Concurrent ischemic strokes from occlusion of carotid and vertebral arteries following a wasp sting on the tongue - case report

Radojica Stolić; Vekoslav Mitrovic; Snezana Lazic; Bratislav Lazic

doi:10.5937/afmnai42-51007

Radojica Stolić Univerzitet u Kragujevcu Fakultet medicinskih nauka
Vekoslav Mitrovic University of East Sarajevo, Faculty of Medicine Foca, Republika Srpska, Bosnia, and Herzegovina
Snezana Lazic
Bratislav Lazic

DOI: https://doi.org/10.5937/afmnai42-51007

Keywords: Wasp sting, Stroke, Border-zone infarction

Abstract

Background: There are no specific risk factors for stroke after bee or wasp stings. There are examples in the literature that multiple punctures in the head and neck area can significantly cause the appearance of these serious complications. We present the case of a previously healthy man with multiple acute brain infarctions in the subcortical and boundary part of the middle cerebral artery, as a result of total bilateral thrombosis of the internal carotid artery and the right vertebral artery, caused by a with one sting of a wasp in the tongue, with complete neurological recovery.

Case report: Male, 57 years old, right-handed, with a history of arterial hypertension, hyperlipoproteinemia, smoking, positive family history of cardiovascular diseases. He was hospitalized due to a speech disorder, weakness of the left side, and altered behavior. Magnetic resonance imaging of the brain showed multiple infarcts in the border and subcortical part of the middle cerebral artery. Computed tomographic angiography of blood vessels of the head and neck confirmed total bilateral occlusion of the internal carotid artery and the right vertebral artery.

Conclusion: Complete neurological recovery follows during hospitalization. Non-specific clinical pictures and neurological findings, after a wasp sting in the tongue, which are characteristic of border zone infarction, especially of bilateral localization, can confuse the emergency physician and wrongly suspect massive thrombosis of blood vessels of the neck.

Keywords: Wasp sting, Stroke, Border-zone infarction

References

1. Sundaramoorthy K, Vishwanathan S, Arulneyam J. Wasp stingsrelated cerebral infarction in a toddy tapper with multiple previous stings. Eur J Neurol 2011;18:1–3.
2. Kulhari A, Rogers A, Wang H, Kumaraswamy VM, Xiong W, DeGeorgia M. Ischemic stroke after wasp sting. J Emerg Med 2016;51:405–10.
3. Moein P, Zand R. Cerebral Infarction as a Rare Complication of Wasp Sting. J Vasc Interv Neurol 2017;9(4):13-16.
4. Gök S, Ulker S, Hüseyinov A, Hatip FB, Cinar MG, Evinç A. Role of leukotrienes on coronary vasoconstriction in isolated hearts of arthritic rats: effect of in vivo treatment with CI-986, a dual inhibitor of cyclooxygenase and lipoxygenase. Pharmacology 2000;60(1):41-6. doi: 10.1159/000028345.
5. Vidhate MR, Sharma P, Verma R, Yadav R. Bilateral cavernous sinus syndrome and bilateral cerebral infarcts: A rare combination after wasp sting. J Neurol Sci 2011; 15;301(1-2):104-6. doi: 10.1016/j.jns.2010.10.020.
6. Crawley F, Schon F, Brown MM. Cerebral infarction: a rare complication of wasp sting. J Neurol Neurosurg Psychiatry 1999;66:550–1.
7. Riggs JE, Ketonen LM, Bodensteiner JB, Benesch CG. Wasp sting-associated cerebral infarction: a role for cerebrovascular sympathetic innervation. Clin Neuropharmacol 1993; 16:362-5.
8. Romano JT, Riggs JE, Bodensteiner JB, Gutmann L: Wasp sting-associated occlusion of the supraclinoid internal carotid artery: Implications regarding the pathogenesis of Moyamoya syndrome. Arch Neurol 1989;46:607-608.
9. Viswanathan S, Muthu V, Singh AP, Rajendran R, George R. Middle cerebral artery infarct following multiple bee stings. J Stroke Cerebrovasc Dis 2012;21(2):148-50. doi: 10.1016/j.jstrokecerebrovasdis.2010.06.003.
10. Temizoz O, Celik Y, Asil T, Balci K, Unlu E, Yilmaz A. Stroke due to bee sting. Neurologist 2009;15(1):42-3. doi: 10.1097/NRL.0b013e31818c7251.