Stroke after multiple bee sting: a rare presentation
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Various manifestations after bee sting have been described. Local reactions are common. Unusually, manifestations like vomiting, diarrhea, dyspnea, generalized edema, acute renal failure, hypotension and collapse may occur. Rarely vasculitis, serum sickness, neuritis and encephalitis have been described which generally develop days to weeks after a sting.

Published in the Journal of The Association of Physicians of India, the authors report a case of a 25-year-old male who developed left sided monoparesis and transient visual loss following multiple bee stings. Unlike the previous case reports, in this case there has been involvement of both the anterior circulation and posterior circulation territory to the brain.

A 25 year old male working in electric motor workshop was bitten by multiple bees over head and neck region in afternoon. He was treated with intravenous antihistamines and antiemetics and was discharged as out- patient. Patient woke up the next day morning and found that he was having left upper limb weakness and with blurring of vision.

CT brain was immediately taken which revealed right frontal hypodensities with squashing of ipsilateral ventricles with hypodensities over both occipital lobes. MRI brain was obtained which revealed anterior infarct –right frontoparietal region, right occipital region, right gangliocapsular region with mild luminal narrowing of middle cerebral artery with haemorrhagic transformation.

Carotid and vertebral Doppler was also done which was within normal limits. ECG and echocardiography were normal. Patient’s serum homocysteine, lupus anticoagulant and anticardiolipin antibodies were within normal limits. Patient was treated with antioedema measures, antiplatelet drugs and physiotherapy.

His left upper limb monoparesis gradually improved and patient was discharged from the hospital. Patient’s visual acuity also improved. Patient was reevaluvated 8 months after the incident. His left upper limb monoparesis had completely recovered. CT- Brain was again repeated 8 months later which revealed old infarct with gliotic changes in right high parietal and occipital region.

Clinical pearls:-
- In this patient, the authors postulate that the systemic immune mediated reaction to the bee sting caused vasoconstriction and a prothrombotic state with subsequent ischaemia leading to stroke.

- Hypotension caused by anaphylaxis may certainly induce cerebral and optic nerve ischaemia; however, this was not documented in this case.

- Similar to acute myocardial infarction after hymenoptera stings, it has been suggested that vasoconstriction secondary to mediators released after the sting, aggravated by exogenous adrenaline, and platelet aggregation also contribute to cerebral ischaemia.

- Bee venom itself contains histamine, thromboxane, leucotrienes, and other vasoactive and inflammatory mediators.

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Dr. A●●●k D●●●●r and 1 others like this
S●●●●h N●●●●●●●n
S●●●●h N●●●●●●●n General Medicine
Excellent case our hospital also we saw the two cases of stroke after bee sting
Jan 27, 2019Like1
Dr. V●●●●l c●●●●a
Dr. V●●●●l c●●●●a Internal Medicine
I have seen a case of paraparesis after bee sting may be immunological myelopathy responded to steroids
Jan 27, 2019Like