Reddy C Rakesh, Bompelli Nandakishore, Khardenavis Vikram, Deshpande Anirudda
Department of Internal Medicine, Aditya Hospital, Warangal, Telangana, India.
Department of Medicine, Miraj Medical College, Miraj, Maharashtra, India.
BMJ Case Rep. 2017 Oct 11;2017:bcr-2017-221606. doi: 10.1136/bcr-2017-221606.
We report a 54-year-old woman with scorpion bite. After 3 hours of admission, the patient developed sudden onset tachycardia with hypotension. Cardiac evaluation showed raised creatine kinase MB isoenzyme was elevated; ECG and two-dimensional echocardiography findings were suggestive of myocarditis. Subsequently, she developed transient ventricular tachycardia before developing abrupt onset, right hemiplegia, global aphasia and progressive worsening of sensorium 12 hours after the bite. MRI of brain revealed massive left middle cerebral artery (MCA) territory infarct. The magnetic resonance angiography showed non-visualisation of left internal carotid artery (ICA) and MCA. Coagulation parameters were normal. Sudden complete occlusion of left ICA was probably secondary to cardioembolic phenomenon leading to massive infarct. Despite aggressive medical and supportive measures, she clinically worsened rapidly to Glasgow Coma Scale of 3/15 over next 6 hours and succumbed to her illness the next day.
我们报告了一名54岁的被蝎子蜇伤的女性。入院3小时后，患者突然出现心动过速并伴有低血压。心脏评估显示肌酸激酶MB同工酶升高；心电图和二维超声心动图结果提示心肌炎。随后，在蜇伤12小时后，她先出现短暂性室性心动过速，之后突然出现右偏瘫、完全性失语和意识逐渐恶化。脑部MRI显示左侧大脑中动脉（MCA）区域大面积梗死。磁共振血管造影显示左侧颈内动脉（ICA）和MCA不显影。凝血参数正常。左侧ICA突然完全闭塞可能继发于心源性栓塞现象，导致大面积梗死。尽管采取了积极的药物和支持措施，但在接下来的6小时内，她的临床状况迅速恶化至格拉斯哥昏迷量表评分为3/15，并于次日死亡。
