Sildenafil-induced spinal cord infarction: A case report

Sildenafil-induced spinal cord infarction: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sildenafil-induced spinal cord infarction: A case report Mohsen Gholami, Maryam Fard, Maryam Poursadeghfard This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3963489/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 May, 2024 Read the published version in Acta Neurologica Belgica → Version 1 posted You are reading this latest preprint version Abstract Spinal cord infarction is a rare condition, accounting for only a small percentage of strokes. It can be classified into cervical and thoracolumbar infarctions, with various factors contributing to its occurrence. Sildenafil, a phosphodiesterase type 5 inhibitor commonly used for erectile dysfunction, has been associated with cardiovascular side effects, including transient hypotension. In this case report, we present the unusual occurrence of spinal cord infarction in a 65-year-old man who had self-administered high doses of sildenafil without a doctor's prescription. The patient experienced severe radicular pain in the lumbar region and subsequent weakness in the lower limbs. Evaluation revealed an anterior spinal cord infarction in the thoracic region, confirmed by MRI imaging. After excluding other potential causes, it was concluded that the intake of sildenafil likely led to systemic hypotension, resulting in spinal cord infarction. This case highlights the importance of considering sildenafil as a possible contributor to spinal cord infarction, particularly when used at high doses. Further studies are needed to better understand the relationship between sildenafil and vascular complications, including spinal cord infarction. Sildenafil Spinal cord infarction Figures Figure 1 Introduction Spinal cord infarction, which is not common and constitutes 0.3-1% of strokes, is specifically classified into two categories: Cervical & Thoracolumbar. Various factors can cause spinal cord infarction, including Atherosclerosis, Arterial Occlusion, Fibrocartilaginous Embolism, surgery, and Cervical Herniation of the spinal cord ( 1 ). Vascular and Venous abnormalities, Aortic Dissection and Aortic Aneurysm, Cardiac Arrest, and Cryptogenic Transient Ischemic Attack are also relatively common causes of spinal cord infarction ( 2 ). Sildenafil is an inhibitor of cGMP-specific phosphodiesterase type 5 that hinders the hydrolysis of cGMP in the Corpora Cavernosa, thereby increasing the level of cGMP during sexual stimulation. This increased level of cGMP then causes vasodilation of the smooth muscles ( 3 – 4 ). The reported cardiovascular side effects of Sildenafil Citrate are usually minor. The Vasodilation mechanism leads to a minimal decrease in systolic and diastolic blood pressure ( 3 – 8 ). Sildenafil usually causes a transient decrease of 5 to 6 mm/Hg in diastolic blood pressure and a decrease of 8 to 10 mm/Hg in Systolic Blood Pressure. This temporary hypotension usually returns to the normal baseline after 4 hours. In some patients, after taking sildenafil, symptoms such as Ischemic Optic Neuritis, Transient Ischemic attacks, and Transient Global Amnesia have been reported. In addition to Convulsions, Subarachnoid and Intracerebral hemorrhage have been noted after taking these pills ( 9 – 10 ). This is a rare report of a patient with spinal cord infarction after high dose administration of sildenafil citrate (Viagra). Case presentation The patient is a 65-year-old man without any specific disease who had started taking Sildenafil tablets (100 mg) every 8 hours for 2 weeks before admission without a doctor’s prescription. Since the morning before the admission, the patient has experienced severe radicular pain in the Lumbar region which was associated with weakness of the lower limbs after about an hour. Upon admission to the hospital, the muscle strength of the Upper Limbs was 5/5 and in the Lower Limbs was 3/5. The Deep Tendon Reflexes were reduced by 1/2 and the Plantar Reflex was absent. He also complained of Urinary Retention. The patient had no history of recent vaccination or febrile illness in the past few months. He also had no family history of having special diseases or taking drugs or alcohol. In the examination, the patient had sensory level in T8 region and a normal sense of position and vibration. The initial laboratory evaluations including CBC, ESR, CRP, Electrocytes, Viral markers, Vasculitis and NMO were normal. No Aortic Dissection was observed in chest CT Angiography, and the patient had no heart problems too. MRI imaging of Cervical and Thoracic Spine with DWI showed abnormal increase signal intensity in the Anterior spinal cord beginning from T8 and extending to L1 that these findings were consistent with Acute Cord infarction (Fig. 1). Discussion Cervical spinal cord