Abstract
Neurological deficits associated with methylergometrine have been reported primarily as a result of reversible cerebral vasoconstriction syndromes (RCVS). RCVS are characterized by reversible multifocal vasoconstrictions of the cerebral arteries heralded by acute severe headache with or without neurological deficits. Here, we present the first case of suspected RCVS with transient limb myoclonus following the intravenous administration of methylergometrine during cesarean section. A 31-year-old woman who received slowly infused intravenous methylergometrine during a cesarean section suddenly reported severe occipital headache after 40 min, followed by apnea and unconsciousness for 8 min. A second administration of methylergometrine to treat the weakness of her uterine contractions resulted in a repeated loss of consciousness within minutes and the development of limb myoclonus. No abnormalities were detected by brain computerized tomography, magnetic resonance imaging, and electroencephalogram. She fully recovered spontaneously within 12 h. We consider that the transient limb myoclonus in our patient appeared as a result of RCVS caused by the intravenous administration of methylergometrine.
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References
Williams TL, Lukovits TG, Harris BT, Harker Rhodes C. A fatal case of postpartum cerebral angiopathy with literature review. Arch Gynecol Obstet. 2007;275:67–77.
Sekimoto E, Kunishige M, Kuriwaka R, Shinohara M, Ebisutani D, Kitamura K, Doi T, Kushiki N, Mitsui T. Delayed vasospasm in late postpartum cerebral angiopathy after withdrawal of methylergometrine. Cerebrovasc Dis. 2002;13:288–9.
Cassim F, Houdayer E. Neurophysiology of myoclonus. Neurophysiol Clin. 2006;36:281–91.
Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med. 2007;146:34–44.
de Labriolle A, Genée O, Heggs LM, Fauchier L. Acute myocardial infarction following oral methyl-ergometrine intake. Cardiovasc Toxicol. 2009;9:46–8.
Song JK, Fisher S, Seifert TD, Cacayorin ED, Alexandrov AV, Malkoff MD, Grotta JC, Campbell MS. Postpartum cerebral angiopathy: atypical features and treatment with intracranial balloon angioplasty. Neuroradiology. 2004;46:1022–6.
Ursell MR, Marras CL, Farb R, Rowed DW, Black SE, Perry JR. Recurrent intracranial hemorrhage due to postpartum cerebral angiopathy: implications for management. Stroke. 1998;29:1995–8.
de Groot AN, van Dongen PW, Vree TB, Hekster YA, van Roosmalen J. Ergot alkaloids. Current status and review of clinical pharmacology and therapeutic use compared with other oxytocics in obstetrics and gynaecology. Drugs. 1998;56:523–35.
Yoshikawa H, Takamori M. Benign segmental myoclonus: electrophysiological evidence of transient dysfunction in the brainstem. J Clin Neurosci. 2001;8:54–6.
Dyer RA, van Dyk D, Dresner A. The use of uterotonic drugs during caesarean section. Int J Obstet Anesth. 2010;19:313–9.
MacLennan SJ, Martin GR. Actions of non-peptide ergot alkaloids at 5-HT1-like and 5-HT2 receptors mediating vascular smooth muscle contraction. Naunyn Schmiedebergs Arch Pharmacol. 1990;342:120–9.
Henry PY, Larre P, Aupy M, Lafforgue JL, Orgogozo JM. Reversible cerebral arteriopathy associated with the administration of ergot derivatives. Cephalalgia. 1984;4:171–8.
Bogousslavsky J, Despland PA, Regli F, Dubuis PY. Postpartum cerebral angiopathy: reversible vasoconstriction assessed by transcranial Doppler ultrasounds. Eur Neurol. 1989;29:102–5.
Sato S, Shimizu M, Endo K, Homma M, Yamamoto T. Postpartum cerebral angiopathy—a case report the vasculopathy associated with co-administration of two vasoconstrictives, methylergometrine maleate and sumatriptan (in Japanese with English abstract). Rinsho Shinkeigaku (Clin Neurol). 2004;44:96–101.
Nishiyama S, Yamamuro O, Kato N, Kurauchi O, Chaya J, Ono Y. Postpartum cerebral angiopathy due to methylergometrine maleate use. A case report (in Japanese with English abstract). Nippon Shusanki Shinseiji Igakukai Zasshi (Jpn J Perinatal Neonatal Med). 2006;42:101–4.
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Ishibashi, T., Ishibashi, S., Uchida, T. et al. Reversible cerebral vasoconstriction syndrome with limb myoclonus following intravenous administration of methylergometrine. J Anesth 25, 405–408 (2011). https://doi.org/10.1007/s00540-011-1122-7
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DOI: https://doi.org/10.1007/s00540-011-1122-7