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Stroke After Sex

Woman, 35, Suffers Rare Orgasm-Related Stroke
By
WebMD Health News
Reviewed by Louise Chang, MD

Sept. 15, 2008 -- Sex triggered a life-threatening stroke in a healthy 35-year-old Illinois woman, her doctors report.

Sex- and orgasm-triggered strokes in relatively young women and men are rare, but not unheard of. They require a combination of factors and events not unusual in themselves, but which are highly unlikely to occur at the same time.

The 35-year-old woman's symptoms were typical of this unusual kind of "cryptogenic" stroke, says Jose Biller, MD, professor and chair of the neurology department at Loyola University, Chicago.

"This young woman ... while having intercourse had numbness on the left side of her face, slurred speech, and weakness in her left arm," Biller tells WebMD. "When she was transferred to our care six hours after onset, she was completely unable to move her left arm, her face was paralyzed, her speech was garbled, and she was in a state of panic."

It was too late to inject the woman with the clot-busting drug tPA, which must be given within three hours of a stroke. So Biller's team quickly ran a catheter from an artery in the woman's groin up into her brain to find the blood clot by angiography. Once it was found, they had only one option: to apply tPA directly to the clot.

It was a risky decision. "We did this with a lot of sweat," Biller says.

The woman's symptoms began to improve almost immediately; within an hour she was out of the woods and within 12 hours the symptoms were almost gone. Today she is well, with only an almost imperceptible fold in the skin under her nose and slight loss of dexterity in her left hand.

Stroke From Sex

Why did sex trigger this young woman's stroke? She shared one thing in common with six other young people who suffered sex-related strokes: a small opening in the wall between the two upper chambers of her heart.

One in four adults has this minor heart defect, called a patent foramen ovale or PFO. A PFO allows some blood to flow from the right side of the heart to the left side. This blood bypasses the lung and goes straight to the brain.

Most people with a PFO have no symptoms and don't know they have it. But 40% of people who suffer a cryptogenic stroke -- stroke of no known cause -- have a PFO.

Blood flow through a PFO increases when a person strains, such as bearing down during a bowel movement or breathing out with the mouth closed and nostrils pinched shut.

It also happens during sex, particularly during orgasm, says Brett L. Cucchiara, MD, director of the Penn Stroke Center at the University of Pennsylvania. Cucchiara was not involved in the Biller report, but studied two cases of sex-related stroke in 2006.

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