Chani M, Abouzahir A, Haimeur C, Kamili N Drissi, Mion G
Service de réanimation médicale, hôpital militaire d'instruction Mohammed V, Rabat, Maroc.
Ann Fr Anesth Reanim. 2012 Jan;31(1):82-5. doi: 10.1016/j.annfar.2011.08.022. Epub 2011 Dec 6.
An ischaemic stroke is a rare complication of viper envenomation that is due to multifactorial pathophysiological mechanisms. The authors describe the case of a 55-year-old patient bitten by the viper Cerastes cerastes. The patient was admitted to the intensive care unit with multiple organ failure, disseminated intravascular coagulopathy, rhabdomyolysis, anuria and elevated troponin level. The persistent disturbance of consciousness has motivated a brain scan which has revealed a bifocal ischemic stroke. The complex venom of the species C. cerastes may induce hypotension, tissue necrosis, acute renal failure, bleeding disorders or DIC. With the cessation of a non-indicated heparintherapy and haemodialysis, the patient recovered in a few weeks despite the initial infusion of an unsuitable antivenom due to the late identification of the reptile. The preventive treatment of the complications of this envenomation is based on the infusion of the polyvalent antivenom Favirept(®).
缺血性中风是蝰蛇咬伤后的一种罕见并发症，其病因是多因素病理生理机制。作者描述了一名55岁被角蝰（Cerastes cerastes）咬伤患者的病例。该患者因多器官功能衰竭、弥散性血管内凝血、横纹肌溶解、无尿和肌钙蛋白水平升高而入住重症监护病房。持续的意识障碍促使进行脑部扫描，结果显示为双灶性缺血性中风。角蝰的复合毒液可能会导致低血压、组织坏死、急性肾衰竭、出血性疾病或弥散性血管内凝血。由于对该爬行动物的识别较晚，最初输注了不合适的抗蛇毒血清，但在停止未指明的肝素治疗和血液透析后，尽管如此，患者在几周内康复。这种蛇咬伤并发症的预防性治疗基于输注多价抗蛇毒血清Favirept(®)。
