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Correspondence to Dr Anirudda Deshpande, [email protected]
Background
Scorpion bite-induced ischaemic infarct is rare. The mechanism of ischaemia has been attributed to disseminated intravascular coagulation (DIC) due to the coagulins present in the venom, Autonomic storm due to excess catecholamine surge leading to vasospasm of vessels. In absence of the above, cardioembolic strokes secondary to autonomic storm/catecholamine excess induced ventricular/atrial fibrillation/tachycardia could be another plausible explanation for ischaemic infarct.
Our patient did not have haematological findings suggestive of DIC. Complete non-visualisation of her unilateral left internal carotid artery (ICA) and middle cerebral artery (MCA) cannot be attributed to catecholamine-induced vasospasm either. Hence, we propose acute cardioembolic occlusion of left ICA as the cause of stroke. This mechanism has been rarely reported as the cause of infarct in patients with scorpion bite in the past.
Case presentation
A 54-year-old woman from rural India, with no premorbid illnesses, presented with history of scorpion bite to tip of digit 3 of left hand, in the morning just after getting up from sleep. The Indian red scorpion was immediately captured and killed. She was immediately shifted to the hospital. Her vitals were stable. She was immediately administered prazosin, intravenous antihistaminics, intravenous atropine, analgesics, anxiolytic (diazepam), anti-inflammatory medications and intravenous fluids. Routine blood tests including coagulation parameters were normal. There were no abnormal findings on her systemic examination.
Three hours after admission, the patient developed dyspnoea at rest associated with palpitation. There was sinus tachycardia (heart rate 128 per min regular). She also had hypotension
(BP was 70 systolic). The possibility of myocarditis was thought of. ECG showed sinus tachycardia with short RR interval and ST segment elevations in V1-V3 (figure 1