Transient global amnesia associated with sildenafil use: report of one case / Amnesia global transitoria asociada al uso de sildenafil: informe de un caso

ABSTRACT A 69 years old male with erectile dysfunction lasting 2 years, took 50 mg of sildenafil for having sex with his wife at about 6 o'clock in the morning. One hour later his wife detected that he had an anterograde memory impairment: this was interpreted as a confusional state. The neurological examination suggested a transient global amnesia (TGA). EEG and cerebral magnetic resonance imaging were non-informative and memory deficits resolved within 24 h. Therefore, a TGA was diagnosed. Since no other trigger was detectable, sildenafil was deemed responsible for its occurrence,

Se reporta el caso de un individuo de sexo masculino de 69 años con disfunción eréctil, que ingiere 50 mg de sildenafil con objetivo de facilitar el mantener relaciones sexuales con su esposa. Una hora después, su esposa nota que su marido presenta una alteración de su memoria anterógrada, lo que fue interpretado como un estado confusional. Evaluado clínicamente su examen neurológico es sugerente de una amnesia transitoria anterógrada. El EEG y las imágenes por resonancia magnética no muestran hallazgos significativos y el déficit de memoria remite dentro de 24 h. en vista de su evolución, se diagnostica una amnesia global transitoria. Como no se identifica otro gatillante, se consideró que el cuadro fue causado por sildenafil..

Trombosis venosa cerebral asociada a consumo de sildenafil / Cerebral venous thrombosis associated with sildenafil intake

Se presentó un paciente masculino de 59 años de edad, con antecedentes de hipertensión arterial y consumo regular de sildenafil, que ingresó en el servicio de ictus por presentar convulsión aguda y cefalea. Al examen físico se detectó hemiplejia izquierda. Mediante resonancia magnética nuclear de cráneo, con gadolinio se observó lesión expansiva que captó contraste de forma heterogénea. Se planteó el diagnóstico de posible glioma cerebral de alto grado. Se realizó craneotomía frontoparietal derecha y no se visualizó lesión tumoral. Después de descartar la presencia de un glioma de alto grado se valoró el diagnóstico de infarto venoso hemorrágico. Se efectuó angioTAC y estudio de trombofilia para descartar estados protrombóticos que justificaran dicha entidad nosológica. Los estudios de hematología especial se encontraron dentro de valores normales. Se concluyó el caso como una trombosis de senos venosos asociada al consumo de sildenafil(AU)

A 59 year-old male patient with a history of hypertension and regular consumption of sildenafil entered the service because of acute stroke and headache seizure. Physical examination detected left hemiplegia. By skull nuclear gadolinium magnetic resonance, an expansive lesion is observed which caught heterogeneously contrast. Possible diagnosis of high-grade brain glioma was raised. Right frontoparietal craniotomy was performed and a tumor lesion was not visualized. After ruling out the presence of high-grade glioma, the diagnosis of hemorrhagic venous infarction was assessed. CT angiography and clotting was made to rule out prothrombotic states to justify this disease entity. Special hematology studies were within normal values. The case was concluded as a venous sinus thrombosis associated with the use of sildenafil(AU)

Electroretinography and immunohistochemistry of retina in rabbits treated with sildenafil citrate / Eletrorretinografia e imuno-histoquímica da retina de coelhos tratados com citrato de sildenafil

Sildenafil citrate is a type-5 phosphodiesterase inhibitor (PDE-5), able to inhibit type-6 phosphodiesterase (PDE-6) as well, providing clinical benefits and paraeffects, some of them potentially related to the retina. The effects of the sildenafil on the retrobulbar and retinal circulation were studied in 27 adult male rabbits of the White New Zealand breed. The electric activity of the retina was evaluated before and at the end of the treatments, and immunohistochemistry studies were conducted. An amplitude increase of the b wave was found in the mixed response of cones and rods after 7 days of treatment with sildenafil citrate. However, in the other evaluations and periods, the values did not differ from the basal ones. Through immunohistochemistry, no significant decrease of the expression of PDE-5 and PDE-6 proteins was observed. Based on the results obtained, it is possible to admit that the sildenafil citrate did not change the expression of PDE-5 and PDE-6, neither the electroretinographic activity of the retina of male rabbits of the White New Zealand breed.

O citrato de sildenafil é um inibidor da fosfodiesterase do tipo 5 (PDE-5), capaz de inibir também a fosfodiesterase do tipo 6 (PDE-6), proporcionando benefícios clínicos e paraefeitos, alguns deles potencialmente relacionados à retina. Foram estudados efeitos do sildenafil sobre a circulação retrobulbar e a retiniana em 27 coelhos machos adultos, da raça Nova Zelândia Branco. Avaliou-se a atividade elétrica da retina antes e ao término dos tratamentos e realizaram-se estudos à imunoistoquímica. Encontrou-se aumento da amplitude da onda b na resposta mista de cones e de bastonetes, após 7 dias de tratamento com citrato de sildenafil. Entretanto, nas demais avaliações e períodos, os valores não divergiram dos basais. Pela imunoistoquímica, não se observou diminuição significativa da expressão das proteínas PDE-5 e PDE-6. Com base nos resultados obtidos, é possível admitir que o citrato de sildenafil não alterou a expressão de PDE-5 e PDE-6, tampouco, a atividade eletrorretinográfica da retina de coelhos machos da raça Nova Zelândia Branco.

Neurite óptica isquêmica devida à dose inédita de sildenafila / Ischemic optic neuritis due to unprecedented dose of sildenafil

No presente relato de caso, os autores ressaltam aspectos gerais, neuro-oftalmológicos e psicodinâmicos de um paciente que apresentou neurite óptica isquêmica não arterítica devida ao uso de dose inédita da sildenafila.

In this case report, the authors emphasize general, neuro-ophthalmological and psychodynamic aspects, of a patient who developed non-arteritic ischemic optic neuropathy due to the use of unprecedented dose of sildenafil.