using air contrast ultrasonography on a general population. J Ultrasound Med 21:747–751PubMed

Albano B, Gandolfo C, Del Sette M (2010) Post-coital intra-cerebral venous hemorrhage in a 78-year-old man with jugular valve incompetence: a case report. J Med Case Rep 4:225PubMedCentralPubMedCrossRef

Alen JF, Lagares A, Lobato RD, Gomez PA, Rivas JJ, Ramos A (2003) Comparison between perimesencephalic nonaneurysmal subarachnoid hemorrhage and subarachnoid hemorrhage caused by posterior circulation aneurysms. J Neurosurg 98:529–535PubMedCrossRef

Alpsan MH, Bebek N, Ciftci FD, Coban O, Bahar S, Tuncay R (2008) Intracerebral hemorrhage associated with sildenafil use: a case report. J Neurol 255:932–933PubMedCrossRef

Anderson C, Ni Mhurchu C, Scott D, Bennett D, Jamrozik K, Hankey G, Australasian Cooperative Research on Subarachnoid Hemorrhage Study G (2003) Triggers of subarachnoid hemorrhage: role of physical exertion, smoking, and alcohol in the australasian cooperative research on subarachnoid hemorrhage study (ACROSS). Stroke 34:1771–1776PubMedCrossRef

Berkels R, Klotz T, Sticht G, Englemann U, Klaus W (2001) Modulation of human platelet aggregation by the phosphodiesterase type 5 inhibitor sildenafil. J Cardiovasc Pharmacol 37:413–421PubMedCrossRef

Breitmeier D, Mansouri F, Albrecht K, Bohm U, Troger HD, Kleemann WJ (2003) Accidental autoerotic deaths between 1978 and 1997. Institute of Legal Medicine, Medical School Hannover. Forensic Sci Int 137:41–44PubMedCrossRef

Buxton N, Flannery T, Wild D, Bassi S (2001) Sildenafil (Viagra)-induced spontaneous intracerebral haemorrhage. Br J Neurosurg 15:347–349PubMedCrossRef

Calandre L, Arnal C, Ortega JF, Bermejo F, Felgeroso B, del Ser T, Vallejo A (1986) Risk factors for spontaneous cerebral hematomas. Case–control study. Stroke 17:1126–1128PubMedCrossRef

10.

Chiu PJ, Vemulapalli S, Chintala M, Kurowski S, Tetzloff GG, Brown AD, Sybertz EJ (1997) Inhibition of platelet adhesion and aggregation by E4021, a type V phosphodiesterase inhibitor, in guinea pigs. Naunyn Schmiedebergs Arch Pharmacol 355:463–469PubMedCrossRef

11.

De-Giorgio F, Arena V, Arena E, Lodise M, Valerio L, d’Aloja E, Chiarotti M (2011) Subarachnoid hemorrhage during sexual activity after sildenafil intake: an accidental association? Am J Forensic Med Pathol 32:310–311PubMedCrossRef

12.

De-Giorgio F, Di-Giannantonio P, Vetrugno G, Arena V (2011) Death related to aortic coarctation in a young female during sexual intercourse. J Forensic Sci 56:1361–1363PubMedCrossRef

13.

Ehling R, Helbok R, Beer R, Lackner P, Broessner G, Pfausler B, Rocken C, Aguzzi A, Chemelli A, Schmutzhard E (2012) Recurrent intracerebral haemorrhage after coitus: a case report of sporadic cerebral amyloid angiopathy in a younger patient. Eur J Neurol 19:e29–e31PubMedCrossRef

14.

Finelli PF (1993) Coital cerebral hemorrhage. Neurology 43:2683–2685PubMedCrossRef

15.

Galabada DP, Nazar AL (2014) Unusual presentation of aortic dissection: post-coital acute paraplegia with renal failure. Saudi J Kidney Dis Transpl 25:1059–1061PubMedCrossRef

16.

Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA (1998) Oral sildenafil in the treatment of erectile dysfunction. Sildenafil study group. N Engl J Med 338:1397–1404PubMedCrossRef

17.

Greenfield JC Jr, Rembert JC, Tindall GT (1984) Transient changes in cerebral vascular resistance during the Valsalva maneuver in man. Stroke 15:76–79PubMedCrossRef

18.

Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology (2015) Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:2032–2060PubMedCrossRef

19.

Kapadia A, Schweizer TA, Spears J, Cusimano M, Macdonald RL (2014) Nonaneurysmal perimesencephalic subarachnoid hemorrhage: diagnosis, pathophysiology, clinical characteristics, and long-term outcome. World Neurosurg 82:1131–1143PubMedCrossRef

20.

Kim HG, Lim H, Kim HJ, Cho YS (2008) A case of sexual activity-induced external iliac artery rupture of a young healthy woman. Emerg Med J 25:644PubMedCrossRef

21.

Langer DJ, Lasner TM, Hurst RW, Flamm ES, Zager EL, King JT Jr (1998) Hypertension, small size, and deep venous drainage are associated with risk of hemorrhagic presentation of cerebral arteriovenous malformations. Neurosurgery 42:481–486, discussion 487–489PubMedCrossRef

22.

Lee S, Chae J, Cho Y (2006) Causes of sudden death related to sexual activity: results of a medicolegal postmortem study from 2001 to 2005. J Korean Med Sci 21:995–999PubMedCentralPubMedCrossRef

23.

Marti I, Marti Masso JF (2004) Hemiballism due to sildenafil use. Neurology 63:534PubMedCrossRef

24.

