Isolated Ptosis Following a Vipera aspis Bite

Abstract

In Spain, snakebites are uncommon medical emergencies that cause barely 100 hospitalizations annually. Most of the venomous bites are by snakes of the Viperidae family. Venom from Vipera snakes is reported to have cytotoxic and hematotoxic effects, and neurological effects have also been described. Ptosis (cranial nerve III palsy) is the most common sign, although any cranial nerve can be affected. We describe isolated ptosis, which was very likely after a Vipera aspis bite in the East Catalonian Pyrenees. No antivenom was administered. The ptosis resolved spontaneously within 10 h. Although neurologic findings are usually mild, they indicate a moderate or severe envenomation. Treating snakebites can be challenging for clinicians, especially when there are uncommon clinical manifestations. A toxicologist at a poison center should be consulted to help guide management. Development of local protocols may provide clinical support.

Venomous Bites, Stings and Poisoning by European Vertebrates as an Overlooked and Emerging Medical Problem: Recognition, Clinical Aspects and Therapeutic Management

“…Members of this genus are front-fanged, medium-sized (from 40 cm to roughly 100 cm) snakes with a typically stocky body, sub-triangular or sub-oval head distinct from the neck, eyes with vertical elliptical pupil, dorsal scales always keeled and a relatively short tail [ 3 , 26 , 28 , 35 ]. Being ambush predators, members of the genus Vipera are often difficult to spot in the wild because of their highly effective camouflage and often end up biting and envenomating people accidentally stepping on them [ 19 , 36 , 37 , 38 , 39 ].…”