Table 1

 Reports of cerebral hypoxia and infarction following bee/wasp sting

Author/refAge/sexType of stings: locationOnset of neurological deficitExamination findings and symptomsEye examinationMRI/CT findingsTreatmentRecovery
NR = none reported.
Day336/MWasp: multiple on neck, face, and arms<1 hourHeadache, seizure, right hemiplegia, comaEqual and reactive pupilsNR; necropsy showed left haemorrhagic cortical infarctCortisone, antihistamines, phenobarbitalDeceased
Starr and Brasher437/MWasp: 3 stings on arms<1 hourSeizure, right hemiplegiaNRLeft cerebral infarction (CT done 14 months later)Barbiturates, corticosteroids, adrenalinePartial right hemiplegia, one seizure
Riggs et al538/MWasp: multiple on left face and neck2 daysRight hemiplegia, dense global aphasiaNRIschaemic infarction in the distribution of the left MCA; angiogram: left ICA occlusionNRNR
Riggs et al652/MWasp: single, location NR (previous history of wasp sting allergy)A few hours, with worsening 24 days laterAnaphylactic shock with respiratory arrest, slurred speech and left hemiparesis initially, then 24 days later, acute obtundation and quadriparesisNRInitially, 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, respectivelyIV adrenaline, methylprednisolone, diphenhydramineNR
Speach et al730/MBee: single, location NR<1 hourDecerebrate posturing, extensor plantar reflexes, left hemiparesis, hyporeflexia; after coma, patient had motor apraxia and left sensory neglectNRNormal MRI and CTIV diphenhydramine, steroids and nebulised β2 agonist and anticholinergic medicationsResidual ideomotor apraxia
SPECT: hyperperfusion of the left dorsolateral frontal cortex, but no areas of hypoperfusion or other abnormalitiesNormal VF
Crawley et al830/FWasp: left arm<1 hourFacial and arm swelling, widespread urticaria, acute pulmonary oedema, visual lossRight homonymous superior quadrantanopiaLeft occipital ischaemic infarctSQ adrenaline, IV gelofusine, IV hydrocortisone, IM chlorpheniramine, IV furosemideFull recovery from quadrantanopia
Bhat et al935/MBee: multiple “all over the body”<1 dayMultiple swellings all over the body, vomiting, dysarthria, tinnitus, vertigo and swaying gait, hypertension, bilateral cerebellar signs, rhabdomyolysis with acute renal (respiratory?) failureNo papilloedemaBilateral cerebellar haemorrhagic infarctDexamethasone, antihistamines, mannitol, insulin, haemodialysisDeceased
Present report57/FBee: multiple on neck, head, R eye, R side of her neck, face and R arm2 daysNausea, vomiting, vision lossBCVA 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 swellingHaemorrhagic infarct 2 days post-ischaemic strokeIV antihistamines and antiemeticsLeft homonymous hemianopia with inferior arcuate defects; central vision unaffected right eye and only mildly affected left eye