Scorpion sting-induced malignant middle cerebral artery infarction

A previously healthy middle-aged man in his 40s with a history of red scorpion envenomation presented to the emergency department for the management of an acute stroke syndrome, involving the left middle cerebral artery (MCA) territory, that developed 12 hours after the scorpion sting. He presented to the hospital 15 hours following the stroke. The activation of the autonomic nervous system by the Indian red scorpion venom is known to produce severe systemic manifestations, including cardiogenic shock and acute pulmonary oedema. Death is a rare consequence. Neurological complications resulting from red scorpion injuries are exceedingly uncommon and inadequately documented in the literature. The patient underwent an emergency decompressive craniectomy in view of neurological deterioration despite intracranial pressure-reducing agents. Thrombectomy could not be done in view of the malignant infarct (Alberta Stroke Program Early CT Score of 1) which involved over one-third of the MCA territory. Our patient has made a full recovery and at 6 months' follow-up; he was capable of walking without assistance. It is essential to promptly identify and manage this under-recognised presentation in order to yield favourable functional outcomes for the patient.