Cerebral Infarction As a Rare Complication of Wasp Sting

Cerebral Infarction As a Rare Complication of Wasp Sting

Cerebral Infarction as a Rare Complication of Wasp Sting 1 123 Payam Moein, MD and Ramin Zand, MD, MPH 1Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, United States (email: [email protected] 2Department of Neurology, Geisinger Medical Center, Danville, Pennsylvania, United States 3Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia, United States Introduction Journal of Vascular and Interventional Neurology, Vol. 9 Vol. and Interventional Neurology, Journal of Vascular Wasps, bees, and hornets belong to the order of insects There were an expected swelling and redness at the sting called “Hymenoptera.” Millions of cases of Hymenop- site on the back of his right hand. tera stings happen every year around the world. Fre- quently, they are accompanied by local inflammatory The neurological examination was significant for mild reactions. Less commonly, victims develop severe sys- dysarthria, uncontrollable movement of the left hand temic allergic reactions presenting with hypotension or (alien hand syndrome), decreased sensation to touch, anaphylactic shock, generalized edema, respiratory fail- pain, and temperature as well as extinction to double ure, or even multiple organ failures. Although rare, neu- simultaneous stimulation in the entire left upper extrem- rological complications including stroke have been ity. We also noticed vertical and horizontal nystagmus as reported (Table 1). In this paper, we present a case of well as ataxic gait and impaired tandem gait, which, ischemic stroke 30 min after a wasp sting, and a system- according to the patient, were chronic symptoms secon- atic review of the literature. dary to his multiple sclerosis. Case Presentation His initial blood and imaging workup including cell blood count, complete metabolic and coagulation panel, A 53-year old Caucasian man was stung by a wasp on lipid profile, hemoglobin A1c, cardiac enzymes, electro- his right hand while he was working in his garage. Ini- cardiogram, chest x-ray was unremarkable except for a tially, there was just local pain and inflammation without mildly elevated serum creatinine (1.89 mg/dl) and an any systemic reaction. Thirty minutes later, while he was elevated serum low-density lipoprotein (160 mg/dl) and sitting on a chair, he noticed that his left upper limb triglyceride (329 mg/dl). Initial head computed tomogra- became numb and started moving out of his control. He phy (CT) scan was negative for any acute finding. The presented to our emergency department. magnetic resonance imaging (MRI) study of the brain, obtained within 6 hours, showed two punctate diffusion Past medical history was significant for multiple sclero- lesions in the right frontoparietal area consistent with sis which was diagnosed in 2002 and has been inactive acute cerebral infarction (Figure 1). A magnetic reso- since, coronary artery disease with myocardial infarction nance angiography (MRA) of the head and neck was and angioplasty in 2012, hypertension, and hyperlipide- unremarkable. The Doppler ultrasonography of the mia. His home medication included daily lisinopril 20 lower extremities, transthoracic echocardiography and mg and intermittent use of daily aspirin 81 mg. He transesophageal echocardiography, and hypercoagulable denied any history of smoking or alcohol consumption. and vasculitis panel were all unremarkable. A 4-day Family history was negative for stroke. inpatient telemetry results did not show any atrial fibril- lation or other abnormal cardiac rhythm. In the emergency department, the examination revealed a slightly overweight man, afebrile, with normal blood He was prescribed aspirin 325 mg and atorvastatin 80 pressure and respiratory rate, and mild tachycardia with mg daily. The left-hand movement stopped soon after a normal level of consciousness. Lungs were clear to admission; however, there was a mild residual weakness auscultation and heart was regular rate and rhythm with in the left hand. The weakness was completely resolved no adventitious sounds. No carotid bruit was noted. within 4 days. Vol. 9, No. 4, pp. 13–16. Published June, 2017. All Rights Reserved by JVIN. Unauthorized reproduction of this article is prohibited 14 Table 1. Case Reports on Ischemic Stroke and Other Associated Neurological Manifestations Following Bee/ Wasp Bite Presentation Number of stings and Imaging findings Outcome Other complica- location / Time inter- tions val between sting and stroke symptoms Schiffman, et 57 years old with left 30–40 bee sting on MRI & CT – right occipital Partial improvement of Ischemic optic al.[1] homonymous hemianopia head, face, neck and ischemic infarct followed with visual field loss neuropathy, hem- followed by unresponsive- right arm / 2 days a large right temporo-occipital orrhagic stroke ness hemorrhagic infarct Crawley et al. 30-year old with anaphy- Single wasp sting / 36 CT – left occipital infarction Full recovery Anaphylaxis, res- [2] laxis and respiratory failure hours piratory failure after a wasp sting. Right homonymous superior quadrantanopia after 36 hours Riggs et al.