Sildenafil Associated Threatened Ischemic Stroke Reversed with Alteplase

A 68-year-old male presented with a threatened ischemic stroke after ingesting sildenafil. Signs and symptoms promptly reversed with alteplase administration, and subsequent studies disclosed no other likely etiology for stroke. Although ischemic stroke owing to sildenafil has been reported, to our knowledge this is the first demonstration of reversal by alteplase.A 68-year-old male with no prior history of hypertension, cardiac disease or stroke was transported to the emergency department after developing lower extremity weakness and slurred speech 30 minutes after ingesting of 40 mg of sildenafil. He was noted to be normotensive, in sinus rhythm, and to have dysarthria and a right facial droop, suggestive of left hemispheric ischemia. A non contrast CT scan of the head disclosed no evidence of hemorrhage, 6.7 mg of alteplace (TPA) was administered followed by infusion of 60.3 mg, during which all neurologic signs and symptoms abated, and he returned to his normal baseline. EKG showed normal sinus rhythm, CT angiogram of the head and neck, echocardiogram with bubble study, transcranial Doppler with micro-embolus detection and laboratory studies were all normal. His only risk factor for stroke was mild hyperlipidemia, controlled on 5 mg of rosuvastatin daily. There was no family history of stroke.