Reversible segmental cerebral arterial vasospasm and cerebral infarction: possible association with excessive use of sumatriptan and Midrin.
OBJECTIVE
To describe a patient who developed reversible segmental cerebral arterial vasospasm and cerebral infarction while taking excessive amounts of sumatriptan succinate and a combination drug (Midrin) consisting of isometheptene mucate, 65 mg, dichloralphenazone, 100 mg, and acetaminophen, 325 mg.


METHODS
Case report.


METHODS
Tertiary care center.


METHODS
A 43-year-old man who developed a left occipital infarct after taking a total of 23 sumatriptan succinate tablets (25 mg per tablet) and 32 Midrin tablets during a 7-day period and who on digital subtraction angiography was shown to have segmental cerebral arterial narrowing in multiple vessels. An extensive evaluation for other possible risk factors for cerebral infarction was unrevealing.


RESULTS
Discontinuation of sumatriptan and Midrin regimens and administration of nicardipine hydrochloride led to nearly total resolution of the angiographic findings, and the patient had no recurrent strokes.


CONCLUSIONS
One should consider the diagnosis of drug-induced vasospasm in patients with cerebral infarction and a history of excessive use of sumatriptan and Midrin. The initial angiographic abnormalities may resemble those found in patients with primary angiitis of the central nervous system.
Meschia
J F
JF
Department of Neurology, Mayo Clinic Jacksonville, Fla 32224, USA.
Malkoff
M D
MD
Biller
J
J
D000082:Acetaminophen / Q000506:poisoning*; D000328:Adult; D000983:Antipyrine / Q000031:analogs & derivatives* / Q000506:poisoning; D002544:Cerebral Infarction / Q000139:chemically induced*; D002697:Chloral Hydrate / Q000031:analogs & derivatives* / Q000506:poisoning; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D006801:Humans; D002546:Ischemic Attack, Transient / Q000139:chemically induced*; D008297:Male; D008744:Methylamines / Q000506:poisoning*; D009529:Nicardipine / Q000627:therapeutic use; D009778:Occipital Lobe / Q000098:blood supply*; D018170:Sumatriptan / Q000506:poisoning*; D014662:Vasoconstrictor Agents / Q000506:poisoning*; D014665:Vasodilator Agents / Q000627:therapeutic use
D004338:Drug Combinations; D008744:Methylamines; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D000082:Acetaminophen; D002697:Chloral Hydrate; C008527:Midrin; D018170:Sumatriptan; D009529:Nicardipine; D000983:Antipyrine