[4] 52-year old with anaphylac- Single wasp sting / a MRI – diffuse bilateral hemi- Noto reported Seizure, anaphy- tic shock 2 min after a wasp few hours sphere stroke lactic shock sting followed by slurred MRA – complete right internal Journal of Vascular and Interventional Neurology, Vol. 9 Vol. and Interventional Neurology, Journal of Vascular speech and left hemiparesis carotid artery and near com- a few hours later plete left internal carotid artery occlusion Rajendiran et 25-year old with left hemi- Multiple bee stings on MRI – right parietal and basal Complete motor and None al.[5] paresis and transient visual head and neck / not ganglia infarct vision recovery in 8 loss reported months Wani et al.[6] 40-year old with right hem- >50 wasp stings entire MRI – multiple ischemic Vegetative state Anaphy- iparesis, and severe multi- body / 16 hours lesions in bilateral cerebral laxis, multior- organ dysfunction. hemispheres, pons, bilateral gan failure thalami, and left parieto-occipi- tal region. Temizoz et al., 60-year old developed a left Multiple bees stings MRI – ischemic changes in the Residual hemiparesis None 2009[7] sided hemiplegia and dys- entire body / 2 hours frontal lobes, right temporopar- after three months arthria ietal area, and bilateral centrum semiovale Sachdev et al., 40-year old with left hemi- Single wasp sting on MRI – right ventral pons, and Complete motor recovery None 2002[8] plegia and right facial face / 10 hours right cerebellum infarction within 5 days. Some droop improvement of cerebel- lar function and dysarth- ria after two months Stalin Viswa- 59-year old with dysarthria, Multiple bees sting MRI – right MCA territory Complete resolution of Seizure nathan et al., left sided upper motor neu- entire body / 2 hours infarct dysarthria and cranial 2012 [9] ron facial nerve palsy, left nerve deficits with signif- hemiplegia and left conju- icant recovery from the gate gaze palsy left hemiplegia after two weeks J. MURRAY 36-year old with confusion Multiple yellow jackets Not reported several generalized con- Seizure, intracere- DAY, 1962[10] and right hemiplegia stings over the neck, vulsions and hemody- bral hemorrhage, face and arms / 15 namic instability within and death minutes few hours followed by decerebration, intracere- bral hemorrhage, and death within 30 hours after the stings Mukund R. 8 years old with left hemi- Not reported CT: non-hemorrhagic infarcts resolution of encephalop- Orbital cellulitis, Vidhate et al., plegia and altered mental in left frontoparietal and bilat- athy and some improve- bilateral caver- 2011[11] status followed by right eral subcortical regions and ment in left hemiplegia nous sinus throm- hemiplegia, ophthalmople- bilateral cavernous sinus with persistence right bosis gia, and partial left ophthal- thrombosis ophthalmoplegia 15 days moplegia MRI: infarcts in the left fronto- after admission parietal cortex, posterior limb of internal capsule, and right subcortical region Romano JT, et 34 months old with dysarth- Single yellow jacket’s CT – left putamen and caudate NR None al.,1989[12] ria and right hemiparesis sting on the inner side ischemic infarct of his upper lip / 4 days Angiography – left supracli- noid internal carotid artery occlusion Weeranun 64-year old with left hemi- Multiple bee stings on MRI: Large right MCA terri- Complete neurological Non ST-elevated Dechyapirom paresis and heart attack face, neck, chest, and tory ischemic stroke recovery within a week myocardial et al.,2010[13] upper extremities / 16 infarction hours De-Meing 71-year old woman with Multiple wasps entire Arteriography – total occlusion Partial recovery Infrarenal aortic Chen et al., left hemiplegia followed by body / 24 hours of the infrarenal aorta Two artery occlusion 2004[14] paraplegia. weeks later, CT – right MCA territory infarction Moein and Zand 15 Journal of Vascular and Interventional Neurology, Vol. 9 Vol. and Interventional Neurology, Journal of Vascular Figure 1. Diffusion-weighted image (a) and T2-FLAIR (B) brain MRI showed two punctate ischemic lesions in the right frontoparietal. Discussion stroke in the cases of wasp sting to the head and neck area [4]. We found 13 other case reports of ischemic stroke fol- lowing wasp or bee sting in a systematic literature Our patient’s presentation was consistent with “Alien review on articles published prior to July 2015 in hand syndrome” that can occur in patients with stroke. PubMed

View Full Text

Details

  • File Type
    pdf
  • Upload Time
    -
  • Content Languages
    English
  • Upload User
    Anonymous/Not logged-in
  • File Pages
    4 Page
  • File Size
    -

Download

Channel Download Status
Express Download Enable

Copyright

We respect the copyrights and intellectual property rights of all users. All uploaded documents are either original works of the uploader or authorized works of the rightful owners.

  • Not to be reproduced or distributed without explicit permission.
  • Not used for commercial purposes outside of approved use cases.
  • Not used to infringe on the rights of the original creators.
  • If you believe any content infringes your copyright, please contact us immediately.

Support

For help with questions, suggestions, or problems, please contact us