1524 | Intracerebral Hemorrhage after Sildenafl Citrate Use: An Incidental Association? Giyas Ayberk, 1 Mehmet Faik Ozveren, 1 Mesut Emre Yaman, 2 Hakan Tosun 1 Corresponding Author: Gıyas Ayberk, MD Department of Neurosurgery, Ataturk Training and Research Hospital, 06800 Bilkent, Ankara, Türkiye. Tel: +90 312 291 2525 Fax: +9 312 291 2705 E-mail: giyas67@hotmail.com Received March 2013 Accepted June 2013 1 Department of Neurosurgery, Ataturk Training and Research Hospital, 06800 Bilkent, Ankara, Türkiye. 2 Department of Neurosur- gery, Kecioren State Hospital, Ankara, Türkiye. Keywords: cerebral hemorrhage; disability evaluation; sildenafl; incidental fndings. INTRODUCTION T he most common causes of intracerebral hemorrhage (ICH) are structural vascular anomalies and dysfunctional coagulation. ICH caused by sildenafl is rarely reported in the literature. Sildenafl is a selective phosphodiesterase-5 (PDE-5) enzyme in- hibitor, and causes an increase in cyclic guanosine monophosphate (cGMP) in the vascular smooth muscle of the corpus cavernosum, leading to muscle relaxation and vasodilation. Sildenafl has same effects on intracranial vasculature by way of PDE-1 and 2 enzymes. Overdose of sildenafl or use over an extended period of time increases the likelihood of intracerebral hemorrhage. CASE REPORT A 35-year-old male was admitted to the emergency department in a disoriented state and with a serious headache. His wife reported that he had noticed a serious headache two hours after taking 50 mg of sildenafl without having sexual activity. He had used the drug for nearly a month, two to three times in a day without supervision of an urologist. He had no hyperten- sion, family history of cerebral arteriovenous malformation, cerebral aneurysms, or ICH. On CASE REPORT Case Report