Etiology of unprovoked subarachnoid hemorrhage (SAH) is predominantly from cerebral aneurysm rupture and manifests classically as a thunderclap headache. Orgasmic cephalgia may herald SAH given that 4-12% of SAH sufferers were found to have engaged in prior sexual activity.(1) Precipitating causes of SAH leading to aneurysmal rupture may be the rise in blood pressure caused by physical activity. A conventional angiogram (CTA) is used to reveal a source of the bleed and but occasionally this is normal, and is labelled angiogram-negative SAH or non-aneurysmal SAH. In those cases digital subtraction imaging (DSA) is needed for verification. Herein we discuss an instance of angiogram negative SAH which occurred after sexual activity in a young male with a chronic cannabis habit.
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May, Dakota T. and Lozowska, Dominika
"Angiogram negative subarachnoid hemorrhage in the setting of sexual intercourse and chronic cannabis use,"
Marshall Journal of Medicine:
2, Article 4.
Available at: https://mds.marshall.edu/mjm/vol5/iss2/4