Abstract Number ‐ 222: Spontaneous Simultaneous Bilateral Putaminal Hemorrhages in a Young Woman

• DOI: 10.1161/svin.03.suppl_1.222
• Publication Date: 2023-04-25T07:32:42Z
• Authors: Luis Paixao; Arjun Padalia; Tae Kim; Yan Wang; Derek Holder; Salah Keyrouz
• Keywords: Hypoesthesia; Neurological examination; Hyperreflexia

Introduction Spontaneous simultaneous bilateral basalganglia hemorrhage is an exceedingly rare condition with significant morbidity and mortality. Hypertension the most common underlying etiology followed by intoxication metabolic causes1. Methods Here we describe a 39‐year‐old woman spontaneous putaminal hemorrhages believed to be secondary amphetamine (Adderall) use undiagnosed hypertension. Results A right‐handed history of attention‐deficit/hyperactivity disorder (ADHD) on dextroamphetamine‐amphetamine (Adderall), white coat hypertension prior gestational was brought emergency department due sudden‐onset left hemiparesis, foot numbness, gait instability, abnormal sensation in her right ear. On arrival, blood pressure 239/139 mmHg. Patient noted somewhat drowsybut consistently regarding,able respond, had anosognosia, hypophonia, gaze preference, mild dysarthria, arm leg hypotonia, hemiparesis hypoesthesia involving face, brisk reflexes side.Head CT revelated measuring 10mL 3mL left,with no intraventricular minimal right‐to‐left midline shift.Patient admitted neuro ICU treated nicardipine infusion. CTA/MRI/MRV/MRA catheter angiography revealed structural pathology. Furthermore, patient normal platelet count coagulation profile. Urine drug screen positive for amphetamines, serum metanephrines (0.59 nmol/L) normetanephrines (1.2nmol/L) were elevated setting ofAdderall use. Nicardipine infusion discontinued day one she started carvedilol 12 mg bid amlodipine 5mg daily. Adderall counseled avoiding stimulant medications At time discharge dysarthria resolved but hemiplegia remained unchanged. She discharged 5 hospital stay inpatient rehabilitation facility. fluoxetine 20 daily motor recovery at two months follow‐up visit, have improvement left‐sided strength, facial droop developed spasticity. trial dry needling physical therapy consideration anti‐spasmodic or Botox injections. office been well controlled lisinopril 10 Conclusions Overall, this case report highlights that potential cause spontaneoussimultaneousbilateralbasalgangliahemorrhage.