Transient ischemic attack caused by cerebral ergotism

Ataque isquêmico transitório causado por ergotismo cerebral

Association of protease inhibitors and ergotamine causing systemic ergotism is well established¹,²,³. Cerebral ergotism is poorly reported⁴,⁵. We describe the case of an HIV positive 49 yo man under protease inhibitors (ritonavir) presenting with total reversible left hemiparesis after the intake of 3 g of ergotamine. After 20 minutes he was spontaneously asymptomatic. TIA was diagnosed. Parenchymal MRI was normal, cervical doppler ultrasound showed symmetric narrowing in both internal carotid arteries, causes of cardiac embolism were properly excluded. Angio Magnetic Resonance Imaging (Figures 1 and 2) was performed in acute stage and evolution, as well as cerebral angiography, leading to the diagnosis of cerebral ergotism. Between both MRI showed, only aspirin 325 mg and bed rest was indicated.

Figure 1
Angio MRI showing progressive and symmetrical narrowing in both internal carotid arteries after the origin with minimum intracranial filling. T1 fat suppression secuence did not show a dissection pattern.

Figure 2
Control MRI at 7 days: Normal filling of both internal carotid arteries is seen. Patient was asymptomatic just with aspirin 325 mg, ergotamine cessation and change of antiretroviral therapy.

References

• ¹ Finn BC, Vadalá S, Meraldi A, Bruetman JE, Martínez JV, Young P. [Ergotism and HIV]. Medicina (B Aires). 2013;73(4):346-8. Spanish.
• ² Acle S, Roca F, Vacarezza M, Álvarez Rocha A. [Ergotism secondary to ergotamine-ritonavir association: Report of three cases]. Rev Med Chil. 2011;139(12):1597-600. Spanish. doi:10.4067/S0034-98872011001200010
• ³ Ayarragaray JE. Ergotism: a change of persepective. Ann Vasc Surg. 2014;28(1):265-8. doi:10.1016/j.avsg.2013.02.005
• ⁴ Spiegel M, Schmidauer C, Kampfl A, Sarcletti M, Poewe W. Cerebral ergotism under treatment with ergotamine and ritonavir. Neurology. 2001;57(4):743-4.
• ⁵ Langer B, Bechara MJ, Wolosker N, Sitrangulo Júnior C, Marino JC. [Transient cerebral ischemic attack and amaurosis fugax caused by carotid ergotism]. Rev Paul Med. 1991;109(2):91-2. Portuguese.

• Errata

  Arquivos de Neuro-Psiquiatria. ahead of print Epub 24-Nov-2015.
  Nome correto do autor:
  Gustavo Andrés Gaye-Saavedra.

Publication Dates

• Publication in this collection
  24 Nov 2015
• Date of issue
  Mar 2016

History

• Received
  30 July 2015
• Reviewed
  22 Sept 2015
• Accepted
  14 Oct 2015