Critical vasospasm during fingolimod (FTY720) treatment in a patient with multiple sclerosis

A Schwarz, M Korporal, W Hosch, R Max… - Neurology, 2010 - AAN Enterprises
A Schwarz, M Korporal, W Hosch, R Max, B Wildemann
Neurology, 2010AAN Enterprises
Discussion. The clinical presentation and angiographic findings strongly indicate
vasospasm as primary cause of the disturbed blood flow. Extensive diagnostic investigation
did not show any corresponding pathology to support an embolic etiology, including serum
levels of D-dimer, 24-hour EKG, transesophageal echocardiography, and angiography of
the aortic arch. The thrombi in the distal palmar vessels detectable at follow-up angiography
most likely resulted from persistent blood stasis. Intense evaluation provided no evidence of …
Discussion. The clinical presentation and angiographic findings strongly indicate vasospasm as primary cause of the disturbed blood flow. Extensive diagnostic investigation did not show any corresponding pathology to support an embolic etiology, including serum levels of D-dimer, 24-hour EKG, transesophageal echocardiography, and angiography of the aortic arch. The thrombi in the distal palmar vessels detectable at follow-up angiography most likely resulted from persistent blood stasis. Intense evaluation provided no evidence of an underlying rheumatologic disorder. Furthermore, there was no history of poisoning with ergot alkaloids, and symptoms have not reappeared. Symptoms occurred within 7 days after initiation of treatment and maximal vasospasm was detectable on day 13 after discontinuation of Fingolimod. Given its elimination half-life of 9 days, 2 the chronological sequence of events is suggestive, albeit not confirmable of a causal relation between events. As S1P receptor signaling is involved in protein expres-
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