Dr. Jose Biller treats hundreds of stroke patients each year. But few cases were as baffling as the one he received late one afternoon on Dec. 3, 2007.
What puzzled Biller, chairman of the department of neurology at the Loyola University Medical Center in Chicago, was that this patient didn't fit the profile of a typical stroke sufferer. The patient was a 35-year-old woman with no known cardiovascular risk factors. In short, she was a young, healthy, nonsmoking woman.
But for some reason, on this day, she suffered from a stroke under very unusual circumstances; only minutes after having sexual intercourse with her boyfriend, the woman began complaining of numbness on the left side of her face, her speech became slurred, and her left arm became weak.
"She was in a real state of panic," Biller recalled. "The family, the boyfriend, everyone was very disturbed."
In this case, which was released Monday in the Journal of Stroke and Cerebrovascular Disease, it's likely that the patient's sexual activity triggered her stroke. What made the case Biller faced even more puzzling was the lack of typical risk factors that usually accompany the onset of stroke. Typically, men face a higher risk than women, and it is usually a condition that affects those in their later years.
But it turns out that a defect in the patient's heart predisposed her to the condition. And oddly enough, cases like these are not as rare as one might think.
"I have seen this sort of thing on several occasions and treated many patients -- male and female -- sometimes with success and sometimes without," said Dr. Pat Lyden, medical director of the UCSD Stroke Center.
Fortunately, according to stroke experts, sexual intercourse, in of itself, is not likely to trigger a stroke without accompanying risk factors.
"There is nothing about sex that should be reported to increase stroke risk," Lyden explained. "Stroke can occur any time: in the shower, on the toilet, working out in the gym or during a class. I have seen patients [who suffered a stroke] with each of these scenarios."
According to the National Institute of Neurological Disorders and Stroke, more than 700,000 Americans suffer a stroke each year and about 160,000 of them die. Survivors often face serious disability as a result of the stroke.
Though hopeful about the recovery of his young stroke patient, Biller still faced a much larger dilemma to solve: What was the cause of this patient's stroke, and what could be done to prevent her from having another one?
The only potential risk factor this patient had for developing a blood clot was the fact that she was on birth control pills -- a medication known for increasing one's risk for developing blood clots. But were birth control pills alone to blame for the stroke? In order to find the answer, Biller and a team of neurologists began investigating the patient's medical history and testing the patient's heart function.
Shortly after, they found the source of the problem: This patient had a hole in her heart that had not been previously detected.
Biller and his team immediately pursued the possibility of a blood clot elsewhere in the patient's body that, when teamed up with a hole in the heart, might be the culprit for the cause of her stroke. Soon after, they found that the patient had a blood clot in one of the main veins in her right leg.