Watershed infarction after honey intoxication

Year 2021, , 1157 - 1158, 01.11.2021

Murat Mümin Yazıcı , Esra Yenikurtuluş , Gökçen Akça İsmail Barkın Işık

https://doi.org/10.28982/josam.868911

Abstract

Watershed infarction indicates ischemic lesions at the junction of two central artery regions. These lesions are the cause of 10% of all brain infarctions. In watershed infarctions, disrupted hemodynamics constitute the pathophysiology. A specific type of honey in the Black Sea region of Turkey, “mad honey,” contains grayanotoxin and may cause intoxication. We herein report a case with watershed infarction after honey intoxication. The patient presented with dizziness and paresthesia in the left arm after eating “mad honey.” Imaging revealed carotid stenosis and watershed infarction.

Keywords

Whatershed Infarct, Mad Honey, Stroke

References

• 1. Schneider M. Durchblutung und sauerstoffversorgungdes gehirns. Verh Dtsch Tes Kreislaufforsch. 1953;19:3-12.
• 2. Torvik A. The pathogenesis of watershed infarcts in the brain. Stroke. 1984; 15(2):221-3.
• 3. Derdeyn CP, Khosla A, Videen TO, Fritsch SM, Carpenter DL, Grubb RL Jr, et al. Severe hemodynamic impairment and border zone--region infarction. Radiology. 2001;220(1):195-201.
• 4. Moriwaki H, Matsumoto M, Hashikawa K, Oku N, Ishida M, Seike Y, et al. Hemodynamic aspect of cerebral watershed infarction: assessment of perfusion reserve using iodine-123-iodoamphetamine SPECT. J Nucl Med. 1997;38(10):1556-62.
• 5. Yong SW, Bang OY, Lee PH, Li WY. Internal and cortical border-zone infarction: clinical and diffusion-weighted imaging features. Stroke. 2006;37(3):841-6.
• 6. Gunduz A, Turedi S, Uzun H, Topbas M. Mad honey poisoning. Am J Emerg Med. 2006;24(5):595-8.
• 7. Von Malottki K, Wiechmann HW. Acute life-threatening bradycardia: food poisoning by Turkish wild honey. Dtsch Med Wochenschr. 1996;121(30):936-8.
• 8. Ergun K, Tufekcioglu O, Aras D. A rare cause of atrioventricular block: mad honey intoxication. Int. J.Cardiol. 2005;99:347–348.
• 9. Moustafa RR, Izquierdo-Garcia D, Jones PS, Graves MJ, Fryer TD, Gillard JH, et al. Watershed infarcts in transient ischemic attack/minor stroke with 50% carotid stenosis: hemodynamic or embolic? Stroke. 2010;41(7):1410-6.
• 10. Del Sette M, Eliasziw M, Streifler JY, Hachinski VC, Fox AJ, Barnett HJ. Internal borderzone infarction: a marker for severe stenosis in patients with symptomatic internal carotid artery disease. For the North American Symptomatic Carotid Endarterectomy (NASCET) Group. Stroke. 2000;31(3):631-6.
• 11. Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol. 1998; 55(11):1475-82.
• 12. Onat FY, Yegen BC, Lawrence R, Oktay A, Oktay S. Mad honey poisoning in man and rat. Rev Environ Health. 1991;9(1):3-9.
• 13. Ozhan H, Akdemir R, Yazici M, Gündüz H, Duran S, Uyan C. Cardiac emergencies caused by honey ingestion: a single centre experience. Emerg Med J. 2004;21(6):742-4.