Sexual activity as a trigger for intracranial hemorrhage

Foreman, Paul M.; Griessenauer, Christoph J.; Selim, Magdy; Searls, D. Eric; Safdar, Adnan; Kasper, Ekkehard M.; Ogilvy, Christopher S.; Thomas, Ajith J.

doi:10.1007/s00701-015-2643-x

Cited by 6 publications

(5 citation statements)

References 40 publications

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“…Several plausible biological explanations exist on how trigger factors increase the risk of stroke. First, some trigger factors, such as caffeine consumption, 30,31 certain types of drugs, 32 sexual activity, 33 and vigorous physical exercise 23 transiently increase blood pressure. An increased blood pressure may result in increased shear stress on the arterial vessel wall, potentially resulting in the disruption of the endothelial cell surface.…”

Section: Discussionmentioning

confidence: 99%

“…Vigorous physical exercise and the different bouts of exercise, illicit drug use, fever, and flu-like disease may all result in a temporary rise in blood pressure or a prothrombotic condition. 13,23,26,[30][31][32][33][34][35]37,38 However, this study alone is not enough to validate the causality of trigger factors in young patients with cryptogenic stroke. To obtain further support for a role of trigger factors in (cryptogenic) stroke, these patients could be followed up for recurrent stroke and their relation with the earlier identified trigger factor.…”

Section: Discussionmentioning

confidence: 99%

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Trigger Factors for Stroke in Young Adults

et al. 2023

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Background and Objectives:Causes of stroke in young adults differ from those in the elderly, and in a larger percentage no cause can be determined. To gain more insight in the etiology of (cryptogenic) stroke in the young, we investigated whether trigger factors, such as short-lasting exposure to toxins or infection, may play a role.Methods:Patients aged 18-49 years with a first-ever ischemic stroke or intracerebral hemorrhage (ICH) in 17 participating centers in the Netherlands completed a questionnaire about exposure to nine potential trigger factors in hazard periods and on a regular yearly basis. A case-crossover design was used to assess relative risks (RR) with 95% confidence intervals (95% CI) by the Mantel-Haenszel case-crossover method, for any stroke (ischemic stroke and ICH combined) and for different etiologic subgroups of ischemic stroke.Results:1146 patients completed the questionnaire (1043 patients with an ischemic stroke, 103 with an ICH, median age 44.0 years, 52.6% men). For any stroke an increased risk emerged within one hour of cola consumption (RR 2.0, 95% CI 1.5-2.8) and vigorous physical exercise (RR 2.6, 95% CI 2.2-3.0), within two hours after sexual activity (RR 2.4, 95% CI 1.6-3.5), within 4 hours after illicit drug use (RR 2.8, 95% CI 1.7-4.9) and within 24 hours after fever or flu-like disease (RR 14.1, 95% CI 10.5-31.2; RR 13.9, 95% CI 8.9-21.9). Four trigger factors increased the risk of other determined and cryptogenic ischemic stroke, three that of cardio-embolic stroke, two that of large vessel atherosclerosis and likely atherothrombotic stroke combined and stroke with multiple causes, none that of stroke due to small vessel disease.Discussion:We identified cola consumption, vigorous physical exercise, sexual activity, illicit drug use, fever- and flu-like disease as potential trigger factors for stroke in the young, and found differences in type and number of trigger factors associated with different etiologic subgroups of ischemic stroke. These findings might help in better understanding the pathophysiological mechanisms of (cryptogenic) stroke in the young.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trigger Factors for Stroke in Young Adults

et al. 2023

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“…Schievink et al 15) suggested that a sudden rise in the arterial blood pressure with a drop in the intracranial cerebrospinal fluid pressure creates a transmural pressure gradient, and this has been implicated in rupture of an aneurysm. In addition, aSAH or nIPH may be precipitated by sexual intercourse 5,14) . In 2011, Reynolds et al 14) proposed that coitus may be a cause of aSAH by increasing the mean arterial pressure and/or decreasing the intracranial pressure with hyperventilation at the end of an orgasmic phase based on previous studies 8) .…”

Section: Discussionmentioning

confidence: 99%

“…In 2011, Reynolds et al 14) proposed that coitus may be a cause of aSAH by increasing the mean arterial pressure and/or decreasing the intracranial pressure with hyperventilation at the end of an orgasmic phase based on previous studies 8) . A case series of 16 patients assessed eight patients with aSAH, four with angiogram-negative SAH, two with a ruptured arteriovenous malformation, and two with nIPH, and suggested an association between dramatic increases in the arterial blood pressure and sexual intercourse 5) .…”

