A rare case of quadriparesis.

Abstract

Sir, We read with interest the case of “quadriparesis” published in your esteem journal.[1] At the same time, we felt sorry to note the clinical manifestations of krait bite that include the history of a person who woke up in the middle of the night due to abdominal colic from floor bed published long back.[2] Subsequently, the symptoms such as vomiting, mild sweating, and progressive descending paralysis confirmed the envenoming by krait.[3] In such a situation, there is no need to investigate the victims unnecessarily to rule out Central nervous system (CNS) manifestations.[4] Krait venom is rich in beta-bungarotoxin, which destroys the presynaptic neuromuscular receptors that result in an irreversible block. Recovery depends upon the regeneration of new receptors which may take more than 1 week.[23] Dilated nonreacting pupil seen from the elapid bite did not indicate the irreversible brain damage or coma. Authors mentioned that the patient was unconscious.[5] Because of the paralysis, the victim could not express though he was fully conscious, as venom did not cross the blood–brain barrier. Moreover, the anoxic comatose patient could not be recovered completely. One can note the fine movement of frontalis muscle by asking the patient to look upward.[6] The authors felt that this is a rare case, being not aware of published data,[7] and a chapter on snake bite in API Textbook of Medicine. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.