Valsalva maneuver-induced priapism: a hidden culprit.
BACKGROUND
Priapism is defined as an abnormal prolonged penile erection without sexual interest and failure to subside despite orgasm. The disorder is enigmatic yet devastating because of its elusive etiology, irreversible erectile tissue damage, and resultant erectile dysfunction. A wide variety of provocative factors have been implicated in different types of priapism; however, myelopathy-related ischemic priapism induced by the Valsalva maneuver in the context of spinal extradural arachnoid cyst has never been described.


OBJECTIVE
To report a case with spinal extradural arachnoid cyst heralded by Valsalva maneuver-induced priapism and review the mechanistic basis for acute myelopathy-related priapism.


METHODS
The case report profiled a 42-year-old Chinese man presenting with ischemic priapism following in-flight Valsalva maneuver for unblocking the ears during descent. Magnetic resonance imaging unveiled the hidden culprit behind myelopathy-related priapism, as demonstrated by acute spinal cord compression from a giant extradural arachnoid cyst.


RESULTS
The symptoms subsided rapidly after treatment with ice packing, analgesics, and corporal irrigation with diluted epinephrine. However, surgical removal of the extradural arachnoid cyst failed to achieve a complete recovery of neurological deficits. After 1 year of follow-ups, he still experienced a mild weakness and hypesthesia of the right leg but no further episodes of priapism or sexual dysfunction.


CONCLUSIONS
Myelopathy-related priapism potentiated by the Valsalva maneuver can be easily overlooked without heightened vigilance, leading to poor therapeutic response and prognosis. The indolent nature of spinal extradural arachnoid cyst should be reinforced and better outcomes can only be achieved through expeditious diagnosis and management.
Chen
Wei-Liang
WL
Department of Emergency Medicine, Taipei, Taiwan.
Tsai
Wei-Chi
WC
Department of Neurorehabilitation, Taipei, Taiwan.
Tsao
Yu-Tzu
YT
Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: tsaoyutzu@gmail.com.
D000328:Adult; D044466:Asian People; D006801:Humans; D007511:Ischemia / Q000503:physiopathology*; D008297:Male; D010413:Penis / Q000098:blood supply* / Q000503:physiopathology*; D011317:Priapism / Q000209:etiology* / Q000503:physiopathology*; D013117:Spinal Cord Compression / Q000150:complications; D013118:Spinal Cord Diseases / Q000150:complications; D014636:Valsalva Maneuver