Severe postpartum hypertension and reversible cerebral angiopathy associated with ergot derivative (methergoline) administration.
A 36-year-old woman (gravida 2, para 2) delivered a healthy child by cesarean section at the 37th week of an unremarkable gestation. Blood pressure remained within normal range throughout the pregnancy, surgery, and for the 9 following days. On day 10, about 36 hours after the initiation of oral methergoline to suppress lactation, the patient complained of severe posterior headache, flashing scotomata, hypertension, tonico-clonic seizures and then homonymous left hemianopsia and hemiparesis. Blood pressure monitoring confirmed intermittent and severe hypertension. Angiography demonstrated diffuse narrowing of the small and medium cerebral arteries. Transcranial Doppler ultrasound examination disclosed a bilateral increase in mean flow velocity. Progressive normalization of blood pressure, obtained with labetalol and oral clonidine, was accompanied by amelioration of the neurological deficits until a complete recovery and normalization of transcranial Doppler flow velocity occurred. This case provides further evidences that hypertension might play a major pathogenetic role in reversible cerebral angiopathy. Some ergot derivatives (including methergoline) might trigger the initial rise in blood pressure.
Crippa
G
G
Unità di Ipertensione, Dipartimento di Medicina Interna, Ospedale Civile di Piacenza. crippag@altrimedia.it
Sverzellati
E
E
Pancotti
D
D
Carrara
G C
GC
D000328:Adult; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000000981:diagnostic imaging; D007774:Lactation / Q000187:drug effects; D008711:Metergoline / Q000009:adverse effects*; D020768:Middle Cerebral Artery / Q000503:physiopathology; D011247:Pregnancy; D011644:Puerperal Disorders / Q000139:chemically induced* / Q000000981:diagnostic imaging; D012702:Serotonin Antagonists / Q000009:adverse effects*
D012702:Serotonin Antagonists; D008711:Metergoline