Section: Discussionmentioning

confidence: 99%

Influence of Triggering Events on the Occurrence of Spontaneous Intracranial Hemorrhage : Comparison of Non-Lesional Spontaneous Intraparenchymal Hemorrhage and Aneurysmal Subarachnoid Hemorrhage

Kim

Kang

et al. 2020

J Korean Neurosurg Soc

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Objective : Spontaneous intracranial hemorrhage is a life-threatening disease, and non-lesional spontaneous intraparenchymal hemorrhage (nIPH) and aneurysmal subarachnoid hemorrhage (aSAH) are the leading causes of spontaneous intracranial hemorrhage. Only a few studies have assessed the association between prior physical activity or triggering events and the occurrence of nIPH or aSAH. The purpose of this study is to investigate the role of specific physical activities and triggering events in the occurrence of nIPH and aSAH. Methods : We retrospectively reviewed 824 consecutive patients with spontaneous intracranial hemorrhage between January 2010 and December 2018. Among the 824 patients, 132 patients were excluded due to insufficient clinical data and other etiologies of spontaneous intracranial hemorrhage. The medical records of 692 patients were reviewed, and the following parameters were assessed : age, sex, history of hypertension, smoking, history of stroke, use of antiplatelet or anticoagulation agents, season and time of onset, physical activities performed according to the metabolic equivalents, and triggering event at onset. Events that suddenly raised the blood pressure such as sudden postural changes, defecation or urination, sexual intercourse, unexpected emotional stress, sauna bath, and medical examination were defined as triggering events. These clinical data were compared between the nIPH and aSAH groups. Results : Both nIPH and aSAH most commonly occurred during non-strenuous physical activity, and there was no significant difference between the two groups (p=0.524). Thirty-two patients (6.6%) in the nIPH group and 39 patients (8.1%) in the aSAH group experienced triggering events at onset, and there was a significant difference between the two groups (p=0.034). The most common triggering events were defecation or urination in both groups. Conclusion : Specific physical activity dose no affect the incidence of nIPH and aSAH. The relationship between the occurrence of intracranial hemorrhage and triggering events is higher in aSAH than nIPH.

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“…We identified only one retrospective case series of 16 ICH patients with various etiologies, investigating temporal relationship between ICH and sexual intercourse, with no case-crossover design or controls. [11] Optimally, the patient should be interviewed for triggers as soon as possible after the stroke to obtain reliable responses. The paucity of data in ICH perhaps originate indeed due to problems in obtaining information from the patients with ICH, as they often have reduced level of consciousness, have communication barriers, and may have poor memory around the time of ICH.…”

Section: Introductionmentioning

confidence: 99%

Triggering factors in non-traumatic intracerebral hemorrhage

Sallinen

Putaala

Strbian

2020

Journal of Stroke and Cerebrovascular Diseases

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Background: In ischemic stroke and subarachnoid hemorrhage, there are known preceding triggering events that predispose to the stroke by, for example, abruptly raising blood pressure. We explored, whether triggering events can be identified in nontraumatic intracerebral hemorrhage (ICH). Methods:We used structured questionnaires to interview consented patients with ICH treated in a tertiary teaching hospital, between 2014-2016. We asked of possible trigger factors, including Valsalva-inducing activity, heavy physical exertion, sexual activity, abrupt change in position, a heavy meal, a sudden change in temperature, exposure to traffic jam, and the combination of the first three (any physical trigger) during the hazard period of 0-2 hours prior to ICH. The ratio of the reported trigger during the hazard period was compared to the same 2-hour period the previous day (control period) to calculate the relative risks for each factor (case-crossover design).Results: Of our 216 consented ICH patients, 97 (35.0%) could be interviewed for trigger questions. Reasons for not able to provide consistent and reliable responses included lowered level of consciousness, delirium, impaired memory, and aphasia. None of the studied possible triggers alone were more frequent during the hazard period compared to the control period. However, when all physical triggers were combined, we found an association with the triggering event and onset of ICH (risk ratio 1.32, 95% confidence interval 1.01-1.73). 2Conclusions: Obtaining reliable information on the preceding events before ICH onset was challenging. However, we found that physical triggers as a group were associated with the onset of ICH.

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Sexual activity as a trigger for intracranial hemorrhage

Abstract: Sexual-activity-related ICH is rare and includes various etiologies. The human sexual response in associated with dramatic increases in arterial blood pressure, which likely underlies the association.

Cited by 6 publications

References 40 publications

Trigger Factors for Stroke in Young Adults

Trigger Factors for Stroke in Young Adults

Influence of Triggering Events on the Occurrence of Spontaneous Intracranial Hemorrhage : Comparison of Non-Lesional Spontaneous Intraparenchymal Hemorrhage and Aneurysmal Subarachnoid Hemorrhage

Triggering factors in non-traumatic intracerebral hemorrhage

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