Cerebrovascular Accident and Snake Envenomation: A Scoping Study

Abstract

Background:Snake envenomation is associated with serious complications including infections, bleeding and, in rare occasions, thrombosis. Previous work by our group examined the association of snakebite and acute myocardial infarction. In this systematic review we aim to assess the clinical characteristics and outcomes of acute cerebrovascular accidents that are reported to be extremely rare complications of snake envenomation.Methods:We performed a literature search for reports on stroke associated with snake envenomation between Jan 1995 to Oct 2018, and summarized their characteristics.Results:Eighty-three published cases were reviewed. 66.3% of the cases were younger than 50 years of age. The mean time for the onset of the symptoms is 23.8±10.9 hours after exposure. 77.1% of the cases found to have ischemic stroke, 20.5% with intra-cranial hemorrhage and both infarction and hemorrhage in 2.4%. Mortality was reported in 16.9% with mean time between onset of the symptoms and death is 4.2 days.Conclusion:Stroke secondary to snake envenomation is a rare but serious complication. Once stroke is suspected, initiating appropriate management is crucial in reducing morbidity and mortality associated with this potentially fatal complication of snake envenomation.

Hemorrhagic stroke following snake bite in Burkina Faso (West Africa). A case series

“…We have described the first three cases of hemorrhagic stroke after envenomation in the context of Burkina Faso. All the cases occurred in young patients (< 65 years of age) without vascular risk factors, following previous literature which suggests that only 2% of snake bite patients had a history of diabetes mellitus or hypertension [ 3 ]. All sexes are affected by hemorrhagic stroke [ 6 , 9 , 10 ] and all patients were agro-pastoralists, living in rural areas.…”

“…Venomous snakes can cause stroke due to either their neurotoxic or hemotoxic enzymes [ 2 ]. According to Al-Sadawi et al, ischemic strokes account for 77.1% of the cases while intracerebral hemorrhage account for 20.5% [ 3 ]. Intracerebrale hemorrhage after snake bite has been sporadically reported in different regions of the world and it is an important prognostic factor, associated with high mortality [ 4 ].…”

Top of Basilar Artery Infarction: A Case Series from Sudan

“…Cerebral infarction association with snake bites has been reported less frequently, and it is often due to cerebral or subarachnoid bleeding due to depletion of clotting factors [9]. Snakes' bites secrete enzymes in the body [10]. These enzymes contribute for cerebral infarction due to variant mechanisms such as: Thrombotic occlusion of large vessels, vasculitis and consumption coagulopathy [10].…”

Multiple thromboembolic strokes in a toddler associated with Australian Eastern Brown snake envenomation

“…Snake envenomation has been reported to be cause a variety of neurological conditions and MRI findings depending on the species of snake ( Table 1 ) [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] . In Australia there are approximately 80 snake envenomations per year with 40% of these being from the Eastern Brown snake.…”

“… Russell's viper Australian Eastern Brown snake ( Pseudonaja textilis ) Leukoencephalopathy [10] Russell's viper Saw scaled viper ( Echis carinatus ) Posterior reversible encephalopathy syndrome [11] , [12] Bothrops spp. Indian pit viper Horned viper ( Cerastes cerastes ) Thromboembolic stroke [13] Bothrops spp. Horned viper Russell's viper …”