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Yang S, Wellington J, Chen J, Regenhardt RW, Chen AY, Li G, Yan Z, Fu P, Hu Z, Chen Y. Cerebral infarction following bee stings: Case report and literature review. Transl Neurosci 2022; 13:163-171. [PMID: 35860807 PMCID: PMC9267306 DOI: 10.1515/tnsci-2022-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background To date, only 25 cases of cerebral infarction following a bee or wasp sting have been reported. Due to its rarity, undefined pathogenesis, and unique clinical features, we report a case of a 62-year-old man with progressive cerebral infarction following bee stings, possibly related to vasospasm. Furthermore, we review relevant literature on stroke following bee or wasp stings. Case presentation A 62-year-old retired male presented with progressive ischemic stroke after bee stings to the ear and face. Initial magnetic resonance imaging of the brain showed small punctate infarcts in the left medulla oblongata. Head and neck computed tomography angiography showed significant stenosis in the basilar artery and occlusion in the left V4 vertebral artery. The patient received intravenous alteplase (0.9 mg/kg) without symptomatic improvement. Digital subtraction angiography later demonstrated additional near occlusion in the left posterior cerebral artery (PCA). Thrombectomy was considered initially but was aborted due to hemodynamic instability. Repeated CT brain after 24 h showed acute infarcts in the left parieto-occipital region and left thalamus. The near occluded PCA was found to be patent again on magnetic resonance angiography (MRA) 25 days later. This reversibility suggests that vasospasm may have been the underlying mechanism. Unfortunately, the patient had persistent significant neurological deficits after rehabilitation one year later. Conclusion Cerebral infarction following bee stings is rare. There are several proposed pathophysiological mechanisms. While the natural course of this phenomenon is not well characterized, early diagnosis and treatment are essential. Furthermore, it is important to establish standardized care procedures for this unique entity.
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Affiliation(s)
- Shuiquan Yang
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Jack Wellington
- School of Medicine, Cardiff University, Wales, United Kingdom
| | - Juanmei Chen
- The Second Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alex Y Chen
- Department of Neurology, University Hospital, Case Western Reserve University, Cleveland, United States of America
| | - Guilan Li
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Zile Yan
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Pingzhong Fu
- Department of Radiology, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Zhaohui Hu
- Medical Department and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Yimin Chen
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
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Lai D, Tian Y, Zhang J, Weng CF. Hyperendogenous Heparinization Suggests a Guideline for the Management of Massive Wasp Stings in Two Victims. Wilderness Environ Med 2021; 32:344-350. [PMID: 34294538 DOI: 10.1016/j.wem.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/18/2021] [Accepted: 02/26/2021] [Indexed: 10/20/2022]
Abstract
Bees and wasps (order Hymenoptera) are commonly encountered worldwide and often deliver defensive stings when in contact with humans. Massive envenomation resulting from >50 stings causes a toxic reaction and life-threatening complications that typically result in rhabdomyolysis and disseminated intravascular coagulation. Two male patients who were stung over 80 times by wasps experienced severe coagulation abnormality. Consecutive examination by thromboelastography (TEG) guided by heparinase treatment during their hospitalization evidenced heparin-like coagulation dysfunction despite no clinical use of heparin-like substances. Numerous tests were also conducted to confirm whether the coagulation abnormalities could be attributed to hyperendogenous heparinization and allergic reaction, rhabdomyolysis, and vascular endothelial cell injury without apparent disseminated intravascular coagulation, which might all be affected by the production of endogenous heparin. The reduced coagulation potential caused by hyperendogenous heparinization was associated with the binding of antithrombin and the activation of fibrinolysis. In addition, TEG-identified coagulopathy was moderated using protamine for heparin neutralization. The massively envenomed patients survived and were discharged after completion of medical care. We also review clinical manifestations from other published case reports, including topical treatment. Our study provides clinical evidence and guidance for diagnosis via TEG and appropriate intervention with protamine for patients with massive wasp envenomation.
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Affiliation(s)
- Dong Lai
- Department of Transfusion, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; Intensive Care Unit, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; Department of Clinical Medicine, Xiamen Medical College, Xiamen, China
| | - Yan Tian
- Department of Transfusion, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; Department of Clinical Medicine, Xiamen Medical College, Xiamen, China
| | - Jie Zhang
- Department of Transfusion, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; Intensive Care Unit, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Ching-Feng Weng
- Department of Physiology, School of Basic Medical Science, Xiamen Medical College, Xiamen, China.
