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Scorpion bite-induced ischaemic stroke
Rakesh Reddy C1, Nandakishore Bompelli1, Vikram Khardenavis2
1Department of Internal Medicine, Aditya Hospital, Warangal, Telangana, India.
Insights
A scorpion bite led to a 54-year-old woman developing myocarditis and a massive stroke. This case highlights the severe neurological complications, including middle cerebral artery (MCA) infarct, that can arise from scorpion envenomation.
Area of Science:
- Neuroscience
- Cardiology
- Toxicology
Background:
- Scorpion stings are a significant public health concern, particularly in tropical and subtropical regions.
- While systemic effects are known, severe neurological complications like ischemic stroke are less commonly reported.
- This case examines the intricate relationship between venomous animal encounters and cerebrovascular events.
Observation:
- A 54-year-old female presented with scorpion bite symptoms, rapidly developing tachycardia and hypotension.
- Cardiac investigations revealed myocarditis, evidenced by elevated creatine kinase MB isoenzyme, ECG, and echocardiography.
- Neurological deterioration occurred 12 hours post-bite, manifesting as right hemiplegia, global aphasia, and altered sensorium.
Findings:
- Brain MRI confirmed a massive left middle cerebral artery (MCA) territory infarct.
- Magnetic resonance angiography showed non-visualisation of the left internal carotid artery (ICA) and MCA.
- Normal coagulation parameters suggested a cardioembolic source for the arterial occlusion.
Implications:
- This case underscores the potential for scorpion envenomation to trigger a cardioembolic phenomenon, leading to devastating cerebral infarction.
- It highlights the critical need for comprehensive cardiac and neurological monitoring in patients with severe scorpion stings.
- Understanding these complex pathophysiological pathways is crucial for developing targeted treatments and improving patient outcomes.
Abstract:
We report a 54-year-old woman with scorpion bite. After 3 hours of admission, the patient developed sudden onset tachycardia with hypotension. Cardiac evaluation showed raised creatine kinase MB isoenzyme was elevated; ECG and two-dimensional echocardiography findings were suggestive of myocarditis. Subsequently, she developed transient ventricular tachycardia before developing abrupt onset, right hemiplegia, global aphasia and progressive worsening of sensorium 12 hours after the bite. MRI of brain revealed massive left middle cerebral artery (MCA) territory infarct. The magnetic resonance angiography showed non-visualisation of left internal carotid artery (ICA) and MCA. Coagulation parameters were normal. Sudden complete occlusion of left ICA was probably secondary to cardioembolic phenomenon leading to massive infarct. Despite aggressive medical and supportive measures, she clinically worsened rapidly to Glasgow Coma Scale of 3/15 over next 6 hours and succumbed to her illness the next day.
