Paradoxical Post-Tadalafil Cerebral Vasoconstriction Causing Transient Ischemic Attack
Abstract
A 54-year-old male without medical history presents with sudden-onset right paresthesia during dinner.He admits to having taken Tadalafil-10 mg 1 hour before dinner.His symptoms have resolved while in the ambulance.Computed tomography angiogram showed diffuse vasospasm with near occlusion of the left M2-inferior branch (Figure 1A and 1C).Hemoglobin A1C was 7.2, and he had a patent foramen ovale.Lowerextremity ultrasound and magnetic resonance imaging of the brain were unremarkable (Figure 2).Repeat computed tomography angiogram showed near-resolution of the vasospasm (Figure 1B and 1D).Our case demonstrates Tadalafil causing cerebral vasoconstriction transiently.While diabetes and patent foramen ovale might be risk factors for transient ischemic attacks, it is unlikely to cause a picture of severe transient diffuse cerebral vasospasms as seen in our patient.
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