ONSET OF NEUROLOGIC DEFICITS AFTER TREATMENT WITH DIHYDROERGOTAMINE IN A PATIENT WITH SAGITTAL SINUS THROMBOSIS

A woman with a 7-year history of intermittent migraine had 3 months of gradually worsening headaches. Initial neurologic examination includi ng fundus examination was normal, and initial head computerized tomogr aphic (CT) scan and magnetic resonance imaging (MRI) were thought to b e normal. The patient was given dihydroergotamine (DHE-45), 1.0 mg, in travenously for relief of headache. Five hours later, she complained o f severe diffuse headache and nausea. Neurologic examination showed le ft arm weakness and sensory loss, blurring of the left optic disc, and bilateral Babinski signs. Cerebral arteriography demonstrated thrombo sis of the sagittal sinus, which in retrospect was present on the init ial contrast CT scan and MRI scan. The patient's deficits worsened, an d she eventually died 20 days later as a result of cerebral infarction s and increased intracranial pressure, despite attempts at selective t hrombolysis of the sagittal sinus. DHE has potent venoconstrictive eff ects. We suspect that DHE helped precipitate neurologic deterioration in this patient with sagittal sinus thrombosis.