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Abstract Details

A Case Report of Dihydroergotamine Administration for Status Migrainosus in a Patient on Longstanding Citalopram Causing a Fatal Reversible Cerebral Vasoconstriction Syndrome (RCVS)
Cerebrovascular Disease and Interventional Neurology
P02 - (-)
027
BACKGROUND: Reversible cerebral vasoconstriction syndromes (RCVS) encompass a number of diverse conditions that are charecterized by diffuse, segmental, reversible cerebral vasospasm. Arterial spasm is a well known side effect of ergotamine which is still used to treat migraine attacks. Also, serotonergic agents such as serotonin selective reuptake inhibitors have been reported in association with ischemic stroke.
DESIGN/METHODS: Case report.
RESULTS: Fourty five year old Caucasian female with history of migraine headaches and tobacco use with depression on long standing citalopram presented to the ER with a clinical presentaion consistent with status migrainosus and was treated with intravenous dihydroergotamine and admitted for further management. She developed confusion, and had a magnetic resorance imaging of brain, arteries and veins (MRI/MRA/MRV) that showed irregularities in the anterior circulation of the brain with abnormal high signal in the posterior fossa. She underwent a lumbar puncture which showed normal cerebrospinal fluid analysis. Systemic vasculitis and autoimmune workup was negative. Conventional cerebral angiography showed severe segmental vessel narrowing in all cerebral circulations consistent with vasculitis versus RCVS in addition to delayed circulatory transit time. Intrarterial verapamil was injected and there was mild to moderate improvement in the vasospasm. High dose steroids were given and patient did not improve clinically, a second MRI showed large bihemispheric cerebral infarcts. Course was complicated by increased intracranial pressure requiring extraventricular drain placement and aggressive intracranial pressure management.
CONCLUSIONS: We report this case report of fatal RCVS of a patient on long standing citalopram who developed this after being administered Dihydroergotamine for status migrainosus. As this is thought to be a self-limiting in terms of clinical features. However, some patients may have more severe focal neurologic symptoms and signs, including ischemic or hemorrhagic strokes as described in our patient.
Authors/Disclosures
Khaled Asi, MD (Cleveland Clinic Foundation)
PRESENTER 		No disclosure on file
Joao A. Gomes, MD (Cleveland Clinic) Dr. Gomes has nothing to disclose.
Dhimant Dani, MD Dr. Dani has nothing to disclose.
Patricia K. Coyle, MD, FAAN (SUNY At Stony Brook) Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Accordant. Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Coyle has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sanofi Genzyme. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GlaxoSmithKline. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon Therapeutics. The institution of Dr. Coyle has received research support from CorEvitas LLC. The institution of Dr. Coyle has received research support from Genentech/Roche. The institution of Dr. Coyle has received research support from NINDS. The institution of Dr. Coyle has received research support from Sanofi Genzyme. The institution of Dr. Coyle has received research support from Cleveland Clinic.