A woman was rushed to hospital in an ambulance after her partner noticed she had become unresponsive for several minutes. By the time the 44-year-old arrived in hospital, she was fully conscious and her vital signs had returned to normal.
She was suffering from a moderate headache, rating it 6 out of 10 on the pain scale. Initially, her doctors believed she had suffered a seizure, given her symptoms and the fact her cognitive function had returned to normal. Other than occasional drinking, mild asthma, and a smoking habit, she had been healthy and had no significant medical problems prior to her hospitalization.
Upon further inspection, the doctors came to believe she had suffered a reflex-mediated syncope (a blackout caused by a sudden lack of blood supply to the brain) related to sexual activity.
"On closer history taking, the patient reported nearing orgasm while receiving oral sex from her partner before losing consciousness," the authors write in BMJ Case Reports. Her partner reported that during the episode her body became stiff and she lost consciousness for 2-3 minutes.
The team believed that she may have suffered an intracerebral hemorrhage, given her ongoing headache, and proceeded to give her a CT scan, followed by a CT angiography, which showed she had a right-sided 7-millimeter anterior communicating artery aneurysm (a bulge in the artery). This aneurysm had led to a subarachnoid hemorrhage, which is a kind of stroke.
The team note that changes in blood pressure during sex can be a factor in the onset of a stroke.
"Activities that involve sudden increases in blood pressure and sexual activity is well described as a precipitant," they write in the case report. "Studies with intra-arterial monitoring during coitus demonstrate that during sexual activity blood pressure, as well as heart rate, is very labile, with particular rises during orgasm."
However, they say that this case is slightly different, in that it involved oral rather than penetrative sex.
The patient recovered following endovascular coiling of the aneurysm (where clotting is promoted to prevent blood from entering the aneurysm) and there was no further bleeding. Upon discharge, she had no neurological deficits.
The authors, led by Dr Jonathan Holmes of West Middlesex University Hospital, UK, reported that four months after discharge the patient remains well.
