Placenta hydrolysate/serotonin uptake inhibitors
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Reversible cerebral vasocontriction syndrome (first report with placenta hydrolysate): case report A 44-year-old woman developed reversible cerebral vasoconstriction syndrome (RCVS) following administration of placenta hydrolysate [Laennec]; she was also receiving treatment with an SSRI. The woman started receiving SC injections of placenta hydrolysate once every 2 days for skin whitening and alleviating symptoms of menopausal syndrome [dose not stated]. She received six injections during a 2-week period, and subsequently experienced a thunderclap headache 18 days after starting treatment. This coincided with the start of her menstrual period. She had a history of hypertension and depression, for which she had been receiving an oral SSRI [drug not specified] for the past year. She was taken to a local clinic, where NSAIDs were prescribed and she was sent home. Her pain improved mildly, but did not resolve. Four days after her first headache, she experienced a second thunderclap headache. A CT scan was performed, but no abnormalities were noted. A third headache developed 6 days after her first, and she was hospitalised. An MRI angiography brain scan demonstrated numerous segmental cerebrovascular vasoconstriction in her anterior cerebral arteries and her left middle cerebral artery. The woman was treated with rest and fluids. Her SSRI was continued, and her headache started to improve the following day. On day 12 after onset, her headache had mostly resolved. A diagnosis of RCVS was made. Three months later, a follow-up MRA showed complete resolution. No further headaches occurred in 6 months’ follow-up. Author comment: While it is true that this patient had been taking an oral SSRI, which is a possible inducting factor for RCVS, for a year, the patient had been taking the same dose level up until this episode, and therefore, there is little correlation between the SSRI dosing and this event. However, it is not possible to completely rule out the possibility that it could have had an effect as a combination of factors. Matsuyama Y, et al. A case of reversible cerebral vasoconstriction syndrome (RCVS) triggered by human placenta extract. Rinsho Shinkeigaku 52: 182-185, No. 3, Mar 2012. Available from: URL: http://dx.doi.org/10.5692/ clinicalneurol.52.182 [Japanese; summarised from a translation] 803073547 Japan
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of reversible cerebral vasoconstriction syndrome associated with placenta hydrolysate. The WHO ADR database did not contain any reports of cerebral vasoconstriction associated with placenta extract, non-estrogenic.
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Reactions 14 Jul 2012 No. 1410
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