Transient hemorrhagic encephalopathy following an insect bit
The present case has been reported in the journal Annals of Indian Academy of Neurology.

An 18-year-old boy reported with a history of insect bite while sleeping. He noticed pain in his hand, which woke him up, and mild local redness. However, no bite marks were seen. Thirty minutes later, he developed progressive difficulty in breathing and after 6 h became unconscious.

At presentation, Glasgow Coma Scale was M2E2V2. He was intubated immediately on arrival. External ocular movements were normal by Doll's maneuver, and pupils were reacting to the light. Deep tendon reflexes were all brisk, and plantar responses were bilaterally extensor.

MRI revealed multiple T2- and fluid-attenuated inversion recovery (FLAIR) hyperintense foci in the corpus callosum and bilateral cerebral white matter, with associated microhemorrhages. Electroencephalography revealed background slowing in theta to delta range suggestive of diffuse encephalopathy.

He was put on ventilator support and was managed symptomatically. He received intravenous methylprednisolone in a dosage of 1 g daily for 5 days. He progressively improved, and 15 days later, he had complete resolution clinically and radiologically.

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