Overview
Myelopathy caused by spider venom, particularly from scorpion stings, can lead to severe neurological dysfunction, often manifesting as acute spinal cord involvement and potentially multi-system organ failure.Diagnosis
Clinical presentation includes autonomic dysfunction, muscle weakness, and sensory disturbances.
Laboratory tests may show elevated creatine kinase levels and electrolyte imbalances.
Imaging (MRI) can reveal spinal cord edema or compression 1.Management
First-line treatment: Anti-scorpion venom serum (AScVS) for severe cases 1.
Adjunctive therapies: Alpha blockers may be used but recovery is slower compared to AScVS 1.
Supportive care: Monitoring and management of autonomic storm, respiratory support, and fluid/electrolyte balance adjustments.Special Populations
Pediatrics: Specific dosing and monitoring guidelines for AScVS are not detailed in the provided abstracts 1.
Elderly: No specific considerations mentioned; general supportive care principles apply 1.
Comorbidities: Management should consider underlying conditions, with AScVS remaining a key intervention 1.Key Recommendations
Administer Anti-scorpion venom serum (AScVS) as first-line treatment for severe scorpion envenomation causing myelopathy 1 (Evidence: Strong).
Monitor for and manage complications such as autonomic storm and multi-system organ failure alongside AScVS administration 1 (Evidence: Moderate).
Recovery with AScVS is significantly faster compared to other modalities like alpha blockers, suggesting its preference in severe cases 1 (Evidence: Moderate).References
1 Natu VS, Murthy RK, Deodhar KP. Efficacy of species specific anti-scorpion venom serum (AScVS) against severe, serious scorpion stings (Mesobuthus tamulus concanesis Pocock)--an experience from rural hospital in western Maharashtra. The Journal of the Association of Physicians of India 2006. link