CRITICAL LIMB ISCHEMIA CAUSED BY ERGOTISM - TREATMENT WITH INTRAARTERIAL PROSTAGLANDIN-E1 INFUSION

Severe ischaemia of the left upper limb developed in a 42-year-old wom an (who had suffered from migraine since the age of 6 years) after the intake of 12 mg ergotamine tartrate (six suppositories of Cafergot wi thin 5 hours). The left hand became very painful and pale with loss of touch sensation, and she could not move her fingers. Selective cathet er angiography demonstrated typical signs of vascular ergotism: arteri al spasms, corkscrew-like collaterals and segmental arterial occlusion s. The patient's symptoms began to improve 10 minutes after starting a n intraarterial infusion of prostaglandin El (0.34 ng/kg per min over 10 hours). Sensory function in the fingers was restored after 24 hours and reactive hyperaemia had occurred. Radiological examination after 48 hours showed complete recovery. - This case emphasizes the need for obtaining an exact history regarding drug intake in any case of acute peripheral vascular disorder, but especially if there is no pointer t o arterial thromboembolism. Angiography is of value in the differentia l diagnosis of suspected ergotism. Intraarterial infusion of prostagla ndin E1 has few side effects and is immediately effective.