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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(08): 869-870
DOI: 10.1055/s-0042-1755215
Images in Neurology

Acute Parkinsonism and basal ganglia lesions after wasp sting

Parkinsonismo agudo e lesões de núcleos da base relacionados a picada de vespa
Thiago Frederico de Andrade van Agt 
1   Universidade de Pernambuco, Unidade de Neurologia e Neurocirurgia, Departamento de Neuropsiquiatria, Recife PR, Brazil.
2   Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Recife PR, Brazil.
,
Karina Lúcia Soares de Oliveira 
2   Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Recife PR, Brazil.
,
Marcos Eugênio Ramalho Bezerra 
1   Universidade de Pernambuco, Unidade de Neurologia e Neurocirurgia, Departamento de Neuropsiquiatria, Recife PR, Brazil.
3   Real Neurologia, Instituto de Neurologia, Neurocirurgia e Coluna do Nordeste, Recife PR, Brazil.
,
José Luiz Pedroso 
4   Universidade Federal de São Paulo, Divisão Geral de Neurologia, Unidade de Ataxia, São Paulo SP, Brazil.
,
Clélia Maria Ribeiro Franco 
1   Universidade de Pernambuco, Unidade de Neurologia e Neurocirurgia, Departamento de Neuropsiquiatria, Recife PR, Brazil.
2   Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Recife PR, Brazil.
,
Eduardo Sousa de Melo 
1   Universidade de Pernambuco, Unidade de Neurologia e Neurocirurgia, Departamento de Neuropsiquiatria, Recife PR, Brazil.
5   Universidade Federal de Pernambuco, Centro de Ciências Médicas, Recife PR, Brazil.
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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.

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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]

Author's Contributions

TFAA: study design, patient data collectin and manuscrit wrting; KLSO: patient data collectin and manuscrit writing; MERB, JLP, CMRF, ESM: data interpretation and manuscript critical review.




Publication History

Received: 25 January 2022

Accepted: 15 March 2022

Article published online:
17 October 2022

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