Scorpion sting as a trigger factor for stroke: a case report.

Scorpion Envenomation

The Indian red scorpion (Hottentotta tamulus) sting is a common clinical encounter that presents with cardiovascular complications. Patients presenting with neurological complications are rare. The present case pertains to a 26-year-old man who presented to the emergency department with complaints of pain in his right index finger following a scorpion sting and later developed seizures with right-sided hemiparesis. The relevant investigations and clinical details of this scorpion sting-induced rare case of hemiparesis are discussed herein.

Stroke following scorpion stings is rare and potentially fatal. Some case reports have been documented, especially in the Indian subcontinent. There is no published report of stroke as a complication of scorpion envenomation from South East Nigeria. Presented is the profile of an elderly woman with hemorrhagic stroke as a complication of a sting from a scorpion which was killed and thereafter ingested. A review of relevant literature is also made. An 83-year-old woman from a rural community was admitted in August 2011 at the University of Nigeria Teaching Hospital, Enugu with dysphasia, altered sensorium and right hemiparesis occurring 4 h after a scorpion sting to the left leg 2 weeks before presentation. Preceding the neurological deficits she had local pain and restlessness. She was not a known hypertensive or diabetic, but had been stung on two previous occasions by scorpions. It was customary to eat the scorpion if killed which was the case here. Systemic examination was remarkable only for drowsiness with a Glasgow Coma Scale of 11/15, mild right facial nerve palsy with ipsilateral spastic hemiplegia. Brain computed tomography scan done about 4 weeks after the ictus showed features consistent with a left intracerebral hemorrhage. She was managed conservatively and recovered motor functions over 3 weeks necessitating discharge. Since there was no other detectable risk factor, we can conclude that the patient suffered a stroke as a result of the vasculotoxic actions of the scorpion venom.

Giris Degisik klinik ozelliklere sahip olan akrep sokmasi vakalari ulkemizde en sik Guneydogu Anadolu’da gorulmektedir. Akrep zehiri icerdigi cesitli enzimler nedeniyle farkli klinik tablolara neden olmakta ve ozellikle cocuklarda kalp etkilenimi nedeniyle olum gorulebilmektedir. Akrep sokmasi sonucu ventrikul yetersizligi, miyokart islev bozuklugu, sistemik hipertansiyon, pulmoner odem ve kardiyojenik sok gorulebilmektedir. Kalp etkilenimi gorulen olgularda pozitif inotrop destegi yaninda alfa blokor ilaclar da kullanilmakta prazosin ve doksazosin bu grupta yer almaktadir. Prazosin katekolamin artisi sonucu olusan kalp hasarini onleyerek etki gostermekte ve tasikardi, hipertansiyon, hipersalivasyon, terleme gibi sempatik bulgularin gelistigi olgularda kullanilabilmektedir. Prazosin yerine ayni etkili doksazosin de tedavide kullanilmakta, ancak etkinligi ve kullanimi konusunda literaturde yeterli veri bulunmamaktadir. Bu yazida, doksazosin kullandigimiz olgu sunuldu. Akrep Sokmalarinda Doksazosinin Etkinligi; Cocuk Olgu Sunumu Effectiveness of Doxazosin in Scorpion Stings; Child Case Report

Introduction. Scorpion stings occur mainly in spring and summer, with an estimate of 1.2 million cases per year worldwide. About 300,000 poisonings occur within a year, primarily affecting children and adults older than 65 years. In 2019, Guanajuato (Mexico) ranked third in poisoning by scorpion sting with a total of 43,913 cases. The intoxication grades are three where the signs and symptoms are varied. There are two types of antivenom in the Mexican market, and we use Alacramyn® in our case. Case presentation. A 70-year-old female —with grade 1 scorpion sting poisoning, 30 minutes of evolution, with type 2 diabetes and high blood pressure— received two vials of antivenom according to current regulations. She presented transient vagal reaction and subsequent transient pain in the cervical region that radiates to the sacral region. At discharge, there are no data compatible with scorpion sting poisoning. Conclusions. Transient pain in the cervical region to the sacral region may be secondary to an anxiety crisis, hypersensitivity to IgG, or secondary reaction to administration in less time than recommended by the provider. The benefit was greater than the reactions that occurred.

Background: Scorpion envenomation is a public health problem especially in tropical and sub-tropical regions where it is considered as one of the important health challenges. It is life threatening condition more in paediatric age groups.

Acute coronary syndrome due to scorpion sting: a case report from Spain.

