Spontaneous Intracerebral Bleed Post Snake Envenomation

Abstract

Snakebite envenomation is a commonly encountered emergency in tropical countries with potentially fatal complications. Life threatening neurosurgical complications are rare and infrequently documented in literature. We discuss the case of 28-year-old gentleman, managed successfully for an intracerebral haemorrhage following a viper bite and attempt to obviate some management dilemmas often encountered in viperine envenomation.

Keywords: Decompression; Haematotoxic venom; Intraparenchymal bleed; Viperine envenomation.

[Table/Fig-1]:

Computed tomographic scan (CT Brain) of the brain showing: a-c) Sagittal, coronal and axial respectively) grossly normal scan, taken at the time of admission. Repeat CT scan done after the partial seizure; d) axial section; e) coronal; and f) sagittal sections showing right frontal lobar haematoma with uncal and parafalcine herniation with cerebral oedema. The postop CT scan of the brain; g) showing complete evacuation of haematoma with craniectomy defect and persistent cerebral oedema.

[Table/Fig-2]:

A line graph showing the PT/INR and aPTT values during the hospital stay and symptomatic treatment showing a significant improvement in the coagulation profile.

[Table/Fig-3]:

Fluctuation in platelets, showing thrombocytopenia (at the time of admission) and the response to treatment along with spontaneous drop in platelets and the response following platelet transfusion. The effect of the haematotoxic viperine venom showing a drop in Hb from the time of admission and a concurrent drop in Hematocrit (Hct) and the response after transfusion with the plateau in Hb achieved thereafter.