Motor aphasia: A rare complication of scorpion sting
A 9-year-old male child with a history of “red” scorpion sting was initially admitted at a private clinic where he had one episode of hematemesis and developed pulmonary edema and hypotension. He was later referred to our hospital on Day 3 for further management. On admission, the patient was in respiratory distress with heart rate 180 beats/min, respiratory rate 58 cycles/min, oxygen saturation 80% on 5L of O2, blood pressure 90/70 mmHg with bilateral crepts in the chest and frothing from the mouth. The patient was intubated and was given ventilator care. The chest X-ray was suggestive of pulmonary edema []. After hospitalization, the condition of the patient improved and he was extubated 6 h later, but, on Day 3 of admission, the patient developed bilateral ptosis and right-sided supranuclear facial palsy with motor aphasia.\nHe was investigated, and showed a hemoglobin level of 11.3 g/dl and total leukocyte count of 9,000/cu mm with 85% neutrophils and 15% lymphocytes, erythrocyte sedimentation rate of 12 mm/h and normal peripheral smear with platelet count of 254,000/μl. Urine had no albumin and microscopy was normal. Examination of the cerebrospinal fluid was normal and tuberculin test was negative. Echocardiography (ECG) was performed to rule out cardiac dysfunction, which was normal, and ECG showed rate-related nonspecific ST–T changes. An ultrasound of the supra-aortic region was normal and troponin was negative. Rest of the biological assessment was normal, with no abnormalities of hemostasis. Magnetic Resonance Imaging (MRI) was done, which showed in FLAIR images, hyperintense areas in the superior, middle and inferior temporal gyri, pre-and post-central gyri and supramarginal and angular gyri on the left side [Figure and ], showing a corresponding area of high signal intensity on diffusion-weighted images indicating restriction of diffusion []. These findings are consistent with early infarct and cytotoxic edema in left temporal and parietal lobe in distribution of terminal branches of the left middle cerebral artery.\nAfter symptomatic treatment and inotropic support, the condition of the patient gradually improved. He was then started on low-dose aspirin and steroids. The facial palsy and ptosis improved on the 6th day with persistent aphasia. The patient was discharged in stable condition with persistent motor aphasia on the 8th day of admission.