Background: Intracerebral hemorrhage (ICH) is a serious condition characterized by bleeding within the brain tissue. Although the
use of sildenafil, a vasodilator agent for erectile dysfunction, has been associated with rare cases of ICH, the combination of sildenafil
usage and smoking as risk factors for ICH has not yet been reported. This case report describes the occurrence of ICH in a patient with
a history of both sildenafil usage and heavy smoking.
Case Presentation: A 53-year-old male, with a history of smoking and regular sildenafil use, was brought to the emergency
department due to loss of consciousness with right-side weakness, he initially experienced with nausea, vomiting and dizziness after
taking sildenafil 100mg tablet once. The Glasgow Coma Score (GCS) was 10 with side hemiparesis. Non-contrast CT revealed left
thalamic acute hemorrhage with ventricular extension. Furthermore, a head CT angiography ruled out any vascular anomalies after that
the patient was admitted to the intensive care unit (ICU) for conservative management. After three days on clinical and neurological
improvement, the patient was transferred to the inpatient ward for further management, monitoring and physiotherapy. On day 6, the
patient was discharged and planned for flow up.
Conclusion: This rare case highlights the need for further research and awareness regarding the potential risks associated with the
combination of sildenafil and heavy smoking. Healthcare professionals should carefully evaluate the individual risk factors of patients,
educate them about potential complications, and consider alternative treatments if necessary. Additionally, patients should be
encouraged to quit smoking and adopt a healthy lifestyle to minimize the risk of cerebrovascular events.