Ischemic Stroke in a Child after a Probable Scorpion Sting

Abstract

Scorpion stings are common emergencies in the tropics. Species-specific antivenom therapies are available. However, fatalities resulting from scorpion stings remain a public health concern in many settings. Children residing in rural towns and peri-urban areas represent the most vulnerable populations. Delays in the diagnosis of scorpion stings often occur as a result of the non-specific clinical presentations, which then lead to life-threatening complications. We report a 2-year-old Venezuelan boy presenting with acute pancreatitis and pulmonary edema without an identifiable cause 48 hours after his initial symptoms. We administered antivenom therapy when an undetected scorpion sting was suspected. Despite some initial clinical improvement with respect to his acute pancreatitis, pulmonary edema, and coagulation abnormalities, our patient experienced an ischemic stroke. Fortunately, our patient did demonstrate some neurological improvement. Although acute pancreatitis and pulmonary edema are known end-organ damage manifestations of the sting of Tityus in the Americas, our particular case illustrates the risk of ischemic stroke.

Ischemic stroke in a 4 year child resulting from scorpion envenomation: A case report from Nepal.

“…8 Patients presenting with scorpion envenomation have been split into three grades: Patients in grade (I) merely have local pain; those in grade (II) have systemic symptoms; and those in grade (III) have significant neurological impairment (coma and/or convulsions) or cardiorespiratory symptoms, primarily cardiogenic shock and pulmonary edema. 1,2,3 Depending on the species of arachnid and the toxin's plasma levels, the clinical symptoms can vary considerably. The release of endothelin, neuropeptide Y, and nitric oxide is prompted by the toxin.…”

“…The central nervous system outcomes (grade III) resulting from scorpion stings can vary widely and manifest as diminished consciousness, convulsions, subarachnoid hemorrhage, intracerebral hemorrhage, and ischemic infarcts. 3,6 Neurological complications from scorpion stings are well reported in South America, Venezuela, India, and Turkey. Eight percent of patients in a case series drawn from southern India had neurological involvement; of these, four percent had hemorrhagic stroke and four percent had ischemic stroke.…”

“…Globally, it has been documented in only 2% to 5% of cases of scorpionism. 1,2,3,4,5,6,7,8 We hereby present the case of a 4 year old child with features consistent with autonomic storm following scorpion sting who later developed left sided ischemic stroke. However,he lacked features of defibrination syndrome and myocarditis.…”

Subarachnoid hemorrhage following scorpion bite: case report

“…Clinical findings resulting from involvement of sympathetic and parasympathetic systems are observed in victims of scorpion stings. It is wellknown that they are known to cause a stroke, commonly ischemic or rarely hemorrhagic (3,4). Intracranial hemorrhage, as a kind of hemorrhagic stroke, is a rare life-threatening complication of scorpion sting and here we present an extremely rare case of subarachnoid hemorrhage (SAH) caused by scorpion sting poisoning.…”

“…Scorpion stings are a common health problem, especially in hot climates including Africa, India and Latin American countries (1,2). Nowadays, they are one of the most common envenomation observed in the world (3)(4)(5). In Turkey the most common species of scorpion is mesobuthus gibbosus.…”