Bites and Stings: Exotic Causes of Stroke in Asia.

IF 2 Q3 PERIPHERAL VASCULAR DISEASE Cerebrovascular Diseases Extra Pub Date : 2024-01-01 Epub Date: 2024-09-13 DOI:10.1159/000541381
Udaya K Ranawaka
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Abstract

Background: Many unusual and fascinating causes of stroke are seen in Asia. Although rarely encountered in the Western world, such cases are seen not so infrequently by neurologists, physicians, and other healthcare workers in Asian countries. This article highlights some of these intriguing causes of stroke such as snakebite, scorpion stings, and bee and wasp stings.

Summary: Snakebite is a neglected tropical disease of global importance affecting over 5 million people each year, and scorpion stings and bee and wasp stings affect over a million people worldwide every year. Strokes due to these uncommon causes predominantly affect young males in their most productive years, and many victims die or remain with residual disability with significant socioeconomic consequences to the affected families and society. Both ischaemic and haemorrhagic strokes are seen, with ischaemic strokes being more common. Many unanswered questions remain regarding the pathophysiological mechanisms, clinical spectrum, and the natural history of stroke due to these causes. Antivenom is effective in snake envenoming, antivenom and prazosin are effective in scorpion envenoming, and treatment of anaphylaxis and allergy is recommended in systemic reactions due to bee or wasp stings. However, there are no treatment guidelines or expert recommendations to guide the management of stroke in these patients, and there are no data on the safety and efficacy of stroke-specific treatments such as antiplatelet therapy, thrombolysis or endovascular treatment.

Key messages: More research is clearly needed to unravel the complexities related to stroke following snakebite, scorpion envenoming, and bee and wasp stings, and to guide the development of optimal stroke treatment strategies in these unusual situations. Awareness of these exotic stroke aetiologies is important in early recognition and appropriate management of patients presenting with stroke symptoms in Asian countries, and in global travellers from the region. International collaborations would go a long way in improving our understanding of these rare but fascinating causes of stroke.

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咬伤和蛰伤:亚洲中风的外来病因。
背景:亚洲有许多不寻常的、令人着迷的中风病因。虽然在西方世界很少遇到此类病例,但亚洲国家的神经科医生、内科医生和其他医护人员并不鲜见。摘要:蛇咬伤是一种被忽视的全球性热带疾病,每年影响 500 多万人,蝎子蜇伤、蜜蜂和黄蜂蜇伤每年影响全世界 100 多万人。这些罕见病因导致的脑卒中主要影响正值壮年的年轻男性,许多患者死亡或留下后遗症,给患者家庭和社会带来严重的社会经济后果。缺血性和出血性脑卒中均有发生,其中缺血性脑卒中更为常见。关于这些原因导致的中风的病理生理机制、临床表现和自然病史仍有许多未解之谜。抗蛇毒血清对蛇咬伤有效,抗蛇毒血清和哌唑嗪对蝎子咬伤有效,建议对蜜蜂或黄蜂蛰伤引起的全身反应进行过敏性休克和过敏治疗。然而,目前还没有治疗指南或专家建议来指导这些患者的中风治疗,也没有关于抗血小板治疗、溶栓或血管内治疗等中风特异性治疗的安全性和有效性的数据:关键信息:显然需要开展更多研究,以揭示蛇咬伤、蝎子咬伤、蜂蜇伤和黄蜂蜇伤后中风的复杂性,并指导制定这些异常情况下的最佳中风治疗策略。对这些异国卒中病因的认识对于早期识别和适当处理亚洲国家出现卒中症状的患者以及来自该地区的全球旅行者非常重要。国际合作将极大地提高我们对这些罕见但迷人的中风病因的认识。
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来源期刊
Cerebrovascular Diseases Extra
Cerebrovascular Diseases Extra PERIPHERAL VASCULAR DISEASE-
CiteScore
3.50
自引率
0.00%
发文量
16
审稿时长
8 weeks
期刊介绍: This open access and online-only journal publishes original articles covering the entire spectrum of stroke and cerebrovascular research, drawing from a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. Offering an international forum, it meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues. The journal publishes original contributions, reviews of selected topics as well as clinical investigative studies. All aspects related to clinical advances are considered, while purely experimental work appears only if directly relevant to clinical issues. Cerebrovascular Diseases Extra provides additional contents based on reviewed and accepted submissions to the main journal Cerebrovascular Diseases.
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