Abstract Details

Title Brachial Plexopathy: A Rare Association With A Wasp Sting

Topic General Neurology

Presentation(s) General Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 055

Objective To present an association of brachial plexopathy with a wasp sting.

Background Thousands of people are stung by insects every year in the United States and the effects range from local reactions to anaphylactic shock or even death. Systemic involvement including myocardial infarction, renal failure, and multiorgan failure have been described. Rare neuromuscular manifestations include polyradiculopathy, brachial plexopathy and myasthenia gravis. Immediate hypersensitivity reaction, direct neurotoxic effect of the venom, central and peripheral demyelination are some proposed mechanisms of action.

Design/Methods We present a case of a 35-year-old man with an 11-hour history of progressive left arm weakness, numbness, tingling and extension weakness in left 3rd, 4th and 5th fingers. He denied other past medical history. He was stung by a wasp lateral to his left eye 48 hours prior and developed gradual swelling of the face prompting initial visit to local urgent care. He was prescribed diphenhydramine and solumedrol, and later developed the above mentioned left upper extremity symptoms. On examination, there was swelling of left side of the forehead and face. Cranial nerves were intact. Motor strength in the left biceps, supraspinatus, wrist extensors and first dorsal interosseous were 4/5. There was decreased pin prick over the left 3rd, 4th and 5th finger. Reflexes were diminished in the left upper extremity. Cerebellar and gait examination were normal. Computed tomography and vessel imaging of the head and neck were normal. Standard urine drug screen was negative. Presumptive diagnosis of brachial plexopathy probably triggered by a wasp sting was made. The tingling and numbness improved over a brief stay in the hospital. He failed to return for an electrodiagnostic study. On a follow up phone call, patient mentioned almost complete recovery over a period of next few days.

Results N/A

Conclusions This case highlights the rare association of brachial plexopathy with wasp sting.

Authors/Disclosures
Saad Karim, MD (SLUCare Academic Pavilion) PRESENTER	Dr. Karim has nothing to disclose.
Neha Gandhi, MD (Methodist Dallas Medical Center)	Dr. Gandhi has nothing to disclose.
Ghazala Hayat, MBBS, FAAN (Saint Louis University)	Dr. Hayat has received personal compensation in the range of $500-$4,999 for serving as a Consultant for kabafusion. Dr. Hayat has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for csl. Dr. Hayat has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for alexion. Dr. Hayat has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for MTPA. Dr. Hayat has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for alexion. Dr. Hayat has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for kabafusion.

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