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Basilar artery thrombosis during sexual intercourse.

Andreas Posa1, Tobias Mueller1, Olga Ungurs1

  • 1Martin-Luther-University Halle-Wittenberg, Department of Neurology, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|January 27, 2020
PubMed
Summary

Sexual intercourse can trigger a rare ischemic stroke, specifically basilar artery thrombosis, leading to locked-in syndrome in young individuals. A genetic risk factor, PAI1 4G/4G homozygosity, was identified in this unusual case.

Keywords:
Basilar artery thrombosisHigh intensity transient signals (HITS)Ischemic strokePersistent foramen ovale (PFO)Sexual intercourse

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Area of Science:

  • Neurology
  • Cardiology
  • Genetics

Background:

  • Ischemic stroke is uncommon during sexual activity.
  • Basilar artery thrombosis during sexual intercourse is unprecedented.
  • Young individuals are rarely affected by such severe stroke events.

Purpose of the Study:

  • To report a rare case of basilar artery thrombosis during sexual intercourse.
  • To investigate the underlying causes and risk factors.
  • To highlight unusual stroke triggers in young populations.

Main Methods:

  • Case report of a young woman experiencing stroke symptoms during intercourse.
  • Diagnostic imaging including assessment for right-to-left shunt (e.g., using HITS).
  • Molecular genetic analysis for PAI1 promoter polymorphism (-675 4G/4G).

Main Results:

  • The patient developed life-threatening basilar artery thrombosis and locked-in syndrome.
  • High intensity transient signals (HITS) indicated a right-to-left shunt, suggesting paradoxical embolism.
  • Genetic testing revealed PAI1 4G/4G homozygosity, a known ischemic stroke risk factor.

Conclusions:

  • Sexual intercourse can be an unusual trigger for ischemic stroke, including basilar artery thrombosis.
  • Paradoxical embolism via a right-to-left shunt may be a mechanism.
  • PAI1 4G/4G homozygosity is a significant genetic risk factor for stroke, particularly in young patients.