Jaya Shankar Kaushik1, Biswaroop Chakrabarty1, Sheffali Gulati2, Harsh Patel1, Rakesh Lodha1, Gautham Pai1, Atin Kumar3. 1. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. 2. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Electronic address: sheffaligulati@gmail.com. 3. Department of Radio-Diagnosis, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Abstract
BACKGROUND: Neurological manifestations of elapid snakebites include neuromuscular paralysis and cerebrovascular complications. Autonomic manifestations are observed in almost two third of patients following moderate to severe envenomation. PATIENT SUMMARY: A 10-year-old boy presented with acute onset flaccid quadriparesis with encephalopathy, cranial neuropathy, and respiratory failure after bite of a common Indian krait. He also had features of autonomic instability in the form of hypertension and variable heart rate. Within 10 days, he was weaned from the ventilator and discharged on multiple oral antihypertensives. Within a week, he returned with focