Cerebrovascular events induced by venomous snake bites: A systematic review

Snake bites represent a critical public health issue, affecting approximately 2.7 million people globally each year. Around 20 % of snake species are venomous, and their venom contains a complex array of toxins that can cause multi-organ damage, particularly affecting the nervous system, leading to both ischemic and hemorrhagic cerebrovascular events. This systematic review aims to compile and analyze data on cerebrovascular events associated with venomous snakebites. A comprehensive literature search was conducted using Scopus, PubMed, SciELO, and LILACS databases, with search terms including ("snake bite" OR "viper bite") AND ("stroke" OR "hemorrhagic stroke" OR "ischemic stroke"). Studies in English, Spanish, French and Portuguese were reviewed, yielding 52 eligible articles reporting 73 cases of stroke following snakebites. Most cases were attributed to snakes from the Viperidae family, with 67.12 % of cases occurring in males. Ischemic strokes were the most frequent, comprising 73.97 % of reported cases. The most affected systems were the nervous, cardiovascular, and respiratory systems. Snakes from the Bothrops genera and Daboia russelii specie caused the widest range of symptoms, including altered consciousness, ptosis, hypertension, drowsiness, aphasia, and tachycardia. Stroke is a severe complication of snakebite envenomation. Regarding treatment, the articles included emphasize the use of antivenom serum; however, they do not go into detail about the specific management of cutaneous stroke due to a snakebite, whether ischemic or hemorrhagic It is crucial to develop standardized protocols for the management of snakebite-induced strokes and to conduct further research to identify the snake species whose venom poses the highest risk for cerebrovascular complications.