# Parkinsonism following Bee Sting:  A Case Report

Authors: Ruchika Mittal; Sanjay Munjal; Dheeraj Khurana; Ashok Gupta
Journal: Case Reports in Neurological Medicine
 (2012)

---

## Abstract

We are reporting here a rare case of Parkinsonism (Hypokinetic dysarthria) caused after a bee stung, a member of the hymenoptera order. The main aim of this report is to orient the clinicians with the possibility of extrapyramidal syndromes because of hymenoptera stings.


---

## Body

## 1. Introduction

Parkinsonism  is  a  syndrome  that  encompasses  the  symptoms  of  resting  tremor,  rigidity,  akinesia (paucity  of  movement),  and  postural  instability.  Communication  disorders  are  common  in  Parkinsonism,  often  beginning  with  a  decrease  in  vocal  loudness  and  at  times  progressing  to  more  severe  functional  limitations  characterized  by  changes  in  speaking  rate,  articulatory  precision,  and  speech  intelligibility [1].We  are  reporting  here  one  of  the  relatively  uncommon  cases  of  Parkinsonism (Hypokinetic  dysarthria)  caused  after  being  stung,  a  member  of  the  hymenoptera  order.


## 2. Case  Report

A  46-year-old  female  referred  from  the  Department  of  Neurology  to  the  Speech  and  Hearing  Unit,  Department  of  Otolaryngology  and  Head  and  Neck  Surgery  at  PGIMER,  Chandigarh,  with  chief  complaint  of  difficulty  in  speaking.  The  detailed  case  history  and  the  old  records  of  the  patient  revealed  that  the  patient  developed  an  anaphylactic  shock  after  being  stung  by  a  bee  on  her  left  fourth  finger.  She  was  admitted  in  the  hospital  within  few  hours.  Next  day  onwards  there  was  a  decrease  in  all  motor  activities.  A  possibility  of  secondary  Parkinsonism  was  considered  and  she  responded  to  antiparkinsonism  drugs (carbidopa + levodopa).The  speech  and  language  assessment  of  the  patient   revealed  hypokinetic  dysarthria.  The  main  features  of  her  dysarthric  speech  were  inappropriate  pitch,  breathy  voice,  laboured  speech,  prosodic  insufficiency,  and  rate  disturbances.  The  overall  intelligibility  of  her  speech  was  poor.  The  patient  was  scheduled  for  twice  a  week  therapy  and  the  aim  was  to  improve   the  overall  intelligibility  of  the  speech.  The  techniques  like  relaxation  exercises  to  improve  the  breathing  pattern  and  movement,  pacing  technique  to  control  the  rate  of  speech,  and  adduction  exercises  to  increase  vocal  intensity  were  used.  Measures  during  and  after  therapy  documented  significant  improvement  in  the  overall  intelligibility  of  her  speech  within  two  months.


## 3. Discussion

The  pathology  of  Parkinsonism  is  associated  with  the  loss  of  dopaminergic  neurons  in  the  basal  ganglia (especially  the  substantia  nigra  and  brain stem).  It  is  divided  into  subgroups  depending  upon  its  etiology  and  associated  signs  and  symptoms.  Idiopathic  or  primary  Parkinson’s  disease  (also  known  as  paralysis  agitans)  is  the  term  applied  when  the  cause  of  the  syndrome  is  unknown.  Secondary  Parkinsonism,  which  includes  a  number  of  disorders  with  extrapyramidal  features  that  have  an  identifiable  causal  agent,  some  of  which  would  include  toxins,  infections,  drugs (neuroleptics),  and  reported  trauma  or  multiple  strokes.  Another  group  of  syndromes,  known  as  Parkinsonism Plus,  refers  to  heterogeneous  system  degeneration,  such  as  progressive  supranuclear  palsy,  striatonigral  degeneration,  Shy-Drager  syndrome,  or  olivoponto cerebellar  degeneration.  Because  these  syndromes  are  associated  with  damage  to  multiple  neural  systems,  the  type  of  dysarthria  associated  with  them  may  be  different  from  that  associated  with  Parkinsonism [1].The  literature  was  reviewed  and  interestingly  enough  there  is  only  one  case  report  of  Parkinsonism  after  a  wasp  sting, a  member  of  hymenoptera  order  to  which  bee  also  belongs  too [2].  However,  there  are  few  case  reports  which  document  cerebral  infarction  and  toxic  reactions  associated  with  hymenoptera  stings [3–6].


## 4. Conclusion

Bee  sting  is  very  common  and  it  has  not  been  commonly  associated  with  Parkinsonism.  Therefore,  we  believe  that  the  present  work  may  draw  the  attention  of  the  clinicians  to  include  hymenoptera  stings  in  the  differential  diagnosis  of  acute  and  chronic  extrapyramidal  syndromes.



---

*Source: 476523-2012-10-10.xml*