Status epilepticus and bilateral middle cerebral artery infarction: A rare presentation after viper bite

Abstract

Owing to the antihemostatic property of viper venom, hemorrhagic complications including intracerebral hemorrhage are the most commonly encountered after viper bite. Ischemic strokes have been rarely reported after viper envenomation, and its occurrence has been attributed to multiple mechanisms. Postsnakebite seizures are known to occur after neurotoxic bite. Here, we report the case of a viper bite victim who developed status epilepticus within 3 h after viper bite. He had only mild signs of local envenomation, and prolonged whole blood clotting time was the only manifestation of systemic envenomation. Subsequently, he was found to have developed right hemiparesis and global aphasia. Brain imaging revealed large infarcts in bilateral middle cerebral artery (MCA) territories. We report this as a unique case of viper bite which presented to the emergency room with status epilepticus. Moreover, bilateral MCA infarct, as was found in this case, is genuinely rare in scientific literature. Finally, the absence of overt features of envenomation makes this case stand out from other similar reported occurrences.

Cerebral Complications of Snakebite Envenoming: Case Studies

“…In India, four patients were bitten by D. russelii and diagnosed with cerebral infarction during hospitalization [ 12 , 39 , 40 , 41 ]. Three patients received AV treatment; two of them recovered with no complications.…”

“…Unfortunately, one patient died even after 35 vials of AV administration due to misidentifying the snake species at the beginning of treatment [ 12 ]. One patient did not receive any AV and recovered with motor deficit [ 41 ]. The neurotoxins of D. russelii also caused neural complications such as Gerstmann’s syndrome [ 40 ] and ptosis [ 12 ] in patients.…”