infarction is very rare due to the rich anastomotic arterial network ( 3 – 4 ). In the Upper Cervical Spine, the Cord blood is supplied by the Vertebral Arteries and Posterior Inferior Cerebellar Arteries ( 5 – 6 ). The Thoracic region, having a lower blood supply than the Cervical and Lumbar regions, is more susceptible to Ischemia due to a decrease in Blood Pressure ( 7 ). After eliminating other causes as the source of the patient’s spinal cord infarction ( 8 – 9 ), we concluded that the patient’s symptoms are likely due to the intake of Sildenafil Citrate tablets. This drug has probably led to systemic Hypotension. Hypotension is the main cause of spinal cord infarction in the Cervical, Upper and Lower Thoracic regions ( 10 – 14 ). Conclusion The intake of Sildenafil can potentially cause Hypotension, leading to Ischemia in various tissues such as the Brain and optic nerve. The main possibility is that taking Sildenafil, especially at high doses, may significantly cause spinal cord infarction. However, it is generally recommended to conduct further studies in this field. Declarations Originality: This manuscript is an original work that has not been published or submitted elsewhere. Authorship: All authors have made substantial contributions to the conception, design, acquisition, analysis, or interpretation of data for the work. All authors have drafted or revised the work critically for important intellectual content. All authors have approved the final version of the manuscript and agree to be accountable for all aspects of the work. The Signs are NOT APPLICABLE Ethics: This work has been conducted in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013. Informed consent was obtained from the patient for the publication of this case report and any accompanying images. (IR.SUMS.MED.REC.1402.469) Competing interests: The authors declare that the competing interests do not compromise the scientific rigor or ethical standards of the research or its findings. The authors have read and adhered to the journal's policy on competing interests. The Signs are NOT APPLICABLE Funding: This research was funded by Shiraz University of Medical Sciences [grant number is NOT APPLICABLE]. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Author’s contribution: Mohsen Gholami and Maryam Poursadeghfard conceived and designed the study, M. Gholami followed the patient and was the first person who examined him and prescribed. Maryam Fard wrote and revised the manuscript. Maryam Poursadgfard provided ethical guidance and supervised the study and contributed to the data interpretation. All authors read and approved the final manuscript. References Masson, C. Pruvo, JP. Meder, JF. Spinal cord infarction: clinical and magnetic resonance imaging findings and short-term outcome. Journal of Neurology 2004. Millichap, JJ. Sy, BT. Leacock, RO. Spinal cord infarction with multiple etiologic factors. J Gen Intern Med 2007. Cheitlin, MD. Hutter, AM Jr. Brindis, RG. Use of sildenafil (Viagra) in patients with cardiovascular disease: Technology and Practice Executive Committee. Circulation 1999. Holt, A. Blanche, P. Jensen, AKG. Adverse events associated with coprescription of phosphodiesterase type 5 inhibitors and oral organic nitrates in male patients with ischemic heart disease: a case … acpjournals 2022. Kuker, W. Weller, M. Klose, U. Diffusion-weighted MRI of spinal cord infarction: high-resolution imaging and time course of diffusion abnormality. J Neurology 2004. Vuong, SM. Jeong, WJ. Morales, H. Vascular diseases of the spinal cord: infarction, hemorrhage, and venous congestive myelopathy. Seminars in Ultrasound, CT 2016. Kim, MS. Developmental anomalies of the distal vertebral artery and posterior inferior cerebellar artery: diagnosis by CT angiography and literature review. Surgical and Radiologic Anatomy 2016. Farooq, MU. Naravetla, B. Moore, PW. Role of sildenafil in neurological disorders. Clin Neuropharmacology 2008. Wang, CX. Cironi, K. Mathkour, M. Anatomical study of the posterior spinal artery branches to the medulla oblongata. World Neurosurgery 2021. Egan, RA. Pomeranz, H. Transient ischemic attack and stroke associated with sildenafil (Viagra) use. Neurology 2002 Morgan, JC. Alhatou, M. Oberlies, J. Transient ischemic attack and stroke associated with sildenafil (Viagra) use. Neurology 2001. Martirosyan, NL. Feuerstein, JS. Theodore, N. Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions: A review. J of Neurosurgery: Spine 2011. Walden, JE. Castillo, M. Sildenafil-induced cervical spinal cord infarction. American Journal of Neuroradiology 2012. Savitz, SA. Caplan, LR. Transient global amnesia after sildenafil (Viagra) use. Neurology 2002. