A Rare Case of Snake Bite with Acute Ischemic Dual Circulation Stroke

Abstract

We present the case of a 26-year-old male patient who was admitted with a history of loss of consciousness for around 1 hour following a Viper snake bite. Subsequent investigation revealed multiple infarcts in the right frontal, bilateral parietal lobe, bilateral centrum semiovale, head of the right caudate nucleus and bilateral cerebellar hemispheresindicating involvement of both ACA and PCA territories. He was treated with polyvalent anti-snake venom, a single antiplatelet drug and other supportive treatments. The patient improved symptomatically and was discharged with a single antiplatelet drug. A follow-up visit 10 days later showed a dramatic improvement. The antiplatelet drug was stopped and the patient was reassured.

Although viper bite has been associated with haemorrhagic strokes, thrombotic stroke following viper bite is a rare occurrence. To the best of our knowledge, this is one of the very few case reports of thrombotic stroke involving both the ACA and PCA territories caused by Viper bite. This may be due to a number of potential causes including endothelial injury, vasospasm, vasculitis, the procoagulant action of toxins and DIC.