黄蜂蜇伤并发缺血性脑卒中

Wasp sting complicated by ischemic stroke

黄蜂蜇伤并发缺血性脑卒中非常罕见。目前,全世界范围内有20余例公开病例报道。与一般脑梗死相比,与蜂蜇伤相关脑卒中的病理生理学机制和治疗的信息还非常有限。病例该文报道了1例25岁男性患者,在黄蜂蜇伤后以癫痫样发作为首发表现。经头部CT及MRI检查,诊断为“缺血性脑卒中”。DSA检查未见右侧颈总动脉及其远端血管显影,血管内介入治疗抽吸出少许红色血栓,复查血管再通。然而,其后发生了“脑梗死后出血转化,并脑疝形成”。虽经去骨瓣减压、颅内血肿清除术及系统康复治疗,但预后不理想,日常生活活动仍严重依赖他人照料。这是国内蜂蜇伤继发缺血性脑损伤并出血转化的首例报道。蜂蜇后脑血管损伤是一个持续性进展过程,首诊医师需高度警惕蜂毒的迟发性血管损伤效应,需动态监测D-二聚体、凝血功能、超敏C-反应蛋白等血液指标。早期抗组胺或类固醇药物抑制炎症反应有助于延缓病情发展。炎症反应和凝血功能不稳定可能是蜂蜇后缺血性脑损伤的主要机制。与一般缺血性脑卒中患者相比,介入治疗的出血性风险更高。

Wasp sting complicated by ischemic stroke is extremely rare in clinical practice, with more than 20 public case reports worldwide, and compared with general cerebral infarction, there is limited information on the pathophysiological mechanism and treatment of wasp sting-related stroke. Case Summary This article reports a case of a male patient, aged 25 years, who developed epileptiform seizure as the initial manifestation after wasp sting. The patient was diagnosed with ischemic stroke after cranial CT and MRI examinations. DSA showed no visualization of the right common carotid artery and its distal vessels. A few red thrombi were aspirated by endovascular intervention, and reexamination showed that the blood vessels were recanalized. However, the patient then developed post-cerebral infarction hemorrhagic transformation and cerebral herniation. Although the patient was given decompressive craniectomy, removal of intracranial hematoma, and systematic rehabilitation treatment, he still had an unsatisfactory prognosis and needed others to take care of his activities of daily living. This is the first report of secondary ischemic brain injury and hemorrhagic transformation after wasp sting in China.Cerebral vascular injury after wasp stings is a continuously progressive process. Therefore, physicians at initial diagnosis should be highly alert to the effect of wasp venom in causing delayed vascular injury, and related blood parameters should be monitored dynamically, such as D-dimer, coagulation function, and high-sensitivity C-reactive protein. Early inhibition of inflammatory response by antihistamines or steroids helps to delay the progression of the disease. Inflammatory response and coagulation dysfunction may be the main mechanisms of ischemic brain injury after wasp sting. Such patients tend to have a higher hemorrhagic risk of interventional treatment compared with the patients with general ischemic stroke.