Case report| Volume 74, P238-240, April 2020

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Basilar artery thrombosis during sexual intercourse

Published:January 22, 2020DOI:


      • A basilar artery thrombosis during sexual intercourse is very rare.
      • A right-to-left shunt was obtained by High-Intensity-Transient-Signals detection.
      • Sexual intercourse may be considered as a possible trigger of cerebral ischemia.


      An ischemic stroke during sexual intercourse is very rare. A basilar artery thrombosis during sexual intercourse has not been described previously. We report a young woman with a life-threatening basilar artery thrombosis during sexual intercourse, with a resulting locked-in syndrome. The positive high intensity transient signals (HITS) diagnosis showed a right-to-left shunt and is in line with paradoxic embolism. The molecular genetics revealed a homozygosity 4G/4G in the region PAI1, -675 (promoter polymorphism) as a risk factor for ischemic stroke. Sexual intercourse is a possible, albeit unusual stroke cause, especially in young people.


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        • Miller P.E.
        • Brown L.
        • Khandheria P.
        • et al.
        Ischemic stroke occurring during intercourse in young women on oral contraceptives.
        Am J Cardiol. 2014; 114: 491e493
        • Becker K.
        • Skalabrin E.
        • Hallam D.
        • et al.
        Ischemic stroke during sexual intercourse: a report of 4 cases in persons with patent foramen ovale.
        Arch Neurol. 2004; 61: 1114-1116
        • Pandian J.D.
        • Perel R.
        • Henderson R.D.
        • et al.
        Unusual triggers for stroke.
        J Clin Neurosci. 2007; 14: 786-787
        • Lee S.J.
        • Kim J.S.
        • Lee K.S.
        • et al.
        Coital transient ischaemic attacks.
        Eur J Neurol. 2008; 15: e101-e102
        • Velicu S.
        • Biller J.
        • Hacein-Bey L.
        • et al.
        Paradoxical embolism to the central nervous system after sexual intercourse in a young woman with a complex atrial septal abnormality.
        J Stroke Cerebrovasc Dis. 2008; 17: 320-324
        • Calabrò R.S.
        • Pezzini A.
        • Casella C.
        • et al.
        Ischaemic stroke provoked by sexual intercourse.
        J Clin Neurosci. 2013; 20: 1316-1317
        • Akhter M.S.
        • Biswas A.
        • Ranjan R.
        • et al.
        Plasminogen activator inhibitor-1 (PAI-1) gene 4G/5G promoter polymorphism is seen in higher frequency in the Indian patients with deep vein thrombosis.
        Clin Appl Thromb Hemost. 2010; 16: 184-188
        • Akhter M.S.
        • Biswas A.
        • Abdullah S.M.
        • et al.
        The role of PAI-1 4G/5G promoter polymorphism and its levels in the development of ischemic stroke in young Indian population.
        Clin Appl Thromb Hemost. 2017;
        • Sharma A.
        • Prasad K.
        • Padma M.V.
        • et al.
        Prevalence of triggering factors in acute stroke: hospital-based observational cross-sectional study.
        J Stroke Cerebrovasc Dis. 2015; 2: 337-347
        • Koton S.
        • Tanne D.
        • Bornstein N.M.
        • et al.
        Triggering risk factors for ischemic stroke: a case-crossover study.
        Neurology. 2004; 63: 2006-2010
        • Handke M.
        • Harloff A.
        • Bode C.
        • et al.
        Patent foramen ovale and cryptogenic stroke: a matter of age?.
        Semin Thromb Hemost. 2009; 35: 505-514
        • Khan A.R.
        • Bin Abdulhak A.A.
        • Sheikh M.A.
        • et al.
        Device closure of patient foramen ovale versus medical therapy in cryptogenic stroke: a systemic review and meta-analysis.
        JACC Cardiovasc Interv. 2013; 6: 1316e1323
        • Yeh Y.C.
        • Fuh J.L.
        • Chen S.P.
        • et al.
        Clinical features, imaging findings and outcomes of headache associated with sexual activity.
        Cephalalgia. 2010; 30: 1329-1335
        • Ebrahim S.
        • May M.
        • Shlomo Y.B.
        • et al.
        Sexual intercourse and risk of ischaemic stroke and coronary heart disease: the Caerphilly study.
        J Epidemiol Community Health. 2002; 56: 99-102