Cerebral infarction after excessive use of nasal decongestants.

Montalbán, J; Ibañez, L; Rodríguez, C.; López, Marisol López; Sumalla, J; Codina, A

doi:10.1136/jnnp.52.4.541

Cited by 19 publications

(9 citation statements)

References 16 publications

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“…There have been case reports of stroke associated with oxymetazoline, but none described cerebral vasoconstriction. 3,4 This case report illustrates that oxymetazoline can cause reversible segmental cerebral vasoconstriction, resulting in thunderclap headache.…”

Section: Commentsmentioning

confidence: 99%

Thunderclap headache and reversible segmental cerebral vasoconstriction associated with use of oxymetazoline nasal spray

Loewen

Hudon²,

Hill³

2004

Canadian Medical Association Journal

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Section: Commentsmentioning

confidence: 99%

Thunderclap headache and reversible segmental cerebral vasoconstriction associated with use of oxymetazoline nasal spray

Loewen

Hudon²,

Hill³

2004

Canadian Medical Association Journal

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“…46,47 The vascular damage in these cases was ascribed to arterial occlusions, in contrast to oral sympathomimetic-related complications, which are predominantly hemorrhages. We describe 2 patients with cerebrovascular complications associated with the application of nasal decongestants.…”

Section: Discussionmentioning

confidence: 99%

“…We found 39 cases reported in the literature: 31 associated with the use of PPA 2-10,19 -21,25-40 ; 4 with pseudoephedrine, ephedrine, and ephedra alkaloid derivatives 16,[41][42][43] ; 2 with phentermine 44,45 ; and 2 with sympathomimetics used by the nasal route (oxymetazoline and fenoxazoline). 46,47 PPA use is associated largely with the occurrence of intracranial hemorrhage 21,26,27 and only occasionally with development of an ischemic stroke. 7,25 Only 1 of the 16 patients in our series had an ischemic stroke, and only 2 cases are described in 31 previous reports.…”

Section: Discussionmentioning

confidence: 99%

Editorial Comment—Over-the-Counter Cold Remedies and Stroke

Brust

2003

Stroke

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Background and Purpose-Phenylpropanolamine (PPA) and pseudoephedrine are sympathomimetics contained in over-the-counter cold preparations. A case-control study linked PPA use with hemorrhagic stroke in women. Twenty-two patients with stroke associated with use of these drugs are described. Methods-In a consecutive stroke registry since 1988, 22 patients had stroke associated with over-the-counter sympathomimetics. Sympathomimetic dosage and type, time interval until stroke onset, and neuroimaging findings are described. Results-Ten male and 12 female patients were included. Intracerebral hemorrhage occurred in 17 patients, subarachnoid hemorrhage in 4, and ischemic stroke in 1. Stroke was associated with PPA use in 16 patients (dose 75 to 675 mg), with pseudoephedrine in 4 (dose 60 to 300 mg), and with others administered by the nasal route in 2 (oxymetazoline and phenylephrine). Stroke occurred after a single dose in 17 patients and after daily use during several days in 5. The interval between drug exposure and clinical onset varied from 30 minutes to 24 hours. Stroke occurred after recommended doses of PPA (50 to 75 mg) in 32% and pseudoephedrine (60 mg) in 50% of patients. Eight patients had acute hypertension at stroke onset. Cerebral angiography was normal in 8 cases and showed diffuse vasospasm or beading in 10 patients. Conclusions-Stroke related to over-the-counter sympathomimetics was associated with acute hypertension and/or vasospasm or angiitis mechanisms, most related to the use of PPA; however, stroke also occurred with the use of other sympathomimetics, particularly pseudoephedrine. Although stroke complications occurred when doses were used that were higher than recommended doses, apparently there is also a stroke risk when these agents are taken properly.

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“…The Kernan study found that women age 18–49 who had taken PPA as a cold remedy had an increased odds ratio of 3.13 for intracranial hemorrhage. The findings of the study prompted the FDA to issue a public health warning regarding PPA and to ban both OTC and prescription products containing PPA [2]. Within hours pharmaceutical companies had removed medications containing PPA from public availability [9].…”

Section: Discussionmentioning

confidence: 99%

“…Related to amphetamines, pseudoephedrine, and ephedra, PPA, norpseudoephedrine, and other sympathomimetics have a long history of intracranial hemorrhage [1]. The mechanism behind this outcome has variously been described as necrotizing angiitis, vascular spasm, and hypertensive crisis [1, 2]. PPA is not unique in causing adverse events; ephedra, phenylephrine, and pseudoephedrine have all been associated with hypertension, stroke, seizure, and death [3].…”

Section: Introductionmentioning

confidence: 99%

Postpartum Phenylpropanolamine-Induced Intracerebral Hemorrhage

Walker¹,

Carlson²

2009

Radiology Case Reports

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Phenylpropanolamine-induced vasculitis and related intracerebral hemorrhage has moved from the spotlight it occupied following its withdrawal from the market at the end of 2000 after the Food and Drug Administration ruled that it was not safe and effective, but the risk from medicines purchased prior to that time and still in the possession of the public can still pose a health hazard. We present the case of a patient who developed intracerebral hemorrhage following phenylpropanolamine ingestion post-partum 4 years following the recall, as well as her difficult recovery process. This case emphasizes the point that physicians should consider phenylpropanolamine when evaluating young females with few risk factors for stroke.

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Cerebral infarction after excessive use of nasal decongestants.

Cited by 19 publications

References 16 publications

Thunderclap headache and reversible segmental cerebral vasoconstriction associated with use of oxymetazoline nasal spray

Thunderclap headache and reversible segmental cerebral vasoconstriction associated with use of oxymetazoline nasal spray

Editorial Comment—Over-the-Counter Cold Remedies and Stroke

Postpartum Phenylpropanolamine-Induced Intracerebral Hemorrhage

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