Abstract
Background
Despite the common occurrence of hymenopteran stings worldwide, primary neurologic
manifestations including stroke are rare. We report a case of a healthy male who developed
a right middle cerebral artery (MCA) territory ischemic stroke after getting stung
by a wasp.
Case Report
A 44-year-old man with hypertension presented to the hospital with sudden-onset left
hemiparesis, left facial weakness, and dysarthria after being stung by a wasp. Magnetic
resonance imaging (MRI) and magnetic resonance angiography (MRA) scans of the brain
revealed a right MCA territory infarct and a lack of flow in the distal right internal
carotid artery and MCA. He was treated with intravenous tissue plasminogen activator.
A computed tomography angiography scan of the brain performed 24 hours later revealed
multiple regions of vasoconstriction in the territory of the bilateral MCA. Evaluations
for causes of stroke, including echocardiography and telemetry, were not revealing.
Immunologic testing showed significantly elevated levels of serum wasp immunoglobulin
E. Therapy with aspirin and atorvastatin was started. At discharge, the patient had
a mild left facial droop but normal strength in his left arm and leg.
Why Should an Emergency Physician Be Aware of This?
Emergency physicians encounter large numbers of hymenopteran sting cases each year.
These patients typically present with local reactions, such as itching, pain, and
erythema. Systemic manifestations, such as anaphylaxis causing severe hypotension
and bronchospasm, are less common but deadly. Neurologic complications, such as ischemic
stroke, are extremely rare. This manuscript highlights the pathophysiology and management
of stroke after a hymenopteran sting. There are no guidelines for the management of
stroke after a hymenopteran sting, and therefore we intend to provide some guidance
to physicians for treating stroke after a hymenopteran sting.
Keywords
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Article info
Publication history
Published online: August 18, 2016
Accepted:
June 4,
2016
Received in revised form:
May 4,
2016
Received:
February 26,
2016
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
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