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Elavarasi A, Haq TM, Thahira T, Bineesh C, Kancharla LB. Acute Ischemic Stroke Due to Multiple Bee Stings_A Delayed Complication. Ann Indian Acad Neurol 2019; 23:135-136. [PMID: 32055140 PMCID: PMC7001444 DOI: 10.4103/aian.aian_118_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Thekkumpurath M Haq
- Department of Neurology, EMS Memorial Cooperative Hospital, Perinthalmanna, Kerala, India
| | - Thekkumpurath Thahira
- Department of Neurology, EMS Memorial Cooperative Hospital, Perinthalmanna, Kerala, India
| | - Cheminikkara Bineesh
- Department of Neurology, EMS Memorial Cooperative Hospital, Perinthalmanna, Kerala, India
| | - Laxmana B Kancharla
- Department of Neurology, EMS Memorial Cooperative Hospital, Perinthalmanna, Kerala, India
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Kausar MA. A review on Respiratory allergy caused by insects. Bioinformation 2018; 14:540-553. [PMID: 31223213 PMCID: PMC6563666 DOI: 10.6026/97320630014540] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023] Open
Abstract
Hypersensitivity or allergy encompasses a wide range of immunological reactions that generally have adverse consequences involving one or many organ systems of the body. Allergens are usually glycoprotein or chemically complex low molecular weight substances. The common allergens include pollen, fungal spores, house dust mite and house dust, animal danders, drugs, foods, insect emanations, and detritus, etc. Information on the role of insects in respiratory allergy is increasing in the literature. There are about 30 million living species of insects. These insects can broadly be classified as stinging insects, biting insects and non-stinging and non-biting insects. All materials form insets namely wings, scales, saliva; dried feces and venom can cause allergic diseases, such as rhinitis, conjunctivitis, asthma and urticaria. There are wide varieties of insects such as moths, butterflies, bees, wasps, hornets, yellow jackets, flies, beetles, cockroaches, and mosquitoes. Exposure to emanations and detritus of these insects may lead to several allergies in some genetically predisposed individuals. Therefore, it is of interest to review allergies caused by various insect's stings and bites and their adverse effect on the human body.
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Affiliation(s)
- Mohd Adnan Kausar
- Department of Biochemistry, College of Medicine, University of Hail, Hail, Saudi Arabia, KSA
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Moein P, Zand R. Cerebral Infarction as a Rare Complication of Wasp Sting. JOURNAL OF VASCULAR AND INTERVENTIONAL NEUROLOGY 2017; 9:13-16. [PMID: 28702114 PMCID: PMC5501123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Payam Moein
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, United States (
| | - Ramin Zand
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, United States (
- Department of Neurology, Geisinger Medical Center, Danville, Pennsylvania, United States
- Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia, United States
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Acute ischemic stroke and severe multiorgan dysfunction due to multiple bee stings. Turk J Emerg Med 2016; 16:126-128. [PMID: 27857993 PMCID: PMC5103060 DOI: 10.1016/j.tjem.2015.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/07/2015] [Accepted: 02/08/2015] [Indexed: 11/22/2022] Open
Abstract
Various manifestations after bee sting have been described. Local reactions, such as pain, wheal, flare, edema and swelling, are common and generally self-limiting. Uncommonly manifestations like vomiting, diarrhea, dyspnea, generalized edema, acute renal failure, anaphylactic shock, myocardial infarction, hypotension, collapse, pulmonary hemorrhage, acute hemorrhagic pancreatitis, and atrial fibrillation may occur. We report a 59 year-old man who sustained ischemic stroke and multi-organ dysfunction following multiple bee stings.
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Kulhari A, Rogers A, Wang H, Kumaraswamy VM, Xiong W, DeGeorgia M. Ischemic Stroke After Wasp Sting. J Emerg Med 2016; 51:405-410. [PMID: 27545856 DOI: 10.1016/j.jemermed.2016.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/04/2016] [Accepted: 06/04/2016] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- Ashish Kulhari
- Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Ashley Rogers
- Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Han Wang
- Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio
| | | | - Wei Xiong
- Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Michael DeGeorgia
- Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio
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Metin K, Kaplan F. Unexpected complication of bee sting; left middle cerebral artery infarction. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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