Prolonged Arteriospasm after Ergotamine

Cameron, Ewen; French, E. B.

doi:10.1136/bmj.2.5413.875-d

Cited by 7 publications

(3 citation statements)

References 3 publications

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“…seldom as oral tablets (4,5,6), can induce prolonged arterial spasms in the limbs, or sometimes in the splanchnic area (spasm of the mesenteric artery: 7), or even of a coronary artery (8).…”

Section: Histologymentioning

confidence: 99%

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Ergotism Anatomo-clinical study of a case

1975

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Ergotamine is a peptidic alkaloid synthetized by the ascomycete claviceps purpurea. It combines one molecule of lysergic acid with two amino-acids, proline and phenylalanin, and one molecule of pyruvic acid.The natural alkaloid of claviceps purpurea share three main effects: they produce an important central nervous system excitation, they paralyse a-receptors at the nerve ends, and thus abolish the action of' adrenaline and nor-adrenaline, and they induce a strong contraction of medium sized arteries and vasa vasorum (1): the spasms are either temporary or prolonged, and can ultimately induce tissular ischemia.There are clinical reports of' isolated spasms of muscular arteries, but, to our knowledge, very few histological descriptions of the vascular lesions in uncomplicated spasms are available (2-3).The present observation belongs to this category. We think thus it is worth while reporting.CASE REPORT Mrs P.M., a 42 year old woman, was first seen on October 1st 1973. She complained of pain in the knees and legs when walking more than 200 meters. This pain (cramplike) had been first noted 6 months earlier.It was accompanied with paresthesias after sustained walks. A diagnosis of' intermittent claudication was made. The patient appeared anxious, complaining of' frequent precordial pains. Besides, since the age of 25, she has suffered of migrainous fits. Upon examination, blood pressure was within normal range (160/80 mm Hg). Femoral, popliteal and pedious pulses were absent on both sides. Oscillometric index was of similar amplitude on both thighs; it decreased somewhat on the right calf and markedly on the left calf. Electrocardiographic tracings, blood and urinary biology were considered within normal limits.Arteriographic investigations were undertaken. Aortography demonstrated a bilateral, symmetrical, stenosis of femoral arteries, more important on the left side (Fig. 1, A and B).

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Section: Histologymentioning

confidence: 99%

“…In 1970, six cases of ergotamine intoxication had been documented (13): in all cases, a symmetrical bilateral arterial constriction of lower (14,12,14,6,1) or/and occasionally upper (6,10,4) limbs could be demonstrated.…”

Section: Histologymentioning

confidence: 99%

Ergotism Anatomo-clinical study of a case

1975

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“…This raises two questions, firstly whether migraine confers protection against the vascular effects of ergotamine and secondly whether the route of administration affects the incidence of complications. Cameron and French (1964) believe that migraine confers no such protection, whilst Young and Humphries (1961) suggest that it is the intermittent nature of the treatment in migraine which accounts for the low incidence of side effects. It is possible that migraine is a manifestation of a generalised vasomotor disorder (Brit.…”

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confidence: 99%

Ergot poisoning

Glazer

Myers

Davies

1966

Postgraduate Medical Journal

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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 ...

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