title: Multifocal and recurrent subarachnoid hemorrhage due to an herbal supplement containing natural coumarins.
abstract: BACKGROUND
  Over-the-counter herbal and alternative medicines are classified as dietary supplements and, unlike drugs, are not rigorously regulated by the United States Food and Drug Administration. Their potential adverse effects are often poorly characterized.
  
  
  METHODS
  Red clover, dong quai, and Siberian ginseng are herbal compounds used for treatment of perimenopausal symptoms such as hot flashes. These compounds are known to contain coumarins, and thus carry the potential for hemorrhagic complications; however, no cases of intracranial hemorrhage have been reported.
  
  
  CONCLUSIONS
  We report a 53-year-old woman with spontaneous subarachnoid hemorrhage due to the use of an herbal supplement containing red clover, dong quai, and Siberian ginseng.
authors.affiliation: Department of Surgery, Neuroscience and Experimental Therapeutics, Texas A and M Health Science Center College of Medicine, College Station, TX, USA. jafriedman@medicine.tamhsc.edu
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Friedman
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Taylor
authors.forename: Wayne
authors.initials: W
authors.lastname: McDermott
authors.forename: Puya
authors.initials: P
authors.lastname: Alikhani
mesh_terms: D029971:Angelica sinensis; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D028001:Eleutherococcus / Q000009:adverse effects*; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D008517:Phytotherapy / Q000009:adverse effects*; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D029921:Trifolium / Q000009:adverse effects*
chemical_list: D004365:Drugs, Chinese Herbal; C044613:angelicae sinensis extract