Le Coz P, Woimant F, Rougemont D, Sanson M, Laplane D, Haguenau M, Pépin B
Service de Neurologie, Hôpital Lariboisière, Paris.
Rev Neurol (Paris). 1988;144(4):295-300.
Heroin, cocaine, amphetamines, sympathomimetic drugs can cause cerebral angiopathy. We report 2 patients with cerebrovascular disorders after ingestion of a nasal vasoconstrictor containing phenylpropanolamine (P.P.A.). The first patient had two acute repetitive attacks of severe headache and vomiting, occurring after a daily treatment with 180 mg of P.P.A. during 6 weeks. The second patient had an intracerebral hemorrhage, occurring some hours after taking for the first time 120 mg of P.P.A. In both cases, cerebral angiography, performed in the next week, demonstrated segmental narrowing and dilatations of medium-size intracranial arteries. None of the usual causes of cerebral vasculitis were present. The outcome was favorable and follow-up angiograms showed the disappearance of the beading pattern. P.P.A. is widely used over the counter in diet pills and stimulants. Cerebral vascular complications have been rarely reported, always hemorrhagic and often associated with cerebral vasculitis. They are unrelated to duration or dosage of treatment. The mechanism is unclear but could result from several factors: chronic or paroxystic high blood pressure, immuno-allergic vasculitis, arterial spasm, direct "toxic" effect of the P.P.A. on the arterial wall may be increased by other drugs and caffeine.
海洛因、可卡因、安非他明、拟交感神经药可引起脑血管病。我们报告2例在摄入含去甲麻黄碱（PPA）的鼻血管收缩剂后出现脑血管疾病的患者。首例患者在6周内每日服用180毫克PPA治疗后，出现两次严重头痛和呕吐的急性反复发作。第二例患者在首次服用120毫克PPA数小时后发生脑出血。在这两例中，于下周进行的脑血管造影均显示颅内中等大小动脉节段性狭窄和扩张。不存在脑血管炎的常见病因。结果良好，随访血管造影显示串珠样改变消失。PPA在非处方的减肥药和兴奋剂中广泛使用。脑血管并发症鲜有报道，均为出血性，且常与脑血管炎相关。它们与治疗持续时间或剂量无关。其机制尚不清楚，但可能由多种因素导致：慢性或阵发性高血压、免疫过敏性血管炎、动脉痉挛、PPA对动脉壁的直接“毒性”作用可能因其他药物和咖啡因而增强。
