Cerebrovascular Injury Following Scorpion Sting and Snake Envenomation: A Case Series

Mishra, Ajay Kumar; Binu, Aditya John; Abraham, Georgi; Vanjare, Harshad Arvind; George, Tina; Iyadurai, Ramya

doi:10.1017/cjn.2018.328

Cited by 12 publications

(8 citation statements)

References 32 publications

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“…These manifestations appear in patients with persistently depressed sensorium and focal neurological deficits that begin early and then develop into cerebrovascular lesions after snakebite envenomation, as was observed in our 2 cases. 15 The diagnoses were confirmed by clinical findings associated with CT examination. Imaging is the method of choice for immediate detection of cerebrovascular hemorrhage.…”

Section: Discussionmentioning

confidence: 89%

Cerebrovascular Accidents Related to Snakebites in the Amazon—Two Case Reports

Sachett

Silva

Dantas³

et al. 2020

Wilderness & Environmental Medicine

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The objective of this case series was to describe 2 patients presenting with subarachnoid hemorrhage with hydrocephalus and hemoventricle after a snakebite caused by presumed Bothrops ssp. Both cases occurred in the municipality of Guajar a (Amazonas state), Western Brazilian Amazon. Both cases featured delay in administration of serum therapy, which may have contributed to the emergence of complications such as stroke. Patient 1 was admitted to hospital 16 h after the snakebite occurred. Before receiving antivenom, testing showed the patient as having unclottable blood. She developed hemorrhagic stroke (a subarachnoid hemorrhage with hydrocephalus and hemoventricle). On the seventh day, she was discharged from hospital. Patient 2 arrived at the hospital 3 d after the snakebite occurred and presented with unclottable blood. He had a stroke (right frontoparietal hemorrhage, intraparenchymal hemorrhage already open to the ventricle) and died on the eighth day after the snakebite. Delay in seeking health care after snake envenomation can result in worse outcome.

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Section: Discussionmentioning

confidence: 89%

Cerebrovascular Accidents Related to Snakebites in the Amazon—Two Case Reports

Sachett

Silva

Dantas³

et al. 2020

Wilderness & Environmental Medicine

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show abstract

“…Clinical findings specific to patients with imaging evidence of cerebrovascular event have not been reported in studies so far. Unlike other infections no specific pattern of neurovascular involvement has been reported [10][11][12].…”

Section: This Article Is Distributed Under the Terms Of The Creative Commonsmentioning

confidence: 81%

Cerebrovascular events in COVID-19 patients

Mishra

Sahu

George

et al. 2020

Monaldi Arch Chest Dis

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Neurological manifestations in patients with COVID–19 are more frequently being reported. Cerebrovascular events have been reported in around 3% of patients. In this review we summarize the published literature on cerebrovascular events in patients with COVID-19 as available on the PubMed database. So far, 3 studies have reported cerebrovascular events. Cerebrovascular events were identified on screening patients with decreased consciousness or in the presence of focal neurological deficits. These events were common in elderly, critically ill patients and in patients with prior cardio-cerebrovascular comorbidities. The diagnosis of cerebrovascular events was confirmed with computed tomography of the brain in most studies reporting neurological events. Multiple pathological mechanisms have been postulated regarding the process of neurological and vascular injury among which cytokine storm is shown to correlate with mortality. Patients with severe illness are found to have a higher cardio- cerebrovascular comorbidity. With an increasing number of cases and future prospective studies, the exact mechanism by which these cerebrovascular events occur and attribute to the poor outcome will be better understood.

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“…Death occurred in one patient following multi organ dysfunction and cardiac rupture after multiple bee stings. As per the author’s knowledge, this is the first review summarizing the various mechanisms, clinical features, management, and outcome following envenomation’s precipitating TTC[ 34 , 35 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Takotsubo cardiomyopathy following envenomation: An updated review

Mishra¹,

George²,

John³

et al. 2023

World J Cardiol

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BACKGROUND Takotsubo cardiomyopathy (TTC) can be diagnosed in patients presenting with clinical features of acute coronary syndrome (ACS) by using Mayo clinic criteria. Multiple precipitators have been attributed to causing TTC. Rarely it has been reported to occur following an acute envenomation. AIM This review describes the various patterns, mechanisms, and outcomes of envenomation induced TTC. METHODS In this review, we included all studies on “TTC” and “envenomation “published in the various databases before June 2022. To be included in the review articles had to have a distinct diagnosis of TTC and an envenomation RESULTS A total of 20 patients with envenomation induced TTC were identified. Most episodes of envenomation induced TTC were reported following a bee sting, scorpion sting, and snake envenomation. Fear and anxiety related to the sting, direct catecholamine toxicity and administration of exogenous beta-adrenergic agents have been commonly postulated to precipitate TTC in these patients. 95% of these patients presented with a clinical picture of ACS. Most of these patients also fulfill at least 3 out of 4 criteria of Mayo clinic criteria for TTC. Echocardiographic evidence of Apical TTC was noted in 72% of patients. 94% of these patients had clinical improvement following optimal management and 35% of these patients were treated with guideline directed medications for heart failure. CONCLUSION Envenomation following multiple insect stings and reptile bites can precipitate TTC. Most reported envenomation related TTC has been due to bee stings and scorpion bites. Common mechanisms causing TTC were fear, anxiety, and stress of envenomation. Most of these patients present with clinical presentation of ACS, ST elevation, and elevated troponin. The most common type of TTC in these patients is Apical, which improved following medical management.

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Cerebrovascular Injury Following Scorpion Sting and Snake Envenomation: A Case Series

Cited by 12 publications

References 32 publications

Cerebrovascular Accidents Related to Snakebites in the Amazon—Two Case Reports

Cerebrovascular Accidents Related to Snakebites in the Amazon—Two Case Reports

Cerebrovascular events in COVID-19 patients

Takotsubo cardiomyopathy following envenomation: An updated review

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