Transient ischemic attack caused by cerebral ergotism.

Association of protease inhibitors and ergotamine causing systemic ergotism is well established1,2,3. Cerebral ergotism is poorly reported4,5. We describe the case of an HIV positive 49 yo man under protease inhibitors (ritonavir) presenting with total reversible left hemiparesis after the intake of 3 g of ergotamine. After 20 minutes he was spontaneously asymptomatic. TIA was diagnosed. Parenchymal MRI was normal, cervical doppler ultrasound showed symmetric narrowing in both internal carotid arteries, causes of cardiac embolism were properly excluded. Angio Magnetic Resonance Imaging (Figures 1 and 2) was performed in acute stage and evolution, as well as cerebral angiography, leading to the diagnosis of cerebral ergotism. Between both MRI showed, only aspirin 325 mg and bed rest was indicated.