A Case Report of Hypertensive Emergency and Intracranial HemorrhageDue to Intracavernosal Phenylephrine

摘要

Intracavernosal injection of phenylephrine is a commonlyused therapy for ischemic priapism and is typically well tolerated with fewsevere adverse side effects. We report a case of intracranial hemorrhage relatedto hypertensive emergency due to intracavernosal phenylephrine. A 43-year-old Caucasian man with history of hypertension,diabetes mellitus type I, end-stage renal disease status post a combinationkidney-pancreas transplant, and recurrent idiopathic priapism presented toemergency department with an episode of priapism. His home medications werelisinopril, metoprolol tartrate, mycophenolate mofetil, prednisone,sulfamethoxazole-trimethoprim, and tacrolimus. After local injection of 2 rounds(1 hour apart) of 100 µg phenylephrine into each corpus cavernosa, priapismresolved. Within 5 minutes, the patient had headaches, dyspnea, and excruciatingchest pain. His blood pressure (BP) was noted to be 240/130 mm Hg but normalizedspontaneously within few minutes. During this period, he developed new-onsetright arm and leg weakness and found to have intracranial hemorrhage in themidbrain. A careful review for pharmacologicinteractions should be performed prior to intracavernosal phenylephrineadministration, and close monitoring should occur after its administration.