Neurotoxic effects of scorpion envenomation, a video of nystagmus, dysmetria, and tongue fasciculations: a case report

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Neurotoxic effects of scorpion envenomation, a video of nystagmus, dysmetria, and tongue fasciculations: a case report

Abstract

Background

Scorpion stings are common in rural areas worldwide, with most cases being benign. However, certain species, such as Centruroides in Southwestern USA, can cause severe neurotoxic envenomations. Neurotoxic symptoms, including nystagmus and ataxia, are well documented in pediatric cases but remain rare in adults. We present a rare case of neurotoxic scorpion envenomation in an adult.

Case presentation

A 32-year-old Hispanic female with a history of anaphylaxis to bee venom presented to the emergency department (ED) following a scorpion sting. While sitting at home, she felt two stings on her posterior right thigh, identified and killed the scorpion, and went to the ED. On evaluation, the patient was alert and oriented (Glasgow Coma Scale score of 15). Her vital signs were stable, and laboratory results were unremarkable. The patient initially experienced localized pain at the sting site, followed by generalized heaviness, muscle twitching, dry mouth, tongue “fuzziness,” and throat heaviness but no respiratory distress. Neurological examination revealed nystagmus, tongue fasciculations, and dysmetria, consistent with neurotoxic envenomation. She was treated with a tetanus–diphtheria–pertussis (Tdap) booster, normal saline, ondansetron, lorazepam, and Centruroides scorpion antivenom (ANASCORP®). Owing to her anaphylaxis history, she was closely monitored for hypersensitivity reactions. The patient had an uneventful recovery and was discharged after 2 days without neurological complications.

Conclusion

Scorpion envenomations can lead to severe neurotoxic effects, even in adults, particularly with multiple stings or enhanced venom absorption. Early recognition of neurotoxic symptoms is crucial for prompt intervention with antivenom and supportive care, significantly improving patient outcomes. This case emphasizes the importance of considering neurotoxic envenomations in adult patients, even when pediatric cases are more common.



Mohammed, S., Herrera, E.R. & Kioka, M. Neurotoxic effects of scorpion envenomation, a video of nystagmus, dysmetria, and tongue fasciculations: a case report. J Med Case Reports 19, 362 (2025). https://doi.org/10.1186/s13256-025-05416-7