Intracranial aneurysm and sildenafil.

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Sildenafil is a widely prescribed medication for erectile dysfunction.
• Previous reports indicate a potential association between sildenafil use and intracranial hemorrhage, including intracerebral bleeding and subarachnoid hemorrhage.

Observation:

• A 49-year-old male with hypertension and diabetes presented with acute pulmonary edema and loss of consciousness post-sildenafil ingestion.
• The patient had an undiagnosed saccular aneurysm.
• Computed tomography confirmed subarachnoid hemorrhage due to aneurysm rupture, with a subsequent re-hemorrhage event.

Findings:

• Sildenafil's mechanism involves phosphodiesterase inhibition, leading to increased cerebral circulation and vasodilation.
• This can cause sympathetic overactivity, potentially elevating blood pressure.
• The patient experienced a hypertensive crisis, leading to pulmonary edema and the subarachnoid hemorrhage.

Implications:

• This case underscores the potential risk of serious cerebrovascular events, like subarachnoid hemorrhage, associated with sildenafil in patients with pre-existing vascular abnormalities.
• Physicians should carefully consider patient history, including risk factors for aneurysms and hypertension, before prescribing sildenafil.
• Further research is warranted to elucidate the precise mechanisms and quantify the risk of sildenafil-induced intracranial bleeding.