Ischemic stroke as a rare complication of scorpion envenomation: a case report

Scorpion envenomation is a common medical emergency in tropical regions and is typically characterized by autonomic and cardiovascular manifestations. Neurological complications, particularly ischemic stroke, are exceedingly rare. We report the case of a 65-year-old male who developed acute left-sided hemiparesis and dysarthria approximately two hours after a scorpion sting. Initial non-contrast computed tomography demonstrated a hyperdense right middle cerebral artery sign, while magnetic resonance imaging confirmed a large acute infarction in the right middle cerebral artery territory with vascular occlusion on magnetic resonance angiography. Laboratory investigations, carotid Doppler ultrasonography, cardiac evaluation, and basic thrombophilia screening did not reveal an alternative embolic source. The temporal relationship between envenomation and neurological deterioration suggests a possible venom-mediated vascular mechanism involving autonomic dysregulation, endothelial dysfunction, inflammatory activation, and thrombogenesis. Although causality cannot be definitively established, this case highlights the importance of early neuroimaging and neurological assessment in patients presenting with focal deficits after scorpion envenomation.