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Intracerebral hemorrhage and phenylpropanolamine use

Departments of Neurology and Neurosurgery, University Hospital and Boston University School of Medicine, and the Boston Veterans Administration Medical Center, Boston, MA.

Two patients developed intracerebral hemorrhage within hours from first-time ingestion of phenylpropanolamine-containing medications. One patient had marked hypertension, presented with three intracerebral hematomas, and developed a fourth hemorrhage 10 days later. Angiogram in one patient revealed "beading" of intracranial arteries, an abnormality also detected in a third patient who developed severe headache, vomiting, and acute hypertension following a single dose of phenylpropanolamine. These cases and others reported in the literature strongly suggest an association between phenylpropanolamine ingestion and hemorrhagic stroke. Direct questioning of use of this medication in cases of unexplained intracranial hemorrhage in previously healthy young individuals may reveal an unsuspected high frequency of this association.

Address correspondence and reprint requests to Dr. Kase, Department of Neurology, Boston University School of Medicine, 720 Harrison Avenue, Suite 604, Boston, MA 02118.

Received April 21, 1986. Accepted for publication in final form July 2, 1986.

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