Ergot poisoning

Abstract

ERGOTAMINE tartrate is frequently prescribed for the treatment of migraine. Complications from the drug are rare but potentially serious.A case is presented of severe lower limb arterial spasm due to ergotamine tartrate taken sublingually and orally for migraine. This case provided an opportunity to study the vascular and systemic effects of the drug and to review the literature concerning the risk, manifestations and treatment of ergot poisoning. Case ReportMr. E.K., a 33 year old van-driver, presented in September 1964 having suffered a sudden onset of severe intermittent claudication in both calves three days previously; this was associated with rest pain in both feet and a low lumbar backache. In 1961 he had experienced an identical acute attack; his symptoms had then improved gradually over six months although a variable degree of mild claudication had persisted. No precise diagnosis had been made and treatment had consisted of numerous vasodilator drugs which had little effect. During the past six months he had noticed post-prandial dyspepsia and had lost one and a half stone in weight.Further questioning revealed that the patient had suffered from typical migraine since adolescence. The headaches were confined to the left eye and left side of the head, and were accompanied by fortification spectra and occasional vomiting. The headaches had been increasing in frequency and by September 1964 were occurring twice a week.The patient had received various drugs for his migraine for many years. There is no record of treatment before 1959 but ergotamine preparations were probably prescribed. From 1959 to 1961 he had consistently taken two tablets per day of Lingraine, a sublingual preparation containing 2 mg. of ergotamine tartrate. From 1961 to 1964 documentation of treatment was incomplete, but ergotamine preparations were often taken. Prior to the recent exacerbation of claudication he had taken eleven tablets of Migril over a period of five days (each tablet containing 2 mg. of ergotamine tartrate, 100 mg. of caffeine and 50 mg. of cyclizine hydrochloride); the last tablet was taken on the day he developed acute claudication and two days later he was admitted to hospital.On admission the oral temperature was 99.20F., the pulse rate was 84 per minute and the blood pressure was 110/80 mm.Hg. in both arms. The pulses in the arms and neck were normal; the femoral pulses were weak and equal, but no pulses were palpable below these in either leg. There were no arterial bruits. The feet were white and cold, with anaesthesia of the toes but no evidence of gangrene. General examination revealed no other abnormality apart from constricted pupils. A provisional diagnosis was made of arteriospasm secondary to chronic overdosage of ergotamine tartrate.Progress: Following admission the patient became drowsy, nauseated and suffered from attacks of vertigo. Five days after cessation of ergotamine therapy the foot pulses became palpable and he then developed intense burning sensations in both feet (St. Anthony's Fire).It was ...

Ischaemic lateral popliteal nerve palsy due to ergot intoxication

“…The elevated ESR suggested alternative diagnoses but this finding has been recorded before in ergotism (Horton and Peters, 1963;Glazer et al, 1966).…”

“…Previous reports of neurological complica-tions from ergot intoxication have described peripheral, symmetrical, sensory loss and paraesthesiae, often with spontaneous pain during recovery (Wilson, 1954;Horton and Peters, 1963;Glazer et al, 1966;Yao et al, 1970). In some respects, these cases resemble the ischaemic neuritis described in atherosclerotic peripheral vascular disease (Mufson, 1952;Hutchinson and Liversedge, 1956;Garven et al, 1962;Eames and Lange, 1967), the pathological features of which are predominantly large fibre demyelination and remyelination with varying degrees of axonal degeneration (Garven et al, 1962;Eames and Lange, 1967).…”

“…The superficial femoral artery appears to be the most commonly affected vessel in cases of ergotism which have been investigated angiographically (Glazer et al, 1966;Fagerberg et al, 1967;Yao et al, 1970).…”

Ergotamine abuse and extra-hepatic portal hypertension

“…Also documented are spasm of the coronary (Yater & Cahill, 1936), carotid (Greene et al, 1977), cranial and renal arteries (Fedotin & Hartman, 1970;Greene et al, 1977). Arteriographic studies have demonstrated spasm of the coeliac axis and superior mesenteric artery (Greene et al, 1977;Stillman et al, 1977) and even aorto-iliac spasm has been recorded (Glazer et al, 1966;Fedotin & Hartman, 1970).…”

Renal homotransplant rejection associated with microangiopathic haemolytic anaemia.

“…COMMENT Peripheral arterial insufficiency due to ergot poisoning, though uncommon, has been reported previously. Glazer et al (1966) and Iuel and Mune (1967) demonstrated the sequential changes of blood flow when studied by plethysmography. These changes were well shown in this patient.…”