Cerebral kounis syndrome: a rare case of cerebral vasospasm following anaphylaxis

Ismail, Mohd Helmie and Muniandy, Sadesvaran and Azmi, MUhammad Shafiq (2026) Cerebral kounis syndrome: a rare case of cerebral vasospasm following anaphylaxis. In: 10th International Virtual Medical Research Symposium, 3rd and 4th February 2026, Online.

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Abstract

Introduction: Kounis syndrome (KS) describes anaphylaxis-induced coronary vasospasm, often misdiagnosed as acute coronary syndrome. It possibly causes similar phenomenon of cerebral vasospasm and manifest as neurological complication of transient ischemic attacks (TIA). It is rare but increasingly recognised as one of stroke mimics. We report a unique presentation of cerebral vasospasm following an anaphylaxis in a previously healthy gentleman. Case description: A 45-year-old gentleman developed sudden right-sided hemiparesis and dysarthria while working outdoors, accompanied by generalised pruritus, rash, presyncope, dyspnea, palpitation and abdominal pain. He received prompt intramuscular epinephrine resulting in rapid symptom resolution and complete recovery in the emergency department. The brain CT scan and ECG were unremarkable. This case underscores the rare neurological manifestations of anaphylaxis. Discussion: This case highlights the dilemma of diagnosis and management. It rarely occurs following anaphylaxis as the brain typically protected by blood brain barrier (BBB). However, the lipid soluble allergen can cross the BBB and cause the cerebral vasospasm and inflammatory-mediated vascular dysfunction. This presentation aligns with the expanded concept of KS involving cerebral vasculature. This case highlights the importance of considering anaphylaxis-related cerebral vasospasm in patients presenting with simultaneous allergic and neurological symptoms. Conclusion: Prompt recognition and early epinephrine administration remain essential while maintaining vigilance for true TIA.

Item Type:	Proceeding Paper (Poster)
Uncontrolled Keywords:	Anaphylaxis; cerebral vasospasm; kounis syndrome
Subjects:	R Medicine > R Medicine (General)
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine Kulliyyah of Medicine > Department of Emergency Medicine
Depositing User:	Dr Mohd Helmie Ismail
Date Deposited:	31 Mar 2026 20:15
Last Modified:	01 Apr 2026 06:37
Queue Number:	2026-03-Q2662
URI:	http://irep.iium.edu.my/id/eprint/128075

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