ergoline and Blindness

Meningitis is an uncommon complication of an untreated pituitary macroadenoma. Meningitis may occur in patients with macroadenomas who have undergone transsphenoidal surgery and radiotherapy and is usually associated with rhinorrhea. Less commonly, cerebrospinal fluid rhinorrhea has been reported as a complication of treatment of prolactinomas by dopamine agonists. Cerebrospinal fluid rhinorrhea in cases of untreated pituitary macroadenoma is reported only in isolated cases. Acute bacterial meningitis without rhinorrhea in patients with an untreated pituitary macroadenoma is an exceptional finding with only three previously reported cases.. A 31-year-old male was urgently admitted for headache, fever and visual loss. Neuroimaging disclosed an invasive pituitary lesion. Cerebrospinal fluid leakage was not clinically detected. Lumbar puncture showed acute meningitis. Blood tests revealed increased inflammatory markers, a serum prolactin of 9000 ng/ml (2.5-11 ng/ml) and panhypopituitarism. Intravenous antibiotics and hydrocortisone replacement therapy were initiated, leading to a favorable clinical outcome. An endoscopic transsphenoidal debulking procedure was performed, it showed that the sphenoid floor was destroyed and the sinus occluded by a massive tumor.. Meningitis should be ruled out in patients with a pituitary mass who present with headache and increased inflammatory tests, even in the absence of rhinorrhea.

Topics: Adult; Anti-Bacterial Agents; Blindness; Cabergoline; Combined Modality Therapy; Ergolines; Fever; Headache; Hormone Replacement Therapy; Humans; Hydrocortisone; Hypophysectomy; Hypopituitarism; Male; Meningitis, Aseptic; Neoplasm Invasiveness; Pituitary Neoplasms; Prolactinoma; Sella Turcica; Third Ventricle; Thyroxine

Topics: Animals; Blindness; Cattle; Cattle Diseases; Ergolines; Hypersensitivity, Delayed; Leukocyte Count; Lisuride; Metipranolol; Mice; Organ Size; Propanolamines; Respiratory Tract Diseases; Spleen; Stress, Physiological; Thymus Gland; Vibration

Clinical ergotism as seen today results almost exclusively from the excessive intake of ergotamine tartrate in the treatment of migraine headache. Although both gangrenous and convulsive symptoms are seen in naturally occurring ergotism resulting from the ingestion of fungus infected rye, only gangrenous ergotism has been reported following the excessive ingestion of ergotamine tartrate. The symptoms of both iatrogenic and naturally occurring ergotism appear to result from regional ischemia caused by ergot induced vasospasm. This report discribes experiences in the diagnosis and management of two patients with unusual manifestations of iatrogenic ergotism. One patient presented with ischemia of all extremities and bilateral foot drop probably due to ischemic damage to the common peroneal nerves, a finding not previously described in ergot intoxication. The foot drop totally resolved in several months following the discontinuation of ergot. A second patient presented with unilateral leg ischemia and transient monocular blindness, both of which resolved after discontinuation of ergot. Both patients displayed typical angiographic findings of ergotism. There is no convincing evidence that any treatment other than discontinuation of ergotamine is of benefit in the treatment of iatrogenic ergotism.

Topics: Adult; Angiography; Arm; Blindness; Ergolines; Ergotamines; Ergotism; Extremities; Female; Femoral Artery; Humans; Ischemia; Leg; Male; Middle Aged; Peripheral Nervous System Diseases; Peroneal Nerve; Popliteal Artery; Retinal Vessels