RESUMO
INTRODUCTION: Ergotism is characterised by an intensive generalised vasoconstriction of small and large blood vessels. The symptoms derive from the regional ischemia caused by the vasospasm produced by ergotamine. Nowadays, ergotism is almost exclusively due to the excessive ingestion of ergotamine tartrate used in the treatment of migraine. The main treatment consists in withdrawing the medication. CASE REPORT: Our study involves a 53-year-old male with a history of migraine since his youth, who was treated with ergotaminic preparations up until the day before admission to hospital. He was admitted because of a 7-day history of symptoms including bilateral and symmetrical anaesthesia of the fingers and a general feeling of weakness, associated with intense pain and cyanosis of the right thenar eminence. On admission, it was not possible to measure his AT in the upper limbs and his peripheral pulses dropped in a generalised manner. Aetiologies involving vasculitis were ruled out. An angiography study showed segmented stenosis of arteries in the upper and lower limbs. Ergotaminic agents were withdrawn and nifedipine was indicated. The symptoms disappeared, the physical examination was normal and results of a control angiography study were also normal. CONCLUSIONS: Ergotamine intoxication can be detected by a thorough interview and physical examination; it should be suspected when faced with symptoms that are compatible with vasospasms and a history of ingestion of the drug, in the absence of any prothrombotic, liver, kidney or vasculitic pathology. This condition is treated by withdrawing the drug and administration of vasodilators if the symptoms are intense. In this paper, we review the history, pathophysiology, initial symptoms and signs, diagnosis and treatment of ergotamine poisoning.
Assuntos
Ergotaminas/efeitos adversos , Ergotismo/fisiopatologia , Ergotaminas/uso terapêutico , Ergotismo/complicações , Extremidades/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , VasoconstriçãoRESUMO
INTRODUCTION: Lafora s disease is a type of progressive myoclonic epilepsy with poor prognosis, is characterized by myoclonic crisis, tonic clonic seizures, absence or partial complex seizures and other neurological manifestations with a progressive course and a poor response to the treatment. It has not been considered as a cause of epileptic status. CASE REPORTS: Two women without important past medical history with normal psychomotor development before their suffering, with manifestations of 2 years of evolution the first one and 8 years on the second case characterized by myoclonic generalized, partial complex seizures and progressive deterioration of the mental functions that joined to our institution in a non convulsive epileptic status and they featured with a different evolution. The first patient with favorable control of the event with a single medication and functionality recover later, the second one with torpid evolution complicated with an epileptic status convulsive widespread condition and a prolonged permanency in the unit of intensive therapy. In both patients the diagnosis of Lafora s disease was established based in the findings of the skin axilar biopsy. DISCUSSION AND CONCLUSION: We believe that Lafora s disease must be suspected as a probable cause of non convulsive epileptic status in patients with myoclonic epilepsy associated with other neurological manifestations and a refractary response to the medical treatment. The evolution and clinical response will depend on the evolutionary stage of the disease.