Compartment Syndrome

Severe pain caused due to the inflammation of an enclosed area (compartment) thereby giving no room for the muscles, blood vessels, nerves and bones within the compartment to expand is called compartment syndrome. Veins, nerves and arteries undergo tremendous pressure thereby resulting in pain and slow circulation to the muscles and nerves. It can cause permanent damage to the tissues. Symptoms include severe pain, weakness and paresthesia. Symptoms of compartment syndrome involve 5 Ps - Pain , Pallor, Paresthesia (tingling or burning sensation on the skin), Pulselessness, and Poikilothermia (problem maintaining constant core temperature independent of ambient temperature). Common causes for compartment syndrome:

• Trauma caused due to elevated-force during a road accident. Compartment Syndrome is mostly noticed in long bone fracture, crush injury and circumferential burns to the extremities.
  
  
• Tightly wound bandages or casts.
  
  
• Repetitive forceful activity focusing on a particular compartment alone.
  
  
• Compartment syndrome is likely to occur more often in the lower legs, forearm and less likely in the upper arm, thigh, hand and foot.
  
  

Even after holding the affected part in an elevated position, if the pain does not reduce it is a typical symptom of compartment syndrome. Other symptoms of compartment syndrome are severe weakness and paleness. In case pain is caused by tight bandage or splint then it has to be loosened. The patient must be kept hydrated and hypotension must be avoided. Surgery is often resorted to for cases of compartment syndrome. Fasciotomy surgery is performed on those suffering acute compartment syndrome to minimize tissue damage. Thus the contents of the compartment are allowed to swell without increasing the pressure. After some days the incision is closed. Skin grafting might be required in the affected region.

Sumatriptan

Sumatriptan, part of the family of drugs called as triptans is prescribed for the treatment of Migraine and cluster headaches. Migraine headaches are thought to be the result of dilation of blood vessels in the head. Sumatriptan causes constriction of the blood vessels thus relieving Migraine. Triptans are technically abortive migraine medications. However, Sumatriptan does not prevent or reduce the number of migraine attacks. There is another 'triptan' drug which has slightly less side effects than Sumatriptan - Rizatriptan.

Dosage and Administration: Starting dosage may be 25 mg or at the discretion of the physician. However, the Physician might want the patient to take the first dosage at his office to monitor any adverse heart events. Normal dosage is 25 mg to 100 mg or as prescribed by the Physician. Maximum dose in any 24 hours should not exceed 300 mg orally. Do not use Sumatriptan concomitantly with Ergotamine containing preparations.

Safety and efficacy has not been proved for patients over 65 years or for children.

Contraindications: The use of Sumatriptan is contraindicated in hypersensitivity, ischemic heart disease or previous myocardial infraction, Prinzmetal's angina, coronary vasospasm and controlled hyper tension. Sumatriptan should not be used unless there is a clear diagnosis of Migraine. Before use, exclude underlying cardiac disease especially in patients with risk factors. Chest symptoms may occur which mimic angina but are rarely found to be the result of vasospasm. Vasospasm may result in arrhythmia, ischemia or myocardial infarction. This drug is to be avoided for patients with impaired renal or hepatic functions.

Sumatriptan should not be administered along with ergot type migraine medications, or with MAO inhibitors. Sumatriptan and Ergotamine together can cause prolonged spasm of the blood vessels. It is essential that the use of these two medications should be separated by at least 24 hours.

Side Effects of Sumatriptan: Pain, tingling sensation, heaviness or pressure in the chest region which may be transient. Rarely severe flushing, dizziness, Paresthesia ( unpleasant and abnormal tingling or burning in the hands, arms, feet or legs) weakness, fatigue, drowsiness may occur. Transient rise in blood pressure may occur.

Ergotism

Ergotism is a condition with symptoms of convulsion and gangrene due to ergot poisoning. It usually occurs because of the toxic alkaloids produced by the Claviceps Purpurea fungus which affects rye, barley, wheat and other cereals. The convulsion occurring owing to Ergotism will include muscle spasms, nausea, vomiting, delusions, hallucinations, crawling sensations on the skin or intense burning sensation on the skin, diarrhea, paresthesia (tingling or pricking sensation on the skin) and headaches. Other symptoms of Ergotism include gangrene due to vasoconstriction of the extremities resulting in local stagnant anoxia - occurring in toes and fingers. During the mediaeval times, ergot poisoning had taken a great toll and monks belonging to the Roman Catholic order of the St.Anthony provided effective treatment - earning the disease a sobriquet 'St.Anthony's Fire' or 'Holy Fire'.

Ergot alkaloids are derivatives of Lysergic Acid Diethylamide (LSD), and ergotism sometimes results in hallucinations of bright colors, changes in space, Formication (insects crawling under the skin) and images of marauding animals.

Recently Ergotism, Ergotoxicosis ensues after high doses of ergot alkaloids such as Ergotamine tartrate (Cafatine) and Dihydroergotamine. If it is a mild manifestation, symptoms fade away after stopping the offending drug. But severe cases can be fatal.