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Acute Disseminated Encephalomyelitis with Baló-like Lesion by Scorpion Sting: Case Report
Juan D Parada-Garza1, Luis A Miranda-Garcia1, German Lopez-Valencia1
1Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde, Jalisco, México.
Abstract:
Acute disseminated encephalomyelitis (ADEM) has been linked to immunizations, viral infections, and occasionally to arthropods stings. Its association with scorpion stings has not been described. A 29-year-old man, who after being stung by a scorpion presented right hemiparesis and language impairment. Brain MRI showed subcortical bihemispheric lesion characteristics of ADEM and a bigger one compatible with Baló concentric sclerosis (BCS). Patient was managed with steroids, showing complete clinical improvement. Magnetic resonance imaging (MRI) after 6 months showed cavitation of the bigger lesion with no new findings. In 2 years of follow-up, there is no clinical relapse or new lesions in MRI. Although cases of ADEM have been reported due to venom of chilopoda and hymenoptera, the scorpion sting can be considered as another new cause; this case being even more relevant due to present a Baló-like lesion in MRI.
Insights
Scorpion stings can cause acute disseminated encephalomyelitis (ADEM), a rare neurological condition. This case highlights a potential new trigger for ADEM and Baló concentric sclerosis (BCS).
Area of Science:
- Neurology
- Toxicology
- Immunology
Background:
- Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disease.
- ADEM is typically associated with viral infections, vaccinations, and arthropod stings.
- A link between scorpion stings and ADEM has not been previously reported.
Observation:
- A 29-year-old male presented with hemiparesis and aphasia following a scorpion sting.
- Brain MRI revealed lesions consistent with ADEM and a Baló concentric sclerosis (BCS)-like lesion.
- The patient received steroid treatment.
Findings:
- Complete clinical recovery was observed after steroid administration.
- Follow-up MRI showed cavitation of the larger lesion without new abnormalities.
- No clinical relapse or new lesions were noted during a 2-year follow-up period.
Implications:
- Scorpion stings represent a novel potential cause of ADEM.
- This case is significant for presenting ADEM with a Baló-like lesion.
- Further research is warranted to explore the neurotoxic effects of scorpion venom.
