title: Sexual activity as a trigger for intracranial hemorrhage.
abstract: BACKGROUND
  Intracranial hemorrhage (ICH) has been reported in association with sexual activity. A case-series of patients with ICH following sexual activity is presented to further elucidate the role of the physiologic sexual response as a trigger of ICH.
  
  
  METHODS
  A retrospective review of the medical record was performed, identifying patients presenting with ICH temporally related to sexual activity. Clinical and radiographic data were collected and reported.
  
  
  RESULTS
  Sixteen patients presented with non-traumatic ICH temporally related to sexual activity. Eight (50 %) patients presented with aneurysmal subarachnoid hemorrhage, four (25 %) with angiogram-negative subarachnoid hemorrhage, two (12.5 %) with a ruptured arteriovenous malformation, and two (12.5 %) with an intracerebral basal ganglia hemorrhage. Overall average age was 49.9 (range, 28-74) years. Sexual activity involved male-female intercourse in 14 (87.5 %) patients and masturbation in 2 (12.5 %) patients.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, 510 20th Street South, FOT 1005, Birmingham, AL, 35294, USA. pforeman03@gmail.com.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Foreman
authors.affiliation: Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Magdy H
authors.initials: MH
authors.lastname: Selim
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: David Eric C
authors.initials: DE
authors.lastname: Searls
authors.affiliation: Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Safdar
authors.affiliation: Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Ekkehard M
authors.initials: EM
authors.lastname: Kasper
authors.affiliation: Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.affiliation: Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Ajith J
authors.initials: AJ
authors.lastname: Thomas
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012725:Sexual Behavior
keywords: Coitus; Hemorrhage; Sex; Sexual activity; Stroke