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Wasp sting-induced bilateral thalamic and midbrain infarction
  1. Megha Priyadarshi1,
  2. Ranveer Singh Jadon1,
  3. Naval Kishore Vikram1 and
  4. Stanzin Spalkit2
  1. 1Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
  2. 2Department of Radiodiagnosis, AIIMS, New Delhi, India
  1. Correspondence to Dr Ranveer Singh Jadon; dr.ranveerjadon{at}yahoo.co.in

Abstract

A male patient in his early 40s presented to the emergency department with an acute onset of respiratory distress and facial oedema, indicative of anaphylaxis. These symptoms emerged 2 hours subsequent to a wasp sting on the left side of his face. Despite initial stabilisation, the patient’s state deteriorated into somnolence and disorientation. Notably, he denied any history of seizures, sensory or motor deficits, or bowel/bladder complications. Physical examination unveiled no focal neurological deficits. Routine laboratory tests and drug screening yielded no significant findings. Subsequent brain MRI with angiography exposed bilateral thalami diffusion restriction, strongly implying an acute infarction within the artery of Percheron territory, an atypical vascular variant. The sequence of events, alongside the absence of other conclusive aetiologies, indicated a wasp sting-induced thalamic infarction driven by vasogenic and thrombogenic effects of inflammatory substances.

  • emergency medicine
  • poisoning
  • neurology
  • neurological injury

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Footnotes

  • Contributors The following authors were responsible for the drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: MP and RSJ. The following authors gave final approval of the manuscript: RSJ, SS and NKV.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.