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Pseudoephedrine-induced Hemorrhage Associated with a Cerebral Vascular Malformation

Published online by Cambridge University Press:  02 December 2014

Steven K. Baker ,
Jamie E. Silva ,
Ken K.S. Lam  and
Steven K. Baker
Steven K. Baker
Affiliation:
Department of Neurology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
Jamie E. Silva
Affiliation:
Department of Neurology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
Ken K.S. Lam
Affiliation:
Department of Neurology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
Steven K. Baker
Affiliation:
Department of Neurology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
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Abstract:

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Background:

Sympathomimetic-related intracerebral hemorrhage is well-documented. Most cases are associated with phenylpropanolamine use.

Case Report:

We report a case of intracerebral hemorrhage occurring in a middle-aged man who suffered from chronic sinusitis and had been ingesting pseudoephedrine daily for one year. This patient was previously well with no known cardiovascular risk factors. Clinical examination revealed no evidence of vasculitis nor coagulopathy and initial neuroimaging (i.e., computed tomography, angiography, magnetic resonance imaging) demonstrated no features consistent with aneurysm, arteriovenous malformation (AVM), cavernoma, nor cerebral metastases. A follow-up cerebral angiogram demonstrated a small AVM arising off a branch of the pericallosal artery and a small arteriovenous fistula arising off the costal marginal branch. The AVM was embolized without incident, however, the AVF was not accessible.

Conclusions:

Sympathomimetics have long been associated with intracerebral hemorrhage. Since 1979, over 30 published case reports have documented the relationship between phenylpropanolamine and stroke. Only one report links phenylpropanolamine consumption to an intracerebral hemorrhage in a patient with an AVM. There is a paucity of literature etiologically inculpating other ephedra alkaloids in the causation of intracerebral hemorrhage. This is a case of pseudoephedrine-induced intracerebral hemorrhage in a patient with an underlying vascular malformation.

Résumé:

RÉSUMÉ:Introduction:

L’hémorragie intracérébrale (HIC) en relation avec les substances sympathomimétiques est bien connue. La plupart des cas sont associés à la phénylpropanolamine.

Cas clinique:

Il s’agit d’un cas de HIC chez un homme d’âge moyen atteint de sinusite chronique qui faisait usage de pseudoéphédrine quotidiennement depuis un an. Ce patient était en bonne santé, sans facteur de risque cardiovasculaire connu. L’examen clinique n’a montré aucun signe de vasculite ou de coagulopathie. À la neuroimagerie (CT, angiographie, RMN), aucune image compatible avec un anévrisme, une malformation artérioveineuse (MAV), un angiome caverneux ou des metastases cérébrales n’a été décelée. Au cours du suivi, une angiographie cérébrale a montré la présence d’une petite MAV issue d’une branche de l’artère péricalleuse ainsi qu’une petite fistule artérioveineuse (FAV) issue d’une branche de l’artère callosomarginale. La MAV a été traitée par embolisation sans incident. Cependant, la FAV n’était pas accessible.

Conclusions:

Le lien entre les agents sympathomimétiques et l’hémorragie intracérébrale est bien connu. Depuis 1979, plus de 30 cas où il existait une relation entre la phénylpropanolamine et l’accident vasculaire cerebral ont été publiés. On a fait un lien dans un seul cas entre l’utilisation de phénylpropanolamine et l’hémorragie intracérébrale chez un patient ayant une MAV. Il existe peu de publications établissant un lien étiologique entre l’hémorragie intracérébrale et d’autres alcaloïdes de l’éphédra. Ce cas est donc le premier cas d’hémorragie intracérébrale induite par la pseudoéphédrine chez un patient porteur d’une malformation vasculaire.

Type
Case Reports
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 2 , May 2005 , pp. 248 - 252
Copyright
Copyright © The Canadian Journal of Neurological 2005

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