Masters WH, Johnson VE (1966) Human sexual response. Little, Brown, and Co., Boston

25.

McDougall CG, Spetzler RF, Zabramski JM, Partovi S, Hills NK, Nakaji P, Albuquerque FC (2012) The barrow ruptured aneurysm trial. J Neurosurg 116:135–144PubMedCrossRef

26.

Monastero R, Pipia C, Camarda LK, Camarda R (2001) Intracerebral haemorrhage associated with sildenafil citrate. J Neurol 248:141–142PubMedCrossRef

27.

Morales A, Gingell C, Collins M, Wicker PA, Osterloh IH (1998) Clinical safety of oral sildenafil citrate (VIAGRA) in the treatment of erectile dysfunction. Int J Impot Res 10:69–73, discussion 73–64PubMedCrossRef

28.

Morris-Stiff G, Coxon M, Ball E, Lewis MH (2008) Post coital aortic dissection: a case report. J Med Case Rep 2:6PubMedCentralPubMedCrossRef

29.

Nikolic S, Zivkovic V (2012) Fatal subarachnoid hemorrhage during sexual anal self-stimulation in a female: a case report. Am J Forensic Med Pathol 33:152–155PubMedCrossRef

30.

Nnoli MA, Kanu OO, Ogo CN (2014) Sudden death during sexual intercourse: profile and pattern of intracranial hemorrhages in African men who died during sexual intercourse. Chirurgia 27:273–277

31.

Passero S, Reale F, Ciacci G, Zei E (2000) Differing temporal patterns of onset in subgroups of patients with intracerebral hemorrhage. Stroke 31:1538–1544PubMedCrossRef

32.

Passero S, Ciacci G, Reale F (2001) Potential triggering factors of intracerebral hemorrhage. Cerebrovasc Dis 12:220–227PubMedCrossRef

33.

Porth CJ, Bamrah VS, Tristani FE, Smith JJ (1984) The Valsalva maneuver: mechanisms and clinical implications. Heart Lung 13:507–518PubMed

34.

Portunato, Landolfa MC, Botto M, Bonsignore A, De Stefano F, Ventura F (2012) Fatal subarachnoid hemorrhage during sexual activity: a case report. Am J Forensic Med Pathol 33:90–92PubMedCrossRef

35.

Qureshi AI, Mohammad Y, Suri MF, Braimah J, Janardhan V, Guterman LR, Hopkins LN, Frankel MR (2001) Cocaine use and hypertension are major risk factors for intracerebral hemorrhage in young African Americans. Ethn Dis 11:311–319PubMed

36.

Reynolds MR, Willie JT, Zipfel GJ, Dacey RG (2011) Sexual intercourse and cerebral aneurysmal rupture: potential mechanisms and precipitants. J Neurosurg 114:969–977PubMedCrossRef

37.

Samada K, Shiraishi H, Aoyagi J, Momoi MY (2009) Cerebral hemorrhage associated with sildenafil (Revatio) in an infant. Pediatr Cardiol 30:998–999PubMedCrossRef

38.

Schievink WI, Karemaker JM, Hageman LM, van der Werf DJ (1989) Circumstances surrounding aneurysmal subarachnoid hemorrhage. Surg Neurol 32:266–272PubMedCrossRef

39.

Steeves TD, Jones LK, Ecker RD, Manno EM (2005) Coital hemorrhage of an arteriovenous malformation after premedication with tadalafil (Cialis). J Stroke Cerebrovasc Dis 14:179–181PubMedCrossRef

40.

Tsementzis SA, Gill JS, Hitchcock ER, Gill SK, Beevers DG (1985) Diurnal variation of and activity during the onset of stroke. Neurosurgery 17:901–904PubMedCrossRef

41.

Vemulapalli S, Chiu PJ, Kurowski S, Brown A, Hartman BD, Leach MW (1996) In vivo inhibition of platelet adhesion by a cGMP-mediated mechanism in balloon catheter injured rat carotid artery. Pharmacology 52:235–242PubMedCrossRef

42.

Vlak MH, Rinkel GJ, Greebe P, van der Bom JG, Algra A (2011) Trigger factors and their attributable risk for rupture of intracranial aneurysms: a case-crossover study. Stroke 42:1878–1882PubMedCrossRef

43.

Westover AN, McBride S, Haley RW (2007) Stroke in young adults who abuse amphetamines or cocaine: a population-based study of hospitalized patients. Arch Gen Psychiatry 64:495–502PubMedCrossRef

44.

Yamakawa H, Ohe N, Yano H, Yoshimura S, Iwama T (2008) Venous drainage patterns in perimesencephalic nonaneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg 110:587–591PubMedCrossRef

Title: Sexual activity as a trigger for intracranial hemorrhage
Authors: Paul M. Foreman
Christoph J. Griessenauer
Magdy H. Selim
David Eric C. Searls
Adnan Safdar
Ekkehard M. Kasper
Christopher S. Ogilvy
Ajith J. Thomas
Publication date: 01-01-2016
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 1/2016
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-015-2643-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sexual activity as a trigger for intracranial hemorrhage

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Working time of neurosurgical residents in Europe—results of a multinational survey

Pure endoscopic transsphenoidal surgery for functional pituitary adenomas: outcomes with Cushing’s disease

Clinical features of clear cell meningioma: a retrospective study of 36 cases among 10,529 patients in a single institution

Parametric study of ventricular catheters for hydrocephalus

Neurosurgical resident education in Europe—results of a multinational survey

Long-term outcomes after supratotal resection of diffuse low-grade gliomas: a consecutive series with 11-year follow-up