Transient ischemic attack caused by cerebral ergotism

Abstract

Association of protease inhibitors and ergotamine causing systemic ergotism is well established 1,2,3 . Cerebral ergotism is poorly reported 4,5 . 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.

Carotid ergotism with retinal ischemia

“…Carotid involvement is uncommon but it has been described. 5 Septicemia, as in the case reported, can increase the vasoconstrictor effect of ergotamine. 2 Treatment involves discontinuation of ergot medication and, in severe cases, the use of vasodilators, including prostaglandin E or methylprednisolone as second-line therapy.…”

Clinical uses and toxicity of Ergot, Claviceps purpurea An evidence-based comprehensive retrospective review (2003-2017)

“…The patient became asymptomatic after a week. (Gaye-Saavedra et al, 2016) The cases reported for Ergot are presented in detail in Table 1, as below;…”