Sildenafil interaction

Abstract

Middle cerebral artery infarction: case report A 57-year-old man developed middle cerebral artery infarction following concomitant administration of sildenafil and alcohol use [indication not stated]. The man presented to the emergency department due to dropping of mouth, speech disorder and inability to recognize his relatives for two days. He had a history of smoking 15 packs/year and rare alcohol consumption. Two days before the presentation, he had received two tablets of sildenafil [Viagra; route and dosage not stated] with alcohol. Initially, his relatives thought the illconsciousness was due to alcohol consumption. Thus, he was not brought to the hospital on the first day. However, his consciousness did not improve. Hence, he was brought to the emergency department. His physical examination showed lethargy, his pupils were anisochoric and left eye myosis. He had sensory and motor aphasia. He also had right-sided haemiplegia. A cranial tomography demonstrated a marked loss of density in the left temporoparietal lobe. His brain MRI showed diffusion limitation in the middle cerebral artery supply area, suggestive of acute infarction. Further imaging study showed an increase in the signal area and plaque in the left common carotid artery distal segment led to 50% stenosis. The left-sided internal carotid artery was found occluded and the plaque was noted at the right internal carotid artery proximal causing critical stenosis. The retrograde filling was noted in the left-sided internal carotid artery. The man started receiving enoxaparin sodium [Clexane], clopidogrel [Plavix] and aspirin. Subsequently, he underwent evaluations that showed normal creatine kinase (CK), CK-myocardial band (MB) levels and normal sinus rhythm without valve pathology. Six days later, his MRI showed acute diffusion restriction on the left-side frontal lobe and parietal lobe along with the middle cerebral artery supply area that impacting the medial segment of his temporal lobe of the brain. He had persistent motor weakness of around 15 days and motor aphasia. No improvement in his right hemiplegia was observed, and his blood pressure remained between 120/80 and 140/90mm Hg. It was concluded that the middle cerebral artery infarction was secondary to drug-alcohol interaction following concomitant administration of sildenafil and alcohol use [duration of treatment to reaction onset not stated].