Stroke After Sex

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.

"In one of the cases we presented, it is a little embarrassing, one
woman had stroke onset coincident with orgasm and having this sort of
spontaneous guttural utterance or moan," Cucchiara tells WebMD.

But just having a PFO isn't enough to cause a stroke. A person also must
have a blood clot, and that blood clot must break loose and enter the heart
just in time to be sucked through the PFO during sex.

Normally a small blood clot would simply get stuck in the lungs and
dissolve. But a blood clot that passes through a PFO can lodge in the brain and
cause a stroke.

Biller's team did indeed find that their patient had a small blood clot in
her leg, probably as a side effect of the oral contraceptives she used for birth control .

"This is a rare occurrence," Biller stresses.

"The vast, vast, vast majority of people with PFOs go through life and
never have any problems," Cucchiara says. "You have to keep this risk
of stroke during sex in perspective. The risk is very low.

"If you develop sudden neurological symptoms during sex, it could be a
stroke and you need to seek help urgently and go to the emergency room,"
Cucchiara says. "But you should not spend a lot of time worrying about
this. Even if you have a PFO, of all the things to worr about in life, this
ranks near the bottom in risk."

There are devices available for closing PFOs. But Biller and Cucchiara both
note that doctors currently don't recommend this procedure -- even for most
people who have already suffered a stroke.

That recommendation didn't convince Biller's young patient.

"She was scared to death, and she and her boyfriend and family were
pushing us very hard to close the defect, so that is what we did," Biller
says. "So she had the device implanted to close the PFO."

Biller's report appears in the September issue of the Journal of Stroke
and Cerebrovascular Diseases.

By Daniel DeNoon
Reviewed by Louise Chang
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