Abstract. An 18-year-old man developed posterior reversible leukoencephalopaty after being bitten by a venomous snake (Bothrops asper). It is possible that this previously unrecognized neurological complication of snake bite envenoming occurred as the result of endothelial dysfunction induced by the venom of the offending snake. This pathogenetic mechanism has also been implicated as the cause of cerebral infarctions in snake bite victims. Alternatively, the leukoencephalopathy might have been a complication of antivenom therapy.

A 28-year-old woman presented with fever, double vision, and facial pain. Neurologic examination showed neck stiffness, pain in the distribution of the right trigeminal nerve, and right abducens palsy (figure 1). Tympanic membranes were normal. MRI revealed sphenoid sinusitis, basilar pachymeningitis, and clivus osteomyelitis (figure 2). CSF analysis showed pleocytosis, increased protein contents, decreased glucose levels, and positive cultures for Staphylococcus aureus. The triad of suppurative otitis media, pain in the distribution of the trigeminal nerve, and abducens palsy is called Gradenigo syndrome. 1 While it most often affects children, it may occur in adults and may rarely present without otitis media. 2 While bone compromise is usually confined to the petrous apex, it may extend to sphenoid sinuses, clivus, and basal meninges.