Gouda Siddalingana, Pandit Vinay, Seshadri Shubha, Valsalan Rohith, Vikas M
Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
Ann Indian Acad Neurol. 2011 Oct;14(4):301-3. doi: 10.4103/0972-2327.91957.
Ischemic stroke following viper bite is rare. We report a case of posterior circulation ischemic infarction following viper bite in a previously healthy woman. Soon after being bitten by the snake on the left leg, she developed local redness, echymosis and one hour later became drowsy. On examination she had skew deviation of eyes and down gaze preference, generalized hypotonia. A CT scan of brain showed infarcts in cerebellar hemispheres and occipital lobes on both sides and that was confirmed on magnetic resonance imaging of brain. Her coagulation profile was deranged. Most common and serious central nervous system complication following snake bite is intracranial hemorrhage. Ischemic stroke commonly involves anterior circulation. Bilateral cerebellar and occipital infraction is not yet reported in literature. Exact cause for the development of infarction is not clear. The possible mechanisms of infarction in this scenario are discussed. Patient was treated with anti-snake venom and showed a good recovery. Early imaging and early treatment with anti-snake venom is important for a favorable outcome.
蝰蛇咬伤后发生缺血性中风较为罕见。我们报告一例既往健康的女性在被蝰蛇咬伤后出现后循环缺血性梗死的病例。在左腿被蛇咬伤后不久,她出现局部发红、瘀斑,一小时后变得嗜睡。检查时,她有眼球斜偏和下视偏好,全身肌张力减退。脑部CT扫描显示双侧小脑半球和枕叶梗死,脑部磁共振成像证实了这一点。她的凝血指标紊乱。蛇咬伤后最常见且严重的中枢神经系统并发症是颅内出血。缺血性中风通常累及前循环。双侧小脑和枕叶梗死在文献中尚未见报道。梗死发生的确切原因尚不清楚。本文讨论了这种情况下梗死发生的可能机制。患者接受了抗蛇毒血清治疗,恢复良好。早期影像学检查和早期使用抗蛇毒血清治疗对于取得良好预后很重要。