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 May, 2024 Read the published version in Acta Neurologica Belgica → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3963489","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":273851546,"identity":"f66a0465-638f-4c1b-83b6-9ce6cc7ddfa9","order_by":0,"name":"Mohsen Gholami","email":"","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohsen","middleName":"","lastName":"Gholami","suffix":""},{"id":273851547,"identity":"fd5c65f4-84a0-4406-96ad-7135ddd6a5d9","order_by":1,"name":"Maryam Fard","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Fard","suffix":""},{"id":273851548,"identity":"92323811-cffc-49bd-b05b-ea862f904852","order_by":2,"name":"Maryam Poursadeghfard","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYPACZgYG9gYgbWBBihaeAyAtEqRokUgAMYjQYs7eY/bxR411Pv/M51c3/CiQYOBv707Aq8Wy54zxbJ5j6ZYzbueU3ewBOkzizNkNeLUY3MgxZmZgO2zAcDsn7QYPUIuBRC5hLYw//h02kL95Ju3mH2K1MPC2HTYwuMF+7DZRtlj2HCtm5u1LNzA8k8N2W8ZAgoegX8zZmzcz/vhmbSB3/Pizm2/+2Mjxt/cScBiCyQNm8+BVjqaF/QFB1aNgFIyCUTAyAQDw7kTUF527swAAAABJRU5ErkJggg==","orcid":"","institution":"Shiraz University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Poursadeghfard","suffix":""}],"badges":[],"createdAt":"2024-02-17 08:16:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3963489/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3963489/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s13760-024-02573-2","type":"published","date":"2024-05-18T02:46:35+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":51450221,"identity":"d1cd6c8a-866e-4b44-8fac-f4cdee29e68d","added_by":"auto","created_at":"2024-02-21 20:21:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":271351,"visible":true,"origin":"","legend":"\u003cp\u003e(A): Midsagittal T2 STIR image shows high signal intensity (arrow) in the lower of the Thoracic spinal cord predominantly in its anterior aspect. (B): Axial DWI shows high signal intensity (arrow) in the spinal cord, which corresponds to low signal intensity (arrow) in the same location on the apparent diffusion coefficient (ADC) map.\u003c/p\u003e","description":"","filename":"F1.png","url":"https://assets-eu.researchsquare.com/files/rs-3963489/v1/7221a2d88c95db08d2e0ea55.png"},{"id":60954365,"identity":"9c7627af-6d33-4b3b-92c9-3eebe20177da","added_by":"auto","created_at":"2024-07-24 02:46:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":448523,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3963489/v1/2252e9b7-1f9b-4f3e-ad71-34b95d13f2f0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sildenafil-induced spinal cord infarction: A case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSpinal cord infarction, which is not common and constitutes 0.3-1% of strokes, is specifically classified into two categories: Cervical \u0026amp; Thoracolumbar. Various factors can cause spinal cord infarction, including Atherosclerosis, Arterial Occlusion, Fibrocartilaginous Embolism, surgery, and Cervical Herniation of the spinal cord (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Vascular and Venous abnormalities, Aortic Dissection and Aortic Aneurysm, Cardiac Arrest, and Cryptogenic Transient Ischemic Attack are also relatively common causes of spinal cord infarction (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSildenafil is an inhibitor of cGMP-specific phosphodiesterase type 5 that hinders the hydrolysis of cGMP in the Corpora Cavernosa, thereby increasing the level of cGMP during sexual stimulation. This increased level of cGMP then causes vasodilation of the smooth muscles (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe reported cardiovascular side effects of Sildenafil Citrate are usually minor. The Vasodilation mechanism leads to a minimal decrease in systolic and diastolic blood pressure (\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Sildenafil usually causes a transient decrease of 5 to 6 mm/Hg in diastolic blood pressure and a decrease of 8 to 10 mm/Hg in Systolic Blood Pressure. This temporary hypotension usually returns to the normal baseline after 4 hours. In some patients, after taking sildenafil, symptoms such as Ischemic Optic Neuritis, Transient Ischemic attacks, and Transient Global Amnesia have been reported. In addition to Convulsions, Subarachnoid and Intracerebral hemorrhage have been noted after taking these pills (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis is a rare report of a patient with spinal cord infarction after high dose administration of sildenafil citrate (Viagra).\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eThe patient is a 65-year-old man without any specific disease who had started taking Sildenafil tablets (100 mg) every 8 hours for 2 weeks before admission without a doctor\u0026rsquo;s prescription. Since the morning before the admission, the patient has experienced severe radicular pain in the Lumbar region which was associated with weakness of the lower limbs after about an hour.