Anadure R K, Narayanan C S, Hande V, Singhal A, Varadaraj G
Senior Advisor (Medicine and Neurology), Department of Medicine, INHS Asvini, Mumbai, Maharashtra.
Senior Consultant Medicine, O/o DGAFMS, New Delhi.
J Assoc Physicians India. 2018 Jan;66(1):92-5.
Neurotoxicity from elapid bite may masquerade as early morning neuroparalytic syndrome (EMNS). We are reporting a series of two cases who presented as EMNS with absent brain stem reflexes, mimicking brain death. The first case was being considered for potential organ retrieval when the diagnosis was revised, and he recovered completely with Anti-snake venom (ASV). The second patient developed severe anaphylaxis to ASV, which made continuation of the empirical therapy in a comatose patient very tricky. She gradually tolerated a low dose ASV infusion under steroid and adrenaline cover, with reversal of paralysis and coma. Both the patients showed excellent recovery post ASV treatment. A simple bedside Neostigmine challenge test and timely ASV therapy can save many helpless patients of EMNS from certain death.
眼镜蛇咬伤所致神经毒性可能会伪装成清晨神经麻痹综合征（EMNS）。我们报告了一系列两例表现为EMNS且脑干反射消失、酷似脑死亡的病例。首例患者在诊断修正前曾被考虑进行潜在的器官获取，使用抗蛇毒血清（ASV）后完全康复。第二例患者对ASV发生严重过敏反应，这使得在昏迷患者中继续经验性治疗变得非常棘手。在类固醇和肾上腺素的掩护下，她逐渐耐受了低剂量ASV输注，瘫痪和昏迷症状得以逆转。两例患者在接受ASV治疗后均恢复良好。一项简单的床边新斯的明激发试验和及时的ASV治疗可以挽救许多无助的EMNS患者免于死亡。
