title: [Multifocal brain haemorrhage associated with migraine and medication abuse].
abstract: BACKGROUND
  Although ischemic stroke is a well known complication of migraine, cerebral hemorrhage has been uncommonly reported.
  
  
  METHODS
  We present the case of a 56-year-old woman with a long history of headache and abuse of ergotamine and antiinflamatory drugs who was admitted for generalized seizures, right hemiparesis and coma. An early brain CT scan showed multiple cortico-subcortical hemorrhages localized amongst others on right frontal, left parietal, and posterior left temporo parietal regions. In the previous two years she had increased the doses on medications containing 1 mg of ergotamine and 500 mg of dipirone consuming two to six tablets a day, and 500 to 1,500 mg of aspirin a day too. Although she exceeded the maximum ergot cumulative doses allowed of 10 mg per week, it cannot be considered a typical nor a pure manifestation of ergotism. When other possible causes of stroke were excluded, the association of migraine with the protracted vasoconstriction of ergotamine, able per se to damage the capillary endothelium, and an altered local hemostasis induced by aspirin remained as the most probable mechanism of brain bleeding. After discharge she had no motor sequelae and she could return to her usual work. A neuropsychological assessment done four months later showed subclinical cognitive deficits depending on an abnormal frontal functioning.
  
  
  CONCLUSIONS
  This life-threatening and potentially disabling complication must stress to physicians about the risks of ergotamine plus aspirin abuse, drawing their efforts to prevent, to recognize and to control the propensity to self medication of some patients with daily headaches.
authors: División de Neurología, Hospital Naval Buenos Aires, Buenos Aires, Argentina. hnpm@uol.com.ar
authors: E
authors: E
authors: Páez de la Torre
authors: G
authors: G
authors: Lasic-Toccalino
authors: F
authors: F
authors: Mercado-Díez
authors: C M
authors: CM
authors: Torres-Calloni
authors: P E
authors: PE
authors: Balcarce-Bautista
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects*; D001777:Blood Coagulation / Q000187:drug effects; D001925:Brain Damage, Chronic / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000209:etiology*; D003072:Cognition Disorders / Q000209:etiology; D004177:Dipyrone / Q000009:adverse effects*; D062787:Drug Overdose; D004830:Epilepsy, Tonic-Clonic / Q000209:etiology; D004878:Ergotamine / Q000009:adverse effects*; D004881:Ergotism / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D020326:Migraine without Aura / Q000150:complications* / Q000188:drug therapy; D012651:Self Medication; D014662:Vasoconstrictor Agents / Q000009:adverse effects*; D020301:Vasospasm, Intracranial / Q000139:chemically induced
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D014662:Vasoconstrictor Agents; D004177:Dipyrone; D004878:Ergotamine; D001241:Aspirin