Cerebral Complications of Snakebite Envenoming: Case Studies

Abstract

There are an estimated 5.4 million snakebite cases every year. People with snakebite envenoming suffer from severe complications, or even death. Although some review articles cover several topics of snakebite envenoming, a review of the cases regarding cerebral complications, especially rare syndromes, is lacking. Here, we overview 35 cases of snakebite by front-fanged snakes, including Bothrops, Daboia, Cerastes, Deinagkistrodon, Trimeresurus, and Crotalus in the Viperidae family; Bungarus and Naja in the Elapidae family, and Homoroselaps (rare cases) in the Lamprophiidae family. We also review three rare cases of snakebite by rear-fanged snakes, including Oxybelis and Leptodeira in the Colubridae family. In the cases of viper bites, most patients (17/24) were diagnosed with ischemic stroke and intracranial hemorrhage, leading to six deaths. We then discuss the potential underlying molecular mechanisms that cause these complications. In cases of elapid bites, neural, cardiac, and ophthalmic disorders are the main complications. Due to the small amount of venom injection and the inability to deep bite, all the rear-fanged snakebites did not develop any severe complications. To date, antivenom (AV) is the most effective therapy for snakebite envenoming. In the six cases of viper and elapid bites that did not receive AV, three cases (two by viper and one by elapid) resulted in death. This indicates that AV treatment is the key to survival after a venomous snakebite. Lastly, we also discuss several studies of therapeutic agents against snakebite-envenoming-induced complications, which could be potential adjuvants along with AV treatment. This article organizes the diagnosis of hemotoxic and neurotoxic envenoming, which may help ER doctors determine the treatment for unidentified snakebite.

Acute ischaemic stroke and deep vein thrombosis following snakebite

“…Towards this end, Feola et al reported 2.6% of patients with cerebrovascular complications among 309 snakebite victims 9. Ischaemic stroke has also been reported in various snake envenomation 16–21. Gawarammana et al found 1.8% ischaemic stroke cases in 500 viper bite patients 22.…”

Acidente crotálico seguido por primeiro episódio psicótico

“…20 Sabe-se ainda que, a depender da gravidade de certas intoxicações, podem-se obter sequelas consideráveis, não sendo possível descartar a possibilidade de que o veneno tenha, de alguma forma, contribuído para alguma agressão cerebral permanente e incomum. 21 Considerando-se os níveis pressóricos aumentados mesmo meses depois do acidente, há de questionar a integridade da saúde vascular em nível sistêmico após o trauma. A título de exemplificação, existe, publicado, um relato de caso indiano que segue esta linha de raciocínio: a ação do veneno vasculotóxico da cobra Daboia russelii em um homem de 42 anos foi suficiente para provocar a síndrome da sela vazia e desencadear transtorno delirante orgânico tipo esquizofrênico.…”

The burden, risk factors and unique etiologies of stroke in South-East Asia Region (SEAR)

“… 64 Chemical compounds with prothrombotic properties in snake venom, such as snake C-type lectin-like proteins, SVSPs (snake-venom serine proteases), and PLA2 (phospholipase A2), are believed to cause ischaemic stroke and procoagulant metalloproteases and hemorrhaging to lead to consumptive coagulopathy and ICH. 64 , 65 …”