Ischemic Stroke After Wasp Sting

Kulhari, Ashish; Rogers, Ashley; Han, Wei; Kumaraswamy, Vishakhadatta Mathur; Xiong, Wei; DeGeorgia, Michael

doi:10.1016/j.jemermed.2016.06.016

Cited by 14 publications

(5 citation statements)

References 15 publications

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“…[ 9 ] Possible mechanisms of cerebral ischemia in this case include systemic effects of venom and anaphylaxis, including hemodynamic instability, myocarditis, and potential arrhythmia, causing thromboembolic stroke, hypoperfusion and watershed infarct, and vasculotoxic effects of venom. [ 10 ] Treatment includes antiplatelets and statins for the thrombogenic response. Anti-histamines and steroids help treat allergic reaction and prevent vasoconstriction.…”

Section: Discussionmentioning

confidence: 99%

Wasp sting – Causing a fatal menace

et al. 2021

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Wasp stings are seen routinely in emergency setup, especially in developing countries. They result in varied manifestations, including both local and systemic reactions. Neurological complications, like stroke, are infrequent in the presentation. A 40-year-old healthy male presented with two episodes of generalized tonic-clonic seizures with left dense hemiplegia after 6 h of massive wasp stings. Local manifestations of urticaria, redness, and itching were present over the face, neck, and upper limbs. Magnetic resonance imaging showed massive infarct in the anterior and middle cerebral artery regions with right internal carotid artery thrombosis. An echocardiogram showed severe left ventricular dysfunction with no evidence of clot, and the carotid duplex study was normal. Systemic manifestations such as anaphylactic shock, stroke, and myocarditis are rare, fatal, and life-threatening. We must be aware of these most unusual and possible complications following a hymenopteran sting.

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Section: Discussionmentioning

confidence: 99%

Wasp sting – Causing a fatal menace

et al. 2021

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“…The only patient who required admission in the Formicidae group had underdiagnosed ischemic stroke. Some studies reported the occurrence of ischemic stroke in association with hymenopteran stings, but most of these cases were associated with Vespidae stings [ 39 , 40 ]. Multiple organ dysfunction syndrome (MODS) is generally reported after multiple wasp stings, but it is less reported because of ant venom, unless the stings are extremely severe [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan

Lin

Chiu

Chang

et al. 2020

IJERPH

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Background: Hymenopteran stings are the most common animal insult injury encountered in the emergency department. With increasing global spread of imported fire ants in recent decades, the rate of Formicidae assault has become a serious problem in many countries. Formicidae-associated injuries gradually increased in Taiwan in recent decades and became the second most common arthropod assault injury in our ED. The present study aimed at comparing the clinical characteristics of Formicidae sting patients with those of the most serious and common group, Vespidae sting patients, in an emergency department (ED) in Taiwan. Methods: This retrospective study included patients who were admitted between 2015 to 2018 to the ED in a local teaching hospital in Taiwan after a Vespidae or Formicidae sting. Cases with anaphylactic reaction were further compared. Results: We reviewed the records of 881 subjects (503 males, 378 females; mean age, 49.09 ± 17.62 years) who visited our emergency department due to Vespidae or Formicidae stings. A total of 538 (61.1%) were categorized into the Vespidae group, and 343 (38.9%) were sorted into the Formicidae group. The Formicidae group had a longer ED length of stay (79.15 ± 92.30 vs. 108.00 ± 96.50 min, p < 0.01), but the Vespidae group had more cases that required hospitalization (1.9% vs. 0.3%, p = 0.04). Antihistamines (76.8% vs. 80.2%, p < 0.01) were more frequently used in the Formicidae group, while analgesics were more frequently used in the Vespidae group (38.1% vs. 12.5%, p < 0.01). The Vespidae group had more local reactions, and the Formicidae group had more extreme, systemic, or anaphylactic allergic reactions. Creatine kinase was significantly higher in the Vespidae group with an anaphylactic reaction. Sting frequency in both groups exhibited the same positive associations with average temperature of the month and weekend days. Conclusion: Formicidae sting patients presented to the ED with higher rate allergic reactions and spent more time in the ED than Vespidae sting patients. However, Vespidae sting patients had more complications and higher rates of admission, especially with anaphylactic reaction. Laboratory data, especially creatine kinase data, were more valuable to check in Vespidae sting patients with an anaphylactic reaction in the ED. Both groups exhibited positive correlations with temperature and a higher rate on weekend days.

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“…[ 1 ] Various mechanisms of stroke following bee sting are as follows: 1) vasospasm of blood vessels due to vasoactive peptides and sympathetic activation; 2) leukotrienes and thromboxane which are prothrombotic and proinflammatory can cause platelet aggregation and can lead to thrombus formation in the blood vessels; 3) cardioembolic stroke following paroxysmal atrial fibrillation; 4) anaphylaxis causing severe hypotension resulting in decreased cerebral hypoperfusion leading to watershed infarct. [ 2 ]…”

Section: T Hrombolysis In I Schemic ...mentioning

confidence: 99%

“…In their case, CT angiography showed multiple areas of vasospasm in the bilateral middle cerebral artery regions. [ 2 ]…”

Section: T Hrombolysis In I Schemic ...mentioning

confidence: 99%