Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2010 Sep;6(3):318-21.
doi: 10.1007/s13181-010-0015-8.

Acute demyelinating encephalomyelitis after anti-venom therapy in Russell's viper bite

S Tripathy  1 , P K Routray, A K Mohapatra, M Mohapatra, S C Dash
Affiliations
Case Reports

Acute demyelinating encephalomyelitis after anti-venom therapy in Russell's viper bite

S Tripathy et al. J Med Toxicol. 2010 Sep.

Abstract

Introduction: Russell's viper is a commonly encountered venomous snake in India. Morbidity and mortality following envenomation and the treatment thereof are frequent. We report a rarely seen complication after a treated Russell's viper bite.

Case report: A 36-year-old male farmer received 30 vials polyvalent anti-snake venom after a viper bite to his right leg. Improvement in initial hematemesis and circulatory shock was followed by acute renal failure managed with regular hemodialysis. He displayed no abnormalities on neurological examination at admission. Fourth day onwards his neurologic status started deteriorating with development of behavioral abnormalities, hemi-spatial neglect of left upper limb, paralysis of left facial nerve, left upper limb, and right lower limb. Acute disseminated encephalomyelitis was confirmed on magnetic resonance imaging (MRI) of brain with typical spectroscopic characteristics. High dose methyl prednisolone was administered and a rapid recovery followed.

Conclusion: Russell's viper bite followed by treatment with antivenom may be complicated by the development of immune complex mediated demyelination and development of acute disseminated encephalomyelitis. MRI spectroscopy helps in early identification of demyelination and in a definite diagnosis. Treatment with corticosteroids was associated with resolution of symptoms in this case.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
CT scan brain on day 4. Edematous changes in right temporal lobe
Fig. 2
Fig. 2
MRI of brain (T2 weighted) showing multiple hyperintense lesions in subcortical and deep white matter of bilateral cerebral hemispheres. The area enclosed in the square demarcates the hyperintense region which has been spectroscopically analyzed
Fig. 3
Fig. 3
Spectroscopy of affected area revealing slightly reduced N-acetyl aspartate, normal creatinine, and high choline peaks. NAA N-acetyl aspartate, Ch choline, Cr creatine, MI myoinisitol, LL lactate/lipids, Leu leucine, Ala alanine
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Boz C, Velioglu S, Ozmenoglu M. Acute disseminated encephalomyelitis after bee sting. Neurol Sci. 2003;23:313–315. doi: 10.1007/s100720300007. - DOI - PubMed
    1. Malhotra P, Sharma N, Awasthi A, Vasishta RK. Fatal acute disseminated encephalomyelitis following treated snake bite in India. Emerg Med J. 2005;22:308–309. doi: 10.1136/emj.2004.014431. - DOI - PMC - PubMed
    1. Garg RK. Acute disseminated encephalomyelitis. Postgrad Med J. 2003;79:11–17. doi: 10.1136/pmj.79.927.11. - DOI - PMC - PubMed
    1. Simpson ID, Robert NL. Snakes of medical importance in India: is the concept of the “Big 4” still relevant and useful? Wilderness Environ Med. 2006;18:2–9. - PubMed
    1. Kohli HS, Sakhuja V. Snake bites and acute renal failure. Saudi J Kidney Dis Transpl. 2003;14:165–76. - PubMed

Publication types

LinkOut - more resources