article · PubMed
Post-coital intracranial haemorrhage refers to non-traumatic brain bleeding that takes place during or within 30 minutes of sexual activity. An observational study conducted over five years at a tertiary referral centre in southern Nigeria monitored 52 adult patients with this condition confirmed by CT scans. Most patients were middle-aged men, with an average age of nearly 50 years. The primary cause was hypertensive bleeding, followed by aneurysmal subarachnoid haemorrhage. The median delay between symptom onset and hospital arrival exceeded 41 hours, with just over a tenth arriving within six hours. At six months, nearly 60 percent of patients achieved a favourable functional recovery, while overall mortality reached roughly 19 percent. Poor outcomes were strongly linked to low consciousness scores at admission, haematoma expansion or rebleeding, and hospital arrival delayed by more than 24 hours.
Post-coital brain haemorrhage can be fatal or disabling, yet significant delays in seeking hospital care remain common due to stigma, misdiagnosis, and financial barriers. Understanding that poorly controlled hypertension is the primary cause highlights the need for public education, routine blood pressure monitoring, and rapid emergency triage for sudden severe headaches following exertion.
The abstract does not indicate an application pathway for commercialisation, as it reports observational clinical and epidemiological data.
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Background: Post-coital intracranial haemorrhage (PC-ICH) is a non-traumatic intracranial bleeding occurring during or within 30 minutes of sexual intercourse. In sub-Saharan Africa, poorly controlled hypertension, delayed presentation, and limited access to neurosurgical care compound its lethality. No prospective series from the region exists. Methodology: Prospective observational cohort study at a tertiary referral centre in a metropolitan city in the south-south region of Nigeria, from January 2021 to December 2025. Consecutive adults presenting with CT-confirmed, non-traumatic ICH where coitus was the immediately preceding activity were enrolled. The primary outcome was the six-month Glasgow Outcome Scale (GOS) score; secondary outcomes were in-hospital mortality and in-hospital complications. Results: Fifty-two patients were enrolled over five years (mean age 49.6 ± 9.8 years; 57.7% male). Hypertensive ICH was the most common aetiology (53.8%; n=28), followed by aneurysmal subarachnoid haemorrhage (aSAH; 36.5%; n=19) and other/undetermined causes (9.6%; n=5). Median time from ictus to hospital arrival was 41.2 hours; only 11.5% presented within six hours. Overall six-month mortality was 19.2% (n=10); a favourable functional outcome (GOS 4-5, i.e. moderate disability or good recovery) was achieved in 59.6% (n=31). Low GCS on admission (OR 9.4; 95% CI 2.6-34.0; p < 0.001), haematoma expansion or rebleeding and presentation delay >24 hours (OR 4.3; p = 0.012) were the strongest independent predictors of poor outcome. Conclusion: PC-ICH in the region is predominantly a complication of uncontrolled hypertension in middle-aged men. Delayed presentation, driven by sociocultural stigma, misdiagnosis, and financial barriers, is the most actionable determinant of poor outcome. Intensification of hypertension control, structured emergency triage for post-coital thunderclap headache, and removal of financial barriers to neurosurgical care are urgently required.
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