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Case Reports
. 2025 Nov 7;17(11):e96290.
doi: 10.7759/cureus.96290. eCollection 2025 Nov.

Middle Cerebral Artery Territory Ischemic Infarction Secondary to Russell's Viper Envenomation: A Case Report

Vijayakumaran Yanusha  1 , Pakkiyaretnam Mayurathan  2   3 , Sithy Sabrina  4
Affiliations
Case Reports

Middle Cerebral Artery Territory Ischemic Infarction Secondary to Russell's Viper Envenomation: A Case Report

Vijayakumaran Yanusha et al. Cureus. .

Abstract

In tropical countries such as Sri Lanka, snake envenomation represents a significant public health concern. Russell's viper is one of the venomous snakes, causing local and systemic manifestations. Ischemic stroke following Russell's viper bite is rare and is underreported. We describe a case of a 40-year-old previously healthy man who developed a left middle cerebral artery territory infarction following a Russell's viper bite, despite the timely administration of snake antivenom. Non-contrast computed tomography (NCCT) brain revealed left-sided middle cerebral artery territory ischemic infarction. Evaluation for stroke excluded common aetiologies, including atherosclerosis, cardiac embolism, and primary vasculitis. This suggests that the most plausible mechanism for the infarction is toxin-induced vasculitis and endothelial injury.

Keywords: hemotoxic; ischemic stroke; russell's viper envenomation; vicc; wbct20.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Russell's viper
Image credit: author's original creation
Figure 2
Figure 2. Left-sided middle cerebral artery territory infarction
See this image and copyright information in PMC

References

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