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Thalamic infarction following a Russell's viper bite.
Abraham M Ittyachen1, Mohan B Jose
1Department of Medicine, Malankara Orthodox Syrian Church Medical College, Kolenchery, Kerala State, India. abyliz@rediffmial.com
The Southeast Asian Journal of Tropical Medicine and Public Health
|February 26, 2013
Summary
Russell's viper bites can cause brain damage. This case highlights a rare instance of bilateral thalamic infarction following a Russell's viper (Daboia russelii) envenomation, a complication not previously reported.
Area of Science:
- Neuroscience
- Toxicology
- Vascular Neurology
Background:
- Russell's viper (Daboia russelii) envenomation is a significant cause of morbidity and mortality, particularly in South Asia.
- Coagulopathy is a common complication of Daboia russelii bites, often leading to hemorrhagic or thrombotic events.
- Cerebral infarction following snakebites has been documented, but specific patterns of brain involvement are not fully characterized.
Observation:
- A 55-year-old male presented with a Russell's viper bite.
- Initial presentation included prolonged clotting times, raising concerns for intracranial hemorrhage.
- Despite coagulopathy control within 24 hours, the patient exhibited restlessness and disorientation.
Findings:
- Magnetic resonance imaging (MRI) revealed bilateral thalamic infarcts.
- These infarcts occurred despite the successful management of coagulopathy.
- This represents the first reported case of bilateral thalamic infarction secondary to Daboia russelii envenomation.
Implications:
- This case expands the spectrum of neurological complications associated with Russell's viper bites.
- It underscores the potential for ischemic cerebrovascular events, even after coagulopathy correction.
- Further research is needed to understand the pathophysiology and risk factors for thalamic infarction in snake envenomation.
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