Tramadol Induced Intracerebral Hemorrhage: A rare case report

Abstract Background: Tramadol is a centrally acting synthetic analgesic, chemically related to morphine and codeine. Tramadol abuse is being used by many people with different adverse effects; most likely seizures, and respiratory depression. Some men use tramadol for erectile dysfunction. We report a case of tramadol-induced intracerebral hemorrhage. Case report: A 36-year-old male with no history of chronic diseases presented to the emergency department with a sudden onset of left-sided weakness. He had no other conventional vascular risk factors such as hypertension, diabetes, or dyslipidemia. A neurological examination showed right gaze preference and mild right facial droop with left-side hemiplegia, and the left Babinski sign was positive. He denied smoking cigars or consuming khat, and he had no family history of stroke. Routine vital signs were normal. The electrocardiogram was normal. And routine blood investigations were normal. NIH Stroke Scale = 22 when he came in. A CT head showed a 53x24 mm hemorrhage in the right basal ganglia region. He had an MRI angiogram, which showed normal intracranial and extracranial vessels. The patient confirmed that he had been using tramadol for two years due to erectile dysfunction. Conclusion: A previously healthy middle-aged male with no vascular risk factors developed a hemorrhagic stroke. It was reported that he had been using tramadol for two years. So, the patient developed the right basal ganglia due to tramadol addiction. It is the first time in the literature that tramadol-induced intracerebral hemorrhage has been reported.