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Abstract Details

Reversal of Serotonergic Induced Vasospasm with Cyproheptadine: A Case ReportTo report a case of cyproheptadine used to reverse vasospasm precipitated by Imitrex in a patient with Reversible Cerebral Vasospasm Syndrome (RCVS).
Cerebrovascular Disease and Interventional Neurology
P10 - Poster Session 10 (5:30 PM-6:30 PM)
4-014
To report a case of cyproheptadine used to reverse cerebral vasospasm precipitated by Imitrex.
Serotonergic agents such a sumatriptan are known to induce intracerebral vasospasm. Cyproheptadine is serotonin antagonist which is often used to treat serotonin agonist overdose. Cyproheptadine has also been observed to improve coronary artery vasospasm. However, its role in reversing intracerebral vasospasm is not known. We present a case of intracerebral vasospasm treated with cyproheptadine.
A case report and review of relevant literature is presented.
A 45-year-old female with history of marijuana use and attention deficit and hyperactivity disorder (ADHD) was admitted for 2-week history of headaches. Prior to admission, she was diagnosed with migraine and prescribed sumatriptan, which she used daily. Her headaches progressively worsened, and she developed new right hemiplegia and bilateral vision loss. Computed tomography (CT) and CT-angiogram showed diffuse multifocal areas of vessel narrowing and infarction with trace subarachnoid blood products concerning for vasospasm. Transcranial Doppler (TCD) showed elevated mean flow velocities in the bilateral middle cerebral arteries. She did not tolerate the initial dose of verapamil due to profound hypotension and she was started on cyproheptadine. Her mean flow velocities markedly improved the following day. Repeat CTA showed resolution of vasospasm. Her headaches, vision, and strength improved.
This case report highlights the use of cyproheptadine in treating intracerebral vasospasm secondary to serotonin agonist sumatriptan. In patients who develop cerebral vasospasm secondary to use of serotonergic drugs, cyproheptadine may be considered as a treatment option due to its antiserotonergic properties.
Authors/Disclosures
Jennifer Chima, MD (Cleveland Clinic)
PRESENTER 		Dr. Chima has nothing to disclose.
Tracey H. Fan, DO Dr. Fan has nothing to disclose.
Christopher R. Newey, DO (Sanford Health) Dr. Newey has nothing to disclose.