Spontaneous Intracerebral Bleed Post Snake Envenomation

Abstract

A 28-year-old male patient presented to the triage with an alleged history of snake bike, while walking by the roadside at dawn. His friends identified the snake to be a "kanthodi" or Viper, however they were unable to capture it. He fell unconscious soon after the incident and was brought within 30 minutes to the triage. There were no spontaneous bleeding manifestations, either, local, or systemic.On admission his vitals were stable. He was not opening eyes to painful stimuli but he was moving all four limbs spontaneously. Both his conjunctiva appeared congested. He did not show any sign of systemic envenomation in the form of diffuse spontaneous bleeding from mucosal surfaces or haematemesis. No signs of central or peripheral cyanosis or compartment syndrome. His pupils were equal and reacting well and there were no cerebral localizing signs in the form of hemiparesis or plegia. A plain Computed Tomographic scan of the brain (CT Brain) was done, which was normal [Table/ Fig-1a-c].He was started on Anti Snake Venom (ASV) as per guidelines and supportive treatment was started. Two days following his admission, he had an episode of focal seizures involving the right upper and lower limb. A repeat CT Brain was done which showed a large intraparenchymal bleed in the right frontal region with uncal and right parafalcine herniation with significant cerebral oedema [ AbSTRACTSnakebite envenomation is a commonly encountered emergency in tropical countries with potentially fatal complications. Life threatening neurosurgical complications are rare and infrequently documented in literature. We discuss the case of 28-year-old gentleman, managed successfully for an intracerebral haemorrhage following a viper bite and attempt to obviate some management dilemmas often encountered in viperine envenomation.[ Table/

Peripheral Arterial Thrombosis following Russell's Viper Bites

“…Bleeding complications (hemorrhage) from SBE inflicted by many viperid species are commonly reported and they can lead to cerebral hemorrhage, 28 29 pituitary failure, 30 pseudoaneurysm, 15 perinephric hematoma, 31 32 and acute kidney injury. 33 These complications can also contribute to the onset of cardiovascular shock and multiple organ failure.…”

An uncommon case of venomous snake bite complicated by intracranial haemorrhage

“…These enzymes cause haemolysis secondary to red cell membrane damage, and promote muscle necrosis. 7 There is formation of weak fibrin clots due to the combined action of these enzymes and the other thrombogenic enzymes, which inturn activate plasmin and result in consumption coagulopathy and haemorrhagic consequences. 8 Snake venom also contains prothrombin activators which cause a variable deficiency in factor V, VII and fibrinogen.…”

“…Page 1031 dose. The use of FFP has been seen to be associated with faster recovery and reduced risk of bleeding 7,10. CONCLUSIONVenomous snake bite can present with an uncommon but potentially disastrous complication in the form of intracerebral haemorrhage.…”

A rare presentation of snake bite

“…Girish Menon et all, reported a case of 28year old gentleman who had intracranial haemorrhage following a viper bite and was successfully managed. 1 Ophitoxaemia describes the various manifestation of snake bite envenomation. Cerebral complications are rare in snake bite.…”

“…Snake bite is commonly encountered in emergency. 1 It results in various complications varying according to the type of venom injected. In India, more than 2,500,000 snake bites are reported annually, out of which 30,000 to 50,000 cases end in mortality.…”