EPILEPSY DUE TO A DESTRUCTIVE BRAIN LESION CAUSED BY SCORPION STING
Abstract number :
1.404
Submission category :
Year :
2003
Submission ID :
578
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Ronan Jose Vieira, Leonardo Bonilha, Enrico Ghizoni, Fernando Cendes, Li Min Li Laboratory of Neuroimaging, State University of Campinas, Campinas, Sao Paulo, Brazil; Poison Control Center, State University of Campinas, Campinas, Sao Paulo, Brazil
Symptomatic acute epileptic seizures may occur in up to 5% of patients victims of scorpion stings, especially children. The occurrence of a long lasting brain lesion or development of epilepsy after a scorpion sting has never been observed. We report a case of a child who developed epilepsy due to an extensive hemispheric destructive brain lesion after a scorpion sting.
We report a case of a child who developed epilepsy due to a destructive brain lesion after a sting by Tityus serrulatus. We review the biological effects of the scorpion toxin and discuss the neurotoxicity of the venom in the setting of the development of a brain lesion and recurrent non-provoked seizures.
A healthy 4 year-old child, living in the State of Bahia, in the Northwestern region of Brazil, was stung in her left middle finger by a brown scorpion. Her mother witnessed the event and undoubtefully described the features of T. serrulatus. She soon developed local pain and paresthesias followed by diaphoresis and somnolence. Approximately 24 hours after the sting, she began to convulse. She was then taken to a hospital where she achieved suboptimal seizure control, with daily tonic-clonic seizures during the period of one week. During this period, and in between the seizures, she stayed alert and conscious, with left hemiplegia. When the seizures began to abate, one week after the bite, she was discharged home. She persisted with almost daily tonic-clonic seizures for two years after the hospitalization, despite anti-epileptic drugs. With dose adjustment she currently achieved almost complete seizure control.
Today she is 15 year-old and her mother states that after the accident she had difficulties for learning and was not able to attend elementary school. She currently presents a moderate global cognitive impairment and a mild left hemiparesis and her seizures occur approximately once monthly.
She underwent neurophysiologic and image investigation. Routine electroencephalogram (EEG) showed the presence of interictal spikes and diffuse slowing in the right brain hemisphere. Magnetic Resonance Imaging (MRI) showed a widespread destructive lesion of her right cerebral hemisphere affecting both the cortical and sub cortical structures.
This case is a rare illustration of exogenous excitotoxicity-induced brain damage leading to recurrent seizures and this may guide further studies regarding excitotoxicity and the development of recurrent seizures.
[Supported by: FAPESP (00/04710-2)]