Sumatriptan-Induced Stroke

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Posted by dougW ( on June 18, 2001 at 15:46:36:

I just came accross this on medscape....interesting.

If you subscribe to medscape, the link is.....

Doug Wright

Two Cases of Apparent Sumatriptan-Induced Stroke Reported

WESTPORT, CT (Reuters Health) Jun 08 - Two cases of hemorrhagic stroke recently occurred hours after injections of sumatriptan, neurologists report.

According to Dr. Pierre C. Combremont, of the University of Lausanne in Switzerland, and Dr. Elliott M. Marcus, of the University of Massachusetts in Worcester, both patients were women in their 40s with 15- to 20-year histories of migraine. Neither had any known risk factors for stroke, and no other potential trigger factors for the hemorrhages could be identified.

According to the clinicians' report in the May 8th issue of Neurology, the first patient injected herself with 6 mg of sumatriptan twice, 2 hours apart. Her migraine was notable for presenting without aura, when her normal presentation was with aura.

Within 30 minutes of the second injection, the intensity of her headache increased. She developed nausea and vomiting, then a left hemiplegia, and finally loss of consciousness.

A parenchymal hemorrhage secondary to an arteriovenous malformation was diagnosed. Surgical evacuation of the clot and resection of the malformation resulted in good recovery over the following 2 years, with rare partial motor seizures.

The second patient used sumatriptan twice within 24 hours. Three hours after the second injection, her headache became "the her life." The pain had changed to a nonthrobbing type and localized to the right-side base of the skull. Computed tomography showed blood in the right suprasellar, interpeduncular, prepontine, and ambient cisterns. There was no recurrence over the following 3 years.

Drs. Combremont and Marcus say they "cannot exclude the possibility that the medication might have triggered a cascade of events, such as a severe arterial vasospasm mediated through the action of sumatriptan on the 5-HT-1B receptor, followed by ischemia and subsequently a rupture of blood vessels."

They advise warning patients not to use antimigraine medications if their headaches differ from normal, either in duration or characteristics.

Neurology 2001;56:1243-1244.


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