Scorpions are a group of arthropods known to be highly toxic to humans. We report the case of a previously healthy 61-year-old male who sustained a sting from an Androctonus crassicauda scorpion to his right eye. The patient was admitted to the intensive care unit (ICU) in a comatose state immediately after the sting. A few days later, he suffered from tearing right-eye pain and loss of vision, which persisted despite initial treatment. The patient was subsequently diagnosed with keratitis and admitted to King Abdullah University Hospital (KAUH). He was prescribed various antibiotics, which initially improved his condition. However, the patient experienced subsequent deterioration and recurrent episodes of keratitis. The patient's visual acuity improved after treatment with a combination of antifungal and antibiotic medications, suggesting a polymicrobial infection. Despite the improvement in his condition, the sting left a central corneal scar, necessitating corneal transplant surgery as a definitive treatment. To the best of our knowledge, this scenario has not been previously documented.

The vasa vasorum is a network of microvessels that supplies nutrients to the vessel wall itself. In pathologic conditions, the vasa vasorum can develop as potential collateral channels. Previous research documents revascularization through hypertrophy of the vasa vasorum after occlusion of the carotid artery. However, the relationship between the cerebral vascular demands and the hypertrophy of the vasa vasorum has not been well delineated by functional studies. A 66-year-old man presented with left hemiparesis, dysarthria, and hemineglect. Magnetic resonance imaging revealed an acute infarction in the vascular territory of the right middle cerebral artery. Transfemoral cerebral angiography revealed occlusion of the right proximal internal carotid artery (ICA). Single-photon emission computed tomography study showed decreased vascular reserve in the right cerebral hemisphere. Right superficial temporal artery-middle cerebral artery bypass surgery was performed in an attempt to improve hemispheric perfusion. Follow-up angiography 1 year later showed revascularization of the distal ICA by the hypertrophied vasa vasorum. Follow-up single-photon emission computed tomography study showed persistent decreased vascular reserve. In cases of ICA occlusion, a 1-year or less hungry period for the cerebral vascular demand may activate potential collateral channels of the vasa vasorum. In addition to the metabolic demand of the occluded vessel wall itself, the vascular demands of the hypoperfused brain may be a trigger factor that leads to hypertrophy of the vasa vasorum as collateral channels.

A growing body of evidence confirms that immune activation and low-grade inflammation could be defined as risks factors for the development and progression of mood episodes. A suggested mechanism leading to immune-inflammatory imbalance is the change in gut microbiota composition provoked by intestinal permeability. Three cases of patients with first episode of depression: a 30-year-old man and two 41 and 46-year-old women are presented in the study. In all cases, the episode was proceeded by the infection of the upper respiratory tract and improper antibiotics therapy. Despite the subsidence of infection, gastrointestinal and depression symptoms appeared. Psychiatric care, anti-depressant treatment, and probiotic supplementation were applied with positive results. Changes in gut microbiota and gut permeability are mechanisms probably involved in the development of mood disorders among the described patients. Lack of microbiota and gut permeability analysis allows defining just a temporary, potential cause-effect relationship between disease symptoms and intestinal microbiome alternations. Further studies to establish the importance of gut bacteria, immune-inflammatory cascade at depression etiopathogenesis and therapy are needed.

Persistent idiopathic facial pain can be extremely difficult and significantly challenging to manage for the patient and the clinician. Pharmacological treatment of these painful conditions is not always successful. It has been suggested that the autonomic reflex plays an important role in the pathophysiology of headaches and facial neuralgia. The key structure in the expression of cranial autonomic symptoms is the sphenopalatine ganglion (SPG), also known as the pterygopalatine ganglion. The role of the SPG in the pathophysiology of headaches and facial pain has become clearer in the past decade. In this case report, we describe a 30-year-old woman with insidious onset of right facial pain. She was suffering from daily pain for more than 9 years prior to her visit at the pain clinic. Her pain was constant with episodic aggravation without a predisposing trigger factor. The patient was evaluated by multiple specialties and tried multimodal therapy, which included antiepileptic medications, with minimal pain relief. A SPG block using short-acting local anesthetic provided significant temporary pain relief. The second and third attempt of SPG block using different local anesthetic medications demonstrated the same responses. After a thorough psychological assessment and ruling out the presence of a correctable cause for the pain, we decided to proceed with SPG electrical neuromodulation. The patient reported significant pain relief during the electrical nerve stimulation trial. The patient underwent a permanent implant of the neurostimulation electrode in the SPG region. The patient was successfully taken off opioid medication and her pain was dramatically responsive during a 6-month follow-up visit. In this article we describe the SPG nerve stimulation and the technical aspect of pterygopalatine fossa electrode placement. The pterygoplatine fossa is an easily accessible location. This case report will be encouraging for physicians treating intractable facial pain by demonstrating a novel therapeutic option. This report shows a minimally invasive approach to the SPG. Key words: Sphenopalatine ganglion, persistent idiopathic facial pain, electrical neuromodulation

