Internal carotid artery vasospasm from ergotism: A case report

Abstract

A 22-year-old Thai woman presented with right hemiparesis and global aphasia about 9 hours prior to hospital. She had underlying migraine headache with frequently used ergotamine-caffeine. The magnetic resonance imaging (MRI) brain, diffusion weighted imaging (DWI) sequence showed small infarction at left superior and left inferior frontal gyri, left periventricular and left basal ganglia with magnetic resonance angiography (MRA) brain showed absent blood flow at left cervical internal carotid artery (ICA) to left middle
cerebral artery (MCA). Then, she was sent to treat with endovascular therapy. The cerebral angiogram revealed occlusion at left supraclinoid ICA, then it immediately and spontaneously recanalized. The severe vasospasm at left supraclinoid ICA to left MCA was possible. So, the nimodipine intra-arterial infusion was done and the vasospasm of vessels were significantly improved. After vessels were recanalized, her clinical condition was significantly improved. The ICA vasospasm in this case was caused by drug or associated with migraine and is a rare cause of stroke. We report an interesting case of ICA vasospasm from ergotamine
drug use.