Acute Parkinsonism and basal ganglia lesions after wasp sting

Parkinsonismo agudo e lesões de núcleos da base relacionados a picada de vespa

A 52-year-old woman presented with acute malaise, syncope, and confusion after a wasp sting. Examination showed cognitive impairment, bradykinesia, and rigidity. Brain magnetic resonance imaging (MRI) scan disclosed symmetric bilateral basal ganglia hyperintense signal (►Figure 1). Serum specific wasp-venom immunoglobulin E (IgE) antibodies were strongly positive. The cerebrospinal fluid (CSF) and general blood tests, as well as the electroencephalography (EEG), were normal. She had mild improvement with levodopa, and at 6-months of follow-up MRI she showed remaining basal ganglia lesions.

Figure 1
Brain MRI. Panel A shows symmetrical bilateral caudate nuclei and putamina T1 hyperintense signal (white arrows). Panels B and C show bilateral T2 and fluid-attenuated inversion recovery (FLAIR) weighted hyperintensities in the same structures (white arrows). Panel D shows iron deposition in the right external capsule in T2-GRE (white arrow). No restricted water diffusion was shown in DWI/ADC map (Panels E and F). After gadolinium injection, there was no contrast enhancement (image not shown).

Anaphylaxis after insect sting (Hymenoptera) may cause several systemic manifestations such as diarrhea, sneezing, cutaneous rash, and angioedema. Neurological features may include agitation, headache, dizziness, confusion, extrapyramidal signs, and encephalitis.¹,² Basal ganglia necrosis-associated Parkinsonism has been previously reported.³

References

• ¹
  Casale TB, Burks AW. Hypmenopter-Sting Hypersensitivity.N Engl J Med 2014;370(15):1432-1439 https://www.nejm.org/doi/10.1056/NEJMcp1302681
  » https://www.nejm.org/doi/10.1056/NEJMcp1302681
• ²
  Maramattom BV. Wasp sting-related allergic encephalitis. Pract Neurol 2021;21(06):515-517. Doi: 10.1136/practneurol-2021-003007
  » https://doi.org/10.1136/practneurol-2021-003007
• ³
  Leopold NA, Bara-Jimenez W, Hallett M. Parkinsonism after awasp sting. Mov Disord 1999;14(01):122-127. Doi: 10.1002/1531-8257(199901)14:1<122:AID-MDS1020>3.0.CO;2-S
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Publication Dates

• Publication in this collection
  21 Nov 2022
• Date of issue
  Aug 2022

History

• Received
  25 Jan 2022
• Accepted
  15 Mar 2022