Albano et al. Journal of Medical Case Reports 2010, 4:225 http://www.jmedicalcasereports.com/content/4/1/225 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Post-coital intra-cerebral venous hemorrhage in a 78-year-old man with jugular valve incompetence: a case report Beatrice Albano1, Carlo Gandolfo1, Massimo Del Sette2* Abstract Introduction: Spontaneous intra-cerebral hemorrhage can occur in patients with venous disease due to obstructed venous outflow. Case presentation: We report the case of a 78-year-old Caucasian man with jugular valve incompetence who experienced an intra-cerebral temporo-occipital hemorrhage following sexual intercourse. He had no other risk factors for an intra-cerebral hemorrhage. Conclusions: To the best of our knowledge, this is the first case of intra-cerebral hemorrhage due to jugular valve incompetence in association with the physical exertion associated with sexual intercourse. Introduction Non-traumatic spontaneous intra-cerebral hemorrhage is usually due to hypertensive arteriolosclerosis or to amyloid angiopathy, which account for 78 to 88% of pri- mary hemorrhages, whereas secondary intra-cerebral hemorrhage is normally associated with arteriovenous malformation, aneurysm, cavernous angioma, neoplasm, coagulopathy or the misuse of drugs [1]. Ganglionic hemorrhages are probably of hypertensive origin, while lobar hemorrhages are frequently due to amyloid angiopathy or vascular malformations [2]. Some authors have reported the occurrence of intra- cerebral hemorrhages that have been caused by venous diseases. These are usually located in the white matter at the border zone between deep and superficial venous systems where collaterals are poor. Venous intra- cerebral hemorrhages are associated with impaired venous hemodynamics, as in the case of cerebral venous thrombosis, compression of the superior cava vein or right cardiac failure [3]. Moreover, the occurrence of petechial hemorrhages during cerebral venous thrombo- sis is a frequent finding on computed tomography (CT) or magnetic resonance imaging (MRI) scans [4,5]. * Correspondence: massimo.delsette@asl5.liguria.it 2S. Andrea Hospital. La Spezia, Italy We report the case of a patient with bilateral severe jugular valve incompetence in whom a cerebral hemor- rhage occurred soon after the physical effort of sexual intercourse. Case presentation A 78-year-old Caucasian man was referred to our stroke unit because of the sudden onset of a headache asso- ciated with speech and visual disturbances during early morning sexual intercourse. He had been lying in a supine position with his head hanging off the bed in a slightly downwards position. The patient was brought to the hospital few hours later. On admission, neurological examination showed a right hemianopia with alexia. His systolic blood pressure was 115 mmHg and the diastolic pressure was 60 mmHg. A thorough review of familial and personal clinical histories suggested no other possible cause for this con- dition. In particular, there were no signs of arterial hypertension or hematological disorders and our patient was not taking anti-coagulants or anti-platelet drugs. He had not experienced any head trauma and had no other risk factors for cerebrovascular disease. He had also not taken sildenafil citrate or any other cyclic guanosine monophosphate (cGMP) inhibitors. A cerebral CT scan showed a small left cortical tem- poro-occipital hemorrhage with mild mass effect and © 2010 Albano et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.