Linda U Iroegbu-Emeruem, Chibuike U Akaa
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.
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.