Reports of cerebral hypoxia and infarction following bee/wasp sting
| Author/ref | Age/sex | Type of stings: location | Onset of neurological deficit | Examination findings and symptoms | Eye examination | MRI/CT findings | Treatment | Recovery |
|---|---|---|---|---|---|---|---|---|
| NR = none reported. | ||||||||
| Day3 | 36/M | Wasp: multiple on neck, face, and arms | <1 hour | Headache, seizure, right hemiplegia, coma | Equal and reactive pupils | NR; necropsy showed left haemorrhagic cortical infarct | Cortisone, antihistamines, phenobarbital | Deceased |
| Starr and Brasher4 | 37/M | Wasp: 3 stings on arms | <1 hour | Seizure, right hemiplegia | NR | Left cerebral infarction (CT done 14 months later) | Barbiturates, corticosteroids, adrenaline | Partial right hemiplegia, one seizure |
| Riggs et al5 | 38/M | Wasp: multiple on left face and neck | 2 days | Right hemiplegia, dense global aphasia | NR | Ischaemic infarction in the distribution of the left MCA; angiogram: left ICA occlusion | NR | NR |
| Riggs et al6 | 52/M | Wasp: single, location NR (previous history of wasp sting allergy) | A few hours, with worsening 24 days later | Anaphylactic shock with respiratory arrest, slurred speech and left hemiparesis initially, then 24 days later, acute obtundation and quadriparesis | NR | Initially, three small focal ischaemic infarcts, two in the right centrum semiovale and one in the right temporal lobe. After worsening, diffuse bilateral ischaemic white matter lesions and left parietal and insular cortical infarctions. MRA and angiogram: complete and near complete occlusions of the right and left ICA, respectively | IV adrenaline, methylprednisolone, diphenhydramine | NR |
| Speach et al7 | 30/M | Bee: single, location NR | <1 hour | Decerebrate posturing, extensor plantar reflexes, left hemiparesis, hyporeflexia; after coma, patient had motor apraxia and left sensory neglect | NR | Normal MRI and CT | IV diphenhydramine, steroids and nebulised β2 agonist and anticholinergic medications | Residual ideomotor apraxia |
| SPECT: hyperperfusion of the left dorsolateral frontal cortex, but no areas of hypoperfusion or other abnormalities | Normal VF | |||||||
| Crawley et al8 | 30/F | Wasp: left arm | <1 hour | Facial and arm swelling, widespread urticaria, acute pulmonary oedema, visual loss | Right homonymous superior quadrantanopia | Left occipital ischaemic infarct | SQ adrenaline, IV gelofusine, IV hydrocortisone, IM chlorpheniramine, IV furosemide | Full recovery from quadrantanopia |
| Bhat et al9 | 35/M | Bee: multiple “all over the body” | <1 day | Multiple swellings all over the body, vomiting, dysarthria, tinnitus, vertigo and swaying gait, hypertension, bilateral cerebellar signs, rhabdomyolysis with acute renal (respiratory?) failure | No papilloedema | Bilateral cerebellar haemorrhagic infarct | Dexamethasone, antihistamines, mannitol, insulin, haemodialysis | Deceased |
| Present report | 57/F | Bee: multiple on neck, head, R eye, R side of her neck, face and R arm | 2 days | Nausea, vomiting, vision loss | BCVA of 20/15 right eye, 20/25 left eye; left homonymous hemianopia, left inferior arcuate and right altitudinal defect; Bilateral oedema (right eye>left eye) w/pallid haemorrhagic swelling | Haemorrhagic infarct 2 days post-ischaemic stroke | IV antihistamines and antiemetics | Left homonymous hemianopia with inferior arcuate defects; central vision unaffected right eye and only mildly affected left eye |