Snakebite, dysautonomia and central nervous system signs

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### Learning Point for Clinicians This report highlights that clinically significant and striking dysautonomia can rarely occur in elapid snakebites and when present in the absence of clear history of snakebite, can cause diagnostic confusion with other mimickers of neuroparalytic snakebite such as myasthenic crisis, Grave’s disease, botulism, Guillain–Barre syndrome and acute porphyria. One early morning in August 2011, a previously healthy girl of 17 years was brought to the emergency medicine department of our hospital with history of sudden onset drooping of upper eyelids, diplopia, difficulty in speaking, swallowing and breathing and weakness of limbs for 2 h. These symptoms were preceded by abdominal pain and vomiting. She was apparently alright the previous night and had slept outside her kutcha house on the ground. There was no history of similar illness in family or deliberate self-poisoning. On admission, she was found to be unconscious, cyanosed with poor respiratory efforts. Pupils were normal and reactive to light. She was intubated immediately and mechanically ventilated. After an …