J Clin Neurol.  2006 Dec;2(4):279-282. 10.3988/jcn.2006.2.4.279.

Ergotism With Ischemia In All Four Extremities: A Case Report

• Jeong SY
• Lim ES
• Shin BS
• Seo MW
• Kim YH
• Kwak HS
• Chung GH
• Jeong SK

• KMID: 1980471
• DOI: http://doi.org/10.3988/jcn.2006.2.4.279

Abstract

Here we describe a case of ergotism that presented with ischemia in all four extremities. A 48-year-old man was admitted for pain and weakness in both upper extremities. He had a long history of migraine and had taken 3 mg of ergotamine daily for more than 21 years. Angiography demonstrated vasospasm involving all four extremities, which resolved partially following intra-arterial prostaglandin infusion. Intravenous nitroprusside was administered, and the patient stopped smoking and stopped taking ergotamine in an attempt to counteract the vasospasm. Follow-up computed tomography angiogram revealed that both brachial arteries had normalized. Thus, in this case of ergotism, severe vasospasm in all of the extremities was resolved with appropriate management.

Keyword

Ergotism; Vasospasm; Angiography

MeSH Terms

Angiography
Brachial Artery
Ergotamine
Ergotism*
Extremities*
Follow-Up Studies
Humans
Ischemia*
Middle Aged
Migraine Disorders
Nitroprusside
Smoke
Smoking
Upper Extremity
Ergotamine
Nitroprusside
Smoke

Figure

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  Figure 1 Angiographic findings in the upper and lower extremities. The proximal portions of the right (A) and left (B) brachial artery, showing the smoothly tapered brachial artery and diffuse "thread-like" narrowing. The distal portions of the right brachial artery exhibit severe vasospasm and collateral formation (C). Multifocal segmental narrowings are evident in both deep femoral arteries (D).

• 

  Figure 2 Angiographic findings in the left hand. The left hand exhibited poor vascular perfusion (A), which was markedly inproved after prostaglandin E1 infusion (B).

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  Figure 3 Follow-up upper-extremity computed tomography angiogram (three-dimensionally rendered). One month after cessation of ergotamine and nitroprusside infusion, both brachial arteries appeared normal.

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