Complete Ophthalmoplegia with Areflexia Following Snake Bite can Mimic Brain Death

Abstract

Ocular complications after snake bite are well reported.External ophthalmoplegia is an established association with neurotoxic envenomation, but, combination of internal and external ophthalmoplegia(complete ophthalmoplegia) can mimic brain death and pose a dilemma to the doctors treating such patients regarding continuation of therapy. We here report a case of a 8 years boy who was playing and something has pierced in his right hand. He thendeveloped pain , swelling in his right hand and forearm and weakness of limbs and subsequently other systemic symptoms and signs.On examinationtwo clean puncture wounds were identified on his right index finger. A provisional diagnosis of snake bite with severe envenomation was made and anti snake venom was started. Over a period of 3-4 hourshis weakness progressed and became areflexic.Subsequently the patient developed internal and external ophthalmoplegia and loss of other brain stem reflexes mimicking brain death.