sildenafil-citrate and Cerebral-Infarction

Sildenafil citrate (Viagra®) is used to treat male erectile dysfunction; however, little is known about the effects of sildenafil overdose and intoxication. We report a patient who presented with cerebral infarction and rhabdomyolysis after intentional sildenafil intoxication.. A 61-year-old man visited the Emergency Department complaining of dysarthria about 1 h after taking more than 30 sildenafil tablets with the intention to commit suicide. Dysarthria and dizziness were observed, but there were no other neurological symptoms. The creatine kinase level was elevated to 3118 U/L, and the patient was diagnosed with rhabdomyolysis. Brain magnetic resonance imaging revealed multiple scattered acute cerebral infarctions in both midbrain artery branches. At 4 h post-intoxication, the dysarthria had improved and we initiated dual antiplatelet therapy for cerebral infarction. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be able to anticipate and treat complications like cerebral infarction and rhabdomyolysis after sildenafil intoxication.

Topics: Cerebral Infarction; Dysarthria; Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Purines; Rhabdomyolysis; Sildenafil Citrate

We present a 49-year-old male who suffered a cerebellar infarction due to a vertebral artery dissection. The patient had taken sildenafil daily for at least 2 years for sexual enhancement. There was no sexual intercourse or traumatic event prior to symptom onset. Sildenafil intake has been associated with aortic dissection and, in the light of this report, we suggest that chronic sildenafil intake could be a risk factor for arterial dissection.

Topics: Anticoagulants; Cerebral Infarction; Clopidogrel; Heparin; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Piperazines; Platelet Aggregation Inhibitors; Purines; Sildenafil Citrate; Sulfones; Ticlopidine; Treatment Outcome; Ultrasonography; Vasodilator Agents; Vertebral Artery Dissection

A 65-year-old man had an embolic stroke of both posterior cerebral arteries in 2002. Two years later he noted rapid improvement of the residual bilateral inferior quadrant anopia whenever he took 25 mg sildenafil. The improvement of scotomas was verified by visual field examinations and persisted reproducibly for 3-7 days. An overlay of a subtraction of functional magnetic resonance imaging (MRI) during visual stimulation before and after medication onto a T1-weighted MRI of the patient revealed additional activations along the margins of the old cerebral infarctions. These findings and the additional results of a perfusion MRI suggest that phosphodiesterase 5 inhibitors may prove beneficial in the rehabilitative course after ischemic strokes.

Topics: Aged; Cerebral Infarction; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Scotoma; Sildenafil Citrate; Sulfones

Topics: Aged; Cerebral Infarction; Erectile Dysfunction; Humans; Male; Piperazines; Purines; Sensation Disorders; Sildenafil Citrate; Sulfones; Thalamic Nuclei; Vasodilator Agents