Hypertensive encephalopathy with locked-in syndrome mimicking brain death: An unusual case of Krait envenomation with literature review.
Publish place: Asia Pacific Journal of Medical Toxicology، Vol: 9، Issue: 4
Publish Year: 1399
نوع سند: مقاله ژورنالی
زبان: English
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شناسه ملی سند علمی:
JR_PJMT-9-4_006
تاریخ نمایه سازی: 2 اسفند 1399
Abstract:
Introduction: Neuroparalytic snake bite is a serious life-threatening hazard all over the world, especially in tropical countries of South-East Asia. But it is one of the most neglected tropical diseases. Patients can present with envenomation signs without a history of snakebite or an identifiable bite mark. Apart from neuroparalysis, symptoms of autonomic dysfunction can also be seen with krait envenomation. Case Report: ۱۱-year-old girl presented with early morning sudden onset altered sensorium. On examination found to have absent spontaneous respirations, severe hypertension, dilated pupils, and absent brainstem reflexes, so labeled as probable brain death. Later with control of hypertension, she was able to respond by blinking but had severe neuroparalysis. There was no evidence of snakebite but with a strong suspicion of krait envenomation, anti-snake venom was given empirically and continued ventilatory support, following which child had a complete recovery. Discussion: As the majority of krait bites occur during sleep and due to its painless nature, they often go unnoticed. Also, krait bite leaves very fine puncture marks and the local reaction is markedly absent, so fang marks couldn’t be easily identified. Autonomic dysfunction following krait envenomation can present as abdominal pain, vomiting, sweating, mydriasis, fluctuation of heart rate and blood pressure, and paralytic ileus. In severe krait envenomation, complete paralysis of all voluntary muscles leads to quadriplegia and anathria which resembles locked-in syndrome. Locked-in syndrome when associated with internal ophthalmoplegia can mimic brain death. Conclusion: Snakebite should be considered in the differential diagnosis of unexplained neuroparalysis and hypertension. Envenomation should not be excluded by the absence of a history of snakebite or identifiable bite mark.
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Authors
Revanth Baineni
Department of pediatric intensive care, Andhra hospitals
Ramesh Mallavarapu
Pediatric intensive care, Andhra hospitals
Bhanuprasad Devarapalli
Consultant, Pediatric intensive care, Andhra hospitals
Venkata Ramarao Paturi
Head, Pediatric intensive care, Andhra hospitals
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