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease affecting mainly the elderly. The subtype of the disease induced by physical agents represents a rare and, therefore, insufficiently characterized form. In the present study, we aimed to contribute to a better understanding of the pathogenetic mechanisms involved in the onset of BP induced by different trigger factors. We have retrospectively analyzed nine cases of BP. All patients were characterized based on clinical, epidemiological and immunological parameters. For each case, the trigger factor involved was specified. In addition to our retrospective analysis, a comprehensive review of the 59 published cases was conducted, regarding the involvement of trigger factor in BP, and clinical, epidemiological and immunological data were collected. In the local study, conducted on nine patients diagnosed with BP, various trigger factors were identified: contrast substance injection, surgical procedure, mechanical trauma, insect bite, thermal burn, radiotherapy and ultraviolet exposure associated with pre-existing psoriasis. The autoantibodies from all patients were shown to activate granulocytes and induce dermal-epidermal split. Different hypotheses regarding the pathogenetic mechanism involving the trigger factors have been discussed. In regard of the pathogenetic mechanism, we believe that the most reliable hypothesis is that BP patients already have low titers of anti-basement membrane autoantibodies which activate the granulocytes. However, more studies are needed for a better understanding of the pathogenetic mechanism of the intervention of trigger factors.

De Novo Dural Arteriovenous Fistula on Draining Veins of Previously Treated Pial Arteriovenous Malformation: a Case Report.

Generalized morphea is a rare fibrosing skin illness that progresses from erythematous, violet-colored skin patches to sclerotic plaques. Another uncommon immune-mediated connective tissue disease called eosinophilic fasciitis (EF) evolves to cause sclerosis and woody skin induration. The coexistence of the two is extremely rare and has a poorer prognosis. Our case report is one of the first to report burn injuries as a trigger factor for EF and generalized morphea overlap. Case Presentation. A 36-year-old man presented with acute onset of rapidly progressing skin thickening, tender edema, and skin contractures involving all extremities, shortly after enduring burn injuries from a gasoline explosion. Workup was remarkable for peripheral eosinophilia, hypergammaglobulinemia, and elevated C-reactive protein. Skin biopsy demonstrated sclerodermoid changes and sclerotic thickening of subcutaneous fibrous septa associated with stromal mucin, dermal perivascular, diffuse lymphoplasmacytic infiltrate with eosinophils, decreased CD34 expression, and increased factor XIIIa. He was subsequently diagnosed with an overlap of generalized morphea and eosinophilic fasciitis. The patient had only limited improvement with steroids, methotrexate, mycophenolate mofetil, and intralesional triamcinolone acetonide injections. Generalized morphea with concomitant EF indicates some degree of therapeutic resistance and poor prognosis with a low quality of life. Burn injuries can be a trigger factor for this overlap syndrome. Prompt identification of at-risk individuals and initiating aggressive management are necessary.

Thyroid storm is an endocrine emergency, and treatment must ensure primary goals, including reducing the production and release of thyroid hormones, mitigating the effects of thyroid hormones, increasing the elimination of thyroid hormones, treating systemic disturbances, and managing triggering factors. However, in a few cases where thyroid storm does not respond to initial treatment, therapeutic plasma exchange (TPE) should be considered. A 50-year-old male patient was admitted to the University Medical Center Ho Chi Minh City due to hypotonia and sensory disturbances gradually spreading from the lower extremities to the entire body. The patient was diagnosed with Guillain-Barré syndrome (GBS) and newly discovered hyperthyroidism. During the treatment course, the patient developed hospital-acquired pneumonia, acting as a trigger factor for a thyroid storm. Despite aggressive treatment for thyroid storm, the patient's condition worsened, leading to the decision to perform TPE. The replacement fluid was a combination of fresh frozen plasma (FFP) and albumin 5%. Subsequently, the patient returned to a euthyroid state and was discharged. Combining FFP and albumin 5% in TPE advantages FFP's high thyroid hormones-binding capacity and albumin's cost-effectiveness, safety, and efficiency. This reduces the drawbacks associated with high volumes of FFP and offers a balanced and effective approach to managing thyroid storms. Moreover, the concurrent presence of GBS and thyroid storm is extremely rare. Through this case, we aim to discuss the role of TPE in the treatment of thyroid storms and the effectiveness of the combination of FFP and albumin 5% as the replacement fluid.