Clinical Practice and Cases in Emergency Medicine

Introduction: Kounis syndrome describes anaphylaxis-induced coronary vasospasm and is often misdiagnosed as acute coronary syndrome. We report a similar phenomenon of cerebral vasospasm following anaphylaxis, a rare and under-recognized mimic of stroke.

Case Report: A previously healthy 45-year-old gentleman developed sudden right-sided hemiparesis and dysarthria while working outdoors, accompanied by generalized pruritus, rash, presyncope, dyspnea, palpitation, and abdominal pain. He received prompt intramuscular epinephrine and other anti-inflammatory agents, resulting in rapid symptom resolution and complete recovery in the emergency department. Computed tomography of the brain and other studies were unremarkable. This case underscores a rare neurological manifestation of anaphylaxis. 

Conclusion: Cerebral vasospasm is an unusual sequela of anaphylaxis that may lead to a diagnostic dilemma. Prompt administration of epinephrine is crucial for recovery. This case highlights the association between hypersensitivity reactions and cerebrovascular events, emphasizing the need for early recognition and timely intervention.