\u003c/p\u003e \u003cp\u003eUpon admission to the hospital, the muscle strength of the Upper Limbs was 5/5 and in the Lower Limbs was 3/5. The Deep Tendon Reflexes were reduced by 1/2 and the Plantar Reflex was absent. He also complained of Urinary Retention. The patient had no history of recent vaccination or febrile illness in the past few months. He also had no family history of having special diseases or taking drugs or alcohol.\u003c/p\u003e \u003cp\u003eIn the examination, the patient had sensory level in T8 region and a normal sense of position and vibration. The initial laboratory evaluations including CBC, ESR, CRP, Electrocytes, Viral markers, Vasculitis and NMO were normal. No Aortic Dissection was observed in chest CT Angiography, and the patient had no heart problems too. MRI imaging of Cervical and Thoracic Spine with DWI showed abnormal increase signal intensity in the Anterior spinal cord beginning from T8 and extending to L1 that these findings were consistent with Acute Cord infarction (Fig.\u0026nbsp;1).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCervical spinal cord infarction is very rare due to the rich anastomotic arterial network (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In the Upper Cervical Spine, the Cord blood is supplied by the Vertebral Arteries and Posterior Inferior Cerebellar Arteries (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The Thoracic region, having a lower blood supply than the Cervical and Lumbar regions, is more susceptible to Ischemia due to a decrease in Blood Pressure (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). After eliminating other causes as the source of the patient\u0026rsquo;s spinal cord infarction (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), we concluded that the patient\u0026rsquo;s symptoms are likely due to the intake of Sildenafil Citrate tablets. This drug has probably led to systemic Hypotension. Hypotension is the main cause of spinal cord infarction in the Cervical, Upper and Lower Thoracic regions (\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe intake of Sildenafil can potentially cause Hypotension, leading to Ischemia in various tissues such as the Brain and optic nerve. The main possibility is that taking Sildenafil, especially at high doses, may significantly cause spinal cord infarction. However, it is generally recommended to conduct further studies in this field.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eOriginality:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This manuscript is an original work that has not been published or submitted elsewhere.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthorship:\u003c/u\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors have made substantial contributions to the conception, design, acquisition, analysis, or interpretation of data for the work. All authors have drafted or revised the work critically for important intellectual content. All authors have approved the final version of the manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eThe Signs are NOT APPLICABLE\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eEthics:\u003c/u\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis work has been conducted in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013. Informed consent was obtained from the patient for the publication of this case report and any accompanying images. (IR.SUMS.MED.REC.1402.469)\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests:\u003c/u\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare that the competing interests do not compromise the scientific rigor or ethical standards of the research or its findings. The authors have read and adhered to the journal\u0026apos;s policy on competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eThe Signs are NOT APPLICABLE\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding:\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by Shiraz University of Medical Sciences [grant number is NOT APPLICABLE]. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthor\u0026rsquo;s contribution:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eMohsen Gholami and Maryam Poursadeghfard conceived and designed the study, M. Gholami followed the patient and was the first person who examined him and prescribed. Maryam Fard wrote and revised the manuscript. Maryam Poursadgfard provided ethical guidance and supervised the study and contributed to the data interpretation. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMasson, C. Pruvo, JP. Meder, JF. Spinal cord infarction: clinical and magnetic resonance imaging findings and short-term outcome. Journal of Neurology 2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMillichap, JJ. Sy, BT. Leacock, RO. Spinal cord infarction with multiple etiologic factors. J Gen Intern Med 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheitlin, MD. Hutter, AM Jr. Brindis, RG. Use of sildenafil (Viagra) in patients with cardiovascular disease: Technology and Practice Executive Committee. Circulation 1999.