Ephedrine-induced intracerebral hemorrhage and central nervous system vasculitis.

To the Editor: A 68-year-old right-handed man was admitted to the emergency room 2 hours after developing headache, dysphasia, and right hemiplegia. Computed tomography demonstrated a left temporoparietal hematoma with rupture into the lateral ventricle. On admission, his wife reported his use of an over-the-counter antiasthma pill containing theophylline 0.025 gm, ephedrine 0.01 gm, caffeine 0.015 gm, and theobromine 0.025 gm. He had taken this medication for 10 years, four to six tablets a day, and had used it 2 hours before the onset of ictus. His medical history consisted of chronic obstructive pulmonary disease for 40 years. Neurologic examination demonstrated nuchal rigidity, confusion, and hemiplegia on his right side.