Ischemic brain infarcts and intracranial haemorrhages following Russell's viper (Daboia russelii) bite in Sri Lanka

Rathnayaka, R.M.M.K. Namal; Kularatne, S.A.M.; Kumarasinghe, K.D.M.; Ranaweera, Janaka; Ranathunga, P.E. Anusha Nishanthi

doi:10.1016/j.toxicon.2016.11.253

Cited by 14 publications

(21 citation statements)

References 13 publications

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“…6 Cerebral infarctions are due to thrombotic occlusion of medium to large vessels in brain and this is due to the prothrombotic properties of Russell's viper venom. 5,6,7,8,9,10,11 In our patient left sided hemiparesis was found on day 21 following snake bite due to bilateral cerebral infarction. This was a late onset of infarction compared to previous reported cases which was documented as minutes to 4 days after the snake bite.…”

Section: Case Reportmentioning

confidence: 49%

Late onset of bilateral cerebral infarction following Russell’s viper (<em>Daboia russelii</em>) bite

Rathnayaka¹,

Ranathunga²

2017

Sri Lankan J Anaesthesiol

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A 53yr old male patient presented with a history of Russell's viper bite to his right side leg. He developed acute kidney injury (AKI) and respiratory failure and intubated and given ICU care. On day 21 of snake bite he was found to have left side weakness of body and revealed bilateral cerebral infarction in CT brain. However the patient died 26th day of snake bite due to complications of acute ischemic stroke and AKI. This is one of rare complications of snake bite and the late onset of cerebral infarction following Russell's viper bite which was not previously documented.

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Section: Case Reportmentioning

confidence: 49%

Late onset of bilateral cerebral infarction following Russell’s viper (<em>Daboia russelii</em>) bite

Rathnayaka¹,

Ranathunga²

2017

Sri Lankan J Anaesthesiol

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“…Common sites of hemorrhage are capsuloganglionic region, cortical and cerebellar, respectively (Table 2) (Images 1 and 2). Patients can also present with coexistent infarcts and hemorrhages, which was 6% in this review 11 32 …”

Section: Discussionmentioning

confidence: 83%

“…[7][8][9] Among all the viper envenomations, reports of CVI are the highest among Russel's viper envenomation. [10][11][12] Similarly, scorpions such as M. tamulus and Tityus serrulatus have been reported to cause cerebrovascular involvement. [13][14][15] Various mechanisms have been postulated in causing vascular injury.…”

Section: Discussionmentioning

confidence: 99%

“…Patients can also present with coexistent infarcts and hemorrhages, which was 6% in this review. 11,32 All patients reviewed had features of severe envenomation at the time of admission. All these patients were treated medically and received blood products, anti-snake venom, an alpha-blocker (in case of scorpion sting) and optimal supportive care.…”

Section: Discussionmentioning

confidence: 99%

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Cerebrovascular Injury Following Scorpion Sting and Snake Envenomation: A Case Series

Mishra

Binu

Abraham

et al. 2018

Can. J. Neurol. Sci.

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BackgroundNeurological complications following snake and scorpion bite are diverse. Literature regarding patterns of cerebrovascular injury (CVI) and outcomes among these patients is scarce. This is a descriptive study of the clinical profile, brain imaging findings, mechanisms of injury, vascular territory involvement and outcomes of CVI following scorpion and snake envenomation, in a tertiary care center in South India.MethodologyPatients with scorpion sting- and snake envenomation-related complications were retrospectively enrolled. Neuroimaging was performed on five patients with each envenomation, and they were found to have neurological involvement. On imaging, three patients were found to have a CVI. Clinical, radiological parameters and outcomes of these patients were studied. We also performed a review of the literature and analyzed the finding of all the cases.ResultIn all, three patients each had evidence of CVI in imaging. An additional 32 reports of scorpion sting-related CVI and 35 reports of snake envenomation-related CVI were identified from the literature. There was a male predominance among these patients. Mean age of the patients with scorpion sting was 42.8 years as compared with 33 years for the patients with snake envenomation. Features of severe envenomation were present in all patients. Persistently depressed sensorium and new-onset focal neurological deficits were seen in 70% of all patients. Infarcts were seen in 88% of patients with snake envenomation and 53% of patients with a scorpion sting. Mortality was 28% among patients with a scorpion sting as compared with 8% with snake envenomation.ConclusionCerebrovascular injuries are uncommon neurological manifestations following scorpion and snake envenomation. These tend to occur in younger patients. Infarcts are more common than bleeds.

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“…Most of the victims, 40 out of 56 cases (71.429%), were hospitalized and the specific antivenom was administered to 26 individuals. In a few cases, the victim was at first treated by a local healer or with traditional remedies [15,20,28,43].…”

Section: Epidemiological Findingsmentioning

confidence: 99%

Snakebite Envenoming a Challenging Diagnosis for the Forensic Pathologist: A Systematic Review

Feola

Marella

Carfora

et al. 2020

Toxins

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Snakebite envenoming (SBE) is a public health issue in developing countries. The estimated annual global incidence of snakebites is about 5.4 million snakebites per year, resulting from 1.8 to 2.7 million cases of SBE and from 81,000 to 138,000 deaths with 400,000 survivors suffering permanent physical and psychological disabilities. There are more than 3000 species of snakes around the world: 600 are venomous and over 200 are considered to be medically important because of their clinical effects. The severity of SBE depends on several factors among which bite localization, snake’s size, condition of glands and teeth, bite angle and bite duration, the microflora of the snake’s mouth and victim’s skin, age of the victim, weight, health status, and victim’s activity after a bite. Snake venoms are mixtures of protein families, and each of these families contains many different toxins or toxin isoforms. Based on their effects, snake venoms can be classified as hemotoxic, neurotoxic, or cytotoxic and they can all act together involving multiple tissues and organs. When the bite is fatal, the mechanism of death is primarily related to the paralysis of respiratory muscles, which causes asphyxia and hypoxic-ischemic encephalopathy, but also anaphylactic shock, hemorrhagic shock, cardiomyopathy, acute tubular necrosis (ATN). The purpose of this literature review is to evaluate epidemiological and post-mortem examination findings in fatal SBEs in order to better understand the pathophysiological mechanisms, thus helping pathologists in defining the correct diagnosis.

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Ischemic brain infarcts and intracranial haemorrhages following Russell's viper (Daboia russelii) bite in Sri Lanka

Cited by 14 publications

References 13 publications

Late onset of bilateral cerebral infarction following Russell’s viper (<em>Daboia russelii</em>) bite

Late onset of bilateral cerebral infarction following Russell’s viper (<em>Daboia russelii</em>) bite

Cerebrovascular Injury Following Scorpion Sting and Snake Envenomation: A Case Series

Snakebite Envenoming a Challenging Diagnosis for the Forensic Pathologist: A Systematic Review

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