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Isolated Ptosis Following a Vipera aspis Bite.

Robert Blasco Mariño1, Iñigo Soteras Martínez2, Ana Isabel Hernandez Roca3

  • 1Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Medical Science, Faculty of Medicine, University of Girona, Girona, Spain.

Wilderness & Environmental Medicine
|April 3, 2022
PubMed
Summary

Vipera aspis snakebites in Spain are rare but can cause neurological issues like ptosis. This case showed isolated ptosis resolving spontaneously, highlighting the need for expert consultation in managing uncommon snakebite symptoms.

Keywords:
medical emergenciessnakebitessnakes

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Area of Science:

  • Toxicology
  • Neurology
  • Herpetology

Background:

  • Snakebites in Spain are infrequent, with approximately 100 annual hospitalizations.
  • Viperidae family snakes, particularly Vipera species, are the primary cause of venomous bites.
  • Vipera venom exhibits cytotoxic and hematotoxic effects, with reported neurological manifestations.

Observation:

  • A case of isolated ptosis (cranial nerve III palsy) following a Vipera aspis bite in the East Catalonian Pyrenees is described.
  • The patient did not receive antivenom treatment.
  • The ptosis resolved spontaneously within 10 hours.

Findings:

  • Neurological effects, such as ptosis, can occur in Vipera envenomation.
  • Isolated ptosis, though uncommon, is a possible manifestation of Vipera aspis bites.
  • Spontaneous resolution of neurological symptoms is possible even without antivenom.

Implications:

  • Uncommon clinical presentations in snakebites can challenge medical management.
  • Consultation with a toxicologist or poison center is crucial for guiding snakebite treatment.
  • Developing local protocols for snakebite management can provide essential clinical support.