A 54-year-old healthy Sri Lankan woman presented 30 minutes
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Mannat Kaur Bhatia
A 54-year-old healthy Sri Lankan woman presented 30 minutes following a Russell’s viper bite. The snake was brought in and identified. On her admission to our facility, a 20-minute whole blood clotting test (20-WBCT) was prolonged with clinical hematuria without other obvious bleeding manifestations. Local envenomation was apparent with edema at the bite site but there were no features of neurotoxicity. Initially, 10 vials of anti-snake venom serum were given and the hematuria eased. In three to four hours, our patient complained of visual blurring followed by bilateral visual loss. There was no ptosis or ophthalmoplegia. Fundoscopic examination and slit lamp examination of her retinae were completely normal but she could perceive only light. There were no other neurological manifestations. CT of her brain showed bilateral posterior circulation infarcts without haemorrhages. Our patient developed cortical blindness due to bilateral, multiple, large artery territory ischemic infarcts with normal funduscopic findings. We postulated a generalized procoagulant effect of snake venom causing thrombosis of multiple large vessels as the underlying pathophysiology. Ischemic stroke though rare needs to be considered in case of snake bite.
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