Tadalafil-Associated Recurrent Intracerebral Hemorrhage (5414)
Abstract
Objective: N/A Background: Traditional risk factors for spontaneous intracerebral hemorrhage include hypertension, cerebral amyloid angiopathy, and underlying neoplasm or vascular malformation. There have been only a handful of published case reports regarding phosphodiesterase type-5 (PDE-5) inhibitor-associated intracerebral hemorrhage. Design/Methods: Case report Results: A 77 year old male presented with headache and vision changes. He was taking daily tadalafil for chronic urinary retention, but also had taken an extra dose prior to sexual intercourse that evening. Initial blood pressure was 135/66. Neurologic exam was only notable for right visual field blurriness. Labs were unremarkable including normal coagulation studies and platelets. MRI brain revealed a 2.5 x 1.3 cm left occipital lobe intraparenchymal hemorrhage, and was negative for underlying neoplasm or microhemorrhages. CT angiogram was negative for vascular malformation. He was discharged home after an uneventful stay, and followed up in clinic with mild residual visual deficits. Two months after the hemorrhage, he presented again with worsening vision changes, nausea, vomiting, and fluent aphasia, again after taking an extra dose of tadalafil prior to sexual intercourse. CT head then revealed a 6 x 3.5 cm left parieto-occipital intraparenchymal hemorrhage with intraventricular extension. The patient declined a diagnostic cerebral angiogram. Conclusions: Our patient is the first described case to have two…
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