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolt, A. Blanche, P. Jensen, AKG. Adverse events associated with coprescription of phosphodiesterase type 5 inhibitors and oral organic nitrates in male patients with ischemic heart disease: a case \u0026hellip; acpjournals 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuker, W. Weller, M. Klose, U. Diffusion-weighted MRI of spinal cord infarction: high-resolution imaging and time course of diffusion abnormality. J Neurology 2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVuong, SM. Jeong, WJ. Morales, H. Vascular diseases of the spinal cord: infarction, hemorrhage, and venous congestive myelopathy. Seminars in Ultrasound, CT 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim, MS. Developmental anomalies of the distal vertebral artery and posterior inferior cerebellar artery: diagnosis by CT angiography and literature review. Surgical and Radiologic Anatomy 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarooq, MU. Naravetla, B. Moore, PW. Role of sildenafil in neurological disorders. Clin Neuropharmacology 2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, CX. Cironi, K. Mathkour, M. Anatomical study of the posterior spinal artery branches to the medulla oblongata. World Neurosurgery 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEgan, RA. Pomeranz, H. Transient ischemic attack and stroke associated with sildenafil (Viagra) use. Neurology 2002\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan, JC. Alhatou, M. Oberlies, J. Transient ischemic attack and stroke associated with sildenafil (Viagra) use. \u003cem\u003eNeurology\u003c/em\u003e 2001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartirosyan, NL. Feuerstein, JS. Theodore, N. Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions: A review. J of Neurosurgery: Spine 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalden, JE. Castillo, M. Sildenafil-induced cervical spinal cord infarction. American Journal of Neuroradiology 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavitz, SA. Caplan, LR. Transient global amnesia after sildenafil (Viagra) use. \u003cem\u003eNeurology\u003c/em\u003e 2002.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sildenafil, Spinal cord, infarction","lastPublishedDoi":"10.21203/rs.3.rs-3963489/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3963489/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSpinal cord infarction is a rare condition, accounting for only a small percentage of strokes. It can be classified into cervical and thoracolumbar infarctions, with various factors contributing to its occurrence. Sildenafil, a phosphodiesterase type 5 inhibitor commonly used for erectile dysfunction, has been associated with cardiovascular side effects, including transient hypotension. In this case report, we present the unusual occurrence of spinal cord infarction in a 65-year-old man who had self-administered high doses of sildenafil without a doctor's prescription. The patient experienced severe radicular pain in the lumbar region and subsequent weakness in the lower limbs. Evaluation revealed an anterior spinal cord infarction in the thoracic region, confirmed by MRI imaging. After excluding other potential causes, it was concluded that the intake of sildenafil likely led to systemic hypotension, resulting in spinal cord infarction. This case highlights the importance of considering sildenafil as a possible contributor to spinal cord infarction, particularly when used at high doses. Further studies are needed to better understand the relationship between sildenafil and vascular complications, including spinal cord infarction.\u003c/p\u003e","manuscriptTitle":"Sildenafil-induced spinal cord infarction: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-21 20:21:30","doi":"10.21203/rs.3.rs-3963489/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a2cb3f78-ca35-4aa0-bc52-0278b5d2e9c0","owner":[],"postedDate":"February 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-24T02:46:35+00:00","versionOfRecord":{"articleIdentity":"rs-3963489","link":"https://doi.org/10.1007/s13760-024-02573-2","journal":{"identity":"acta-neurologica-belgica","isVorOnly":false,"title":"Acta Neurologica Belgica"},"publishedOn":"2024-05-18 02:46:35","publishedOnDateReadable":"May 18th, 2024"},"versionCreatedAt":"2024-02-21 20:21:30","video":"","vorDoi":"10.1007/s13760-024-02573-2","vorDoiUrl":"https://doi.org/10.1007/s13760-024-02573-2","workflowStages":[]},"version":"v1","identity":"rs-3963489","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3963489","identity":"rs-3963489","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}