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Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Ischemic Stroke After Wasp Sting
Ashish Kulhari1, Ashley Rogers1, Han Wang1
1Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio.
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.
Insights
A rare case of ischemic stroke occurred in a healthy male following a wasp sting. This highlights the potential for severe neurologic complications from hymenopteran stings, necessitating emergency physician awareness.
Area of Science:
- Neurology
- Immunology
- Toxicology
Background:
- Hymenopteran stings are common globally, but primary neurologic complications like stroke are exceptionally rare.
- This case report details a rare instance of ischemic stroke following an insect sting.
Observation:
- A 44-year-old man experienced sudden left-sided weakness and facial droop after a wasp sting.
- Brain imaging confirmed a right middle cerebral artery (MCA) territory infarct and revealed widespread vasoconstriction.
Findings:
- The patient presented with symptoms consistent with an MCA stroke post-wasp sting.
- Elevated serum wasp immunoglobulin E levels suggest an immunologic reaction triggered the stroke.
- The patient showed partial recovery with aspirin and atorvastatin therapy.
Implications:
- Emergency physicians must consider rare neurologic complications, such as stroke, in patients presenting after hymenopteran stings.
- This case underscores the need for further research into the pathophysiology and management of stroke secondary to insect stings.
- The findings suggest a potential link between hymenopteran venom exposure and cerebrovascular events.
