Seastroke. (Correspondence).

To the Editor: The etiology of the entity "seastroke" described in a 1993 issue of this journal (1) remains an enigma. The patient in Case 2 unfortunately still remained in the rehabilitation unit 5 years after the acute episode. Theories of trauma, infectious myelitis, infarction, and congenital neurologic defects remain casual possibilities. The paper was distinctive because the injuries occurred in a limited 2-year time period (1990 to 1992) over a restricted geographic location (the southeastern North Carolina coast) and struck three previously healthy young males. Additionally, two of the patients remember stepping on an unusual object on the ocean bottom and the third thought something had stung him on the arm. Thus the possibility that a toxic venom producing these injuries was suggested.

The eventual solution of the pathogenesis of seastroke may unravel as additional similar patients appear; therefore, the following case report is offered.

Case Report. Late in the afternoon on June 28, 2000, a previously healthy 15-year-old adolescent felt a stabbing pain on the dorsal aspect of his left foot as he came out of 0.7 m fresh water in a lake near Lynchburg, in southwestern Virginia. One-half hour later, the patient experienced dysesthesias, pain, and slight numbness in both forearms. This upper girdle pain increased over the next 2 hours, as slight hand weakness and left conjunctival injection was noted. Over the 4-hour period after the episode, abdominal numbness and leg weakness and loss of feeling developed. During the next day, linear erythematous punctate lesions appeared on the feet, inner thighs, and the volar aspect of the upper forearm. These lesions persisted for ten days, during which time the pain and paralysis ascended up into the neck. Intubation with assisted ventilation became necessary. A second transient eruption then occurred on the upper body on the fourth post-episode day. His subsequent course was complicated by a stress ulcer perforation due to steroid therapy. Microscopic examination of the cerebrospinal fluid and MRI and CT scans were nondiagnostic, except to show cord swelling, first at L-2 to T-1, then later atrophy of the middle to lower portion of the cervical cord. A left-sided Homer's syndrome appeared. Now seven months into his disorder, the patient remains significantly impaired. In early August 2000, news reports mentioned the discovery of Craspedacusta sowerbii in the lake where the boy swam. This freshwater jellyfish had been identified 2 years earlier in Lake Norman, NC. It is not known as a toxic animal, yet it does contain nematocysts capable of catching prey. This report is submitted to the journal of the original report to alert your readership, which includes the geographic location of these unfortunate instances.

Joseph W. Burnett, MD

Department of Dermatology

University of Maryland 

405 W Redwood St, 6th Floor

Baltimore, MD 21201

Reference

(1.) Meyer PK: Seastroke: a new entity? South Med J 1993; 86:777-779