Bal arısı sokması sonrası beyin sapında gelişen akut iskemik inme

Arı sokmaları, tüm böcek sokmaları içerisinde en sık olanıdır. Nörolojik etkilenme nadirdir. Ancak ensefalit, akut dissemine ensefalomiyelit, polinöropati ve ekstrapiramidal tutulum ortaya çıkabilmektedir. 79 yaşında erkek hasta sol hemiparezi ve dizartri yakınması ile başvurdu. 1 gün önce 10 tane bal arısı tarafından sokulduğu öğrenildi. Sol kol ve bacakta 4/5 kas gücü, ataksik yürüme ve dizartri bulunmaktaydı. Difüzyon ağırlıklı manyetik rezonans görüntülemede sağ ponsta akut iskemi ile uyumlu lezyon belirlendi. Asetilsalisilik asit (300 mg/gün) vemetformin (1000 mg/gün) başlandı. Arı sokması sonrası salgılanan kimyasal moleküller ile tromboza eğilim artmaktadır. Bu nedenle iskemik inme riski olan hastalar yakın takip edilmelidir. Gerekirse hastalar bu moleküllerin inaktivasyonunu sağlayan ilaçlar ile tedavi edilmelidir. Ancak hipotansiyon ve vazokonstriksiyon oluşturabilen antialerjik ilaçlar başlanmamalıdır.

Bee stings are the most common of all insect all insect insert strings. Neurological involvement is rare. However, encephalitis, acute disseminated encephalomyelitis, polyneuropathy and extrapyramidal disease may ocur. A 79-year-old male patient presented with left hemiparesis and dysarthria. It was learned that he was stung by 10 honey bees 1 day ago. Left hemiparesis (4/5), ataxic walking and dysarthria were deteced. A lesion like acute ischemia was revealedin the right pontine are awith diffusion-weighted magnetic resonance imaging. Acetylsalicylic acid (300 mg/day) and metformin (1000 mg/day) were started. Thrombosis predisposition increases with secreted chemical molecules after bee sting. There fore, patients with risk of ischemic stroke should be closely monitored. If necessary, patients should be treated with drugs that provide inactivation of these molecules. However, antiallergic drugs that can cause vasoconstriction and hypotension should not be started.

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