Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Medical Science, Faculty of Medicine, University of Girona, Girona, Spain.
Department of Medical Science, Faculty of Medicine, University of Girona, Girona, Spain; Department of Emergency, Cerdanya Hospital, Puigcerdà, Spain; Sistema Emergències Mèdiques (SEM), Catalonia, Spain.
Wilderness Environ Med. 2022 Jun;33(2):245-247. doi: 10.1016/j.wem.2022.02.007. Epub 2022 Mar 30.
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.
在西班牙，蛇咬伤是罕见的医疗急症，每年仅导致不到 100 人住院。大多数毒蛇咬伤是由蝰蛇科的蛇引起的。据报道，Vipera 蛇的毒液具有细胞毒性和血液毒性作用，也有描述其具有神经毒性作用。上睑下垂（第三颅神经麻痹）是最常见的体征，尽管任何颅神经都可能受到影响。我们描述了一种非常可能是在东加泰罗尼亚比利牛斯山被 Vipera aspis 咬伤后发生的孤立性上睑下垂。未给予抗蛇毒血清。上睑下垂在 10 小时内自发缓解。尽管神经系统表现通常较轻，但它们表明中度或重度中毒。对于临床医生来说，治疗蛇咬伤可能具有挑战性，特别是当出现罕见的临床表现时。应咨询毒理学家以帮助指导管理。制定局部方案可能提供临床支持。
