[Normalization of the vascular picture with sympathetic block in severe arterial ischemia from ergotism]

This case report presents a 44-year-old woman with severe arterial ischemia leading to claudicatio and acute pain in rest caused by an ergotism. In the history was an abuse of suppositories containing caffeine and ergotamine induced by chronic headache. The initial angiography showed occlusions of the femoral arteries. After excluding other vascular diseases, intraarterial infusions of prostaglandin E were administered. Additionally, physiotherapeutic treatment followed. An progrediency of the symptoms made a epidural catheter for sympathicolysis and treatment of the acute pain necessary. As the results of this intervention were encouraging, a sympathetic blockade with injection of 96% ethanol at the level of L 2/3 and 3/4 was performed. After treatment, the clinical symptoms and the blood flow measured by Doppler ultrasonography normalised. A final angiography demonstrated a now normal arterial status. Ergotism, indication and methods of sympathetic blockades are discussed.