Abstract
IntroductionRussell’s viper (Daboia russelii) is one of the most common medically important snakes reported in Sri Lanka. Its envenomation leads to significant mortality and morbidity with local, hematological, neurological and renal complications. Here we report the case of a patient who presented with bilateral blindness secondary to a bilateral posterior circulation ischemic stroke instead of the usual neurological manifestations of Russell’s viper envenomation. There were no reported cases of cortical blindness following a Russell’s viper bite. Only a few reported cases of ischemic strokes following a Russell’s viper bite were found in the literature.Case presentationA 54-year-old Sri Lankan woman developed bilateral blindness due to a posterior circulation infarct following Russell’s viper envenomation.ConclusionIschemic stroke following a Russell’s viper bite is very rare and cortical blindness is not reported as the clinical presentation. Also, we emphasize the importance of considering the possibility of ischemic stroke in patients who develop unusual neurological manifestations following Russell’s viper envenomation.
Highlights
Russell’s viper (Daboia russelii) is one of the most common medically important snakes reported in Sri Lanka
Ischemic stroke following a Russell’s viper bite is very rare and cortical blindness is not reported as the clinical presentation
Russell’s viper (Daboia russelii) envenomation is common in Sri Lanka [1], and is characterized by coagulopathy (77%), local swelling (92%), renal involvement (18%) and neurotoxicity (78%) [2]
Summary
Ischemic stroke is rare following snake bite, theoretical possibilities of infarction as well as hemorrhage are well explained. We emphasize the importance of considering the possibility of ischemic stroke in patients who develop unusual neurological manifestations following snake bite. 7. Gawarammana I, Mendis S, Jeganathan K: Acute ischemic strokes due to bites by Daboia russelii in Sri Lanka - first authenticated case series. 8. Ameratunga B: Middle cerebral occlusion following Russel’s viper bite. 9. Narang SK, Paleti S, Azeez Asad MA, Samina T: Acute ischemic infarct in the middle cerebral artery territory following a Russell's viper bite. Trans R Soc Trop Med Hyg 1989, 83:732–740. Doi:10.1186/1752-1947-8-99 Cite this article as: Subasinghe et al.: Bilateral blindness following Russell’s viper bite - a rare clinical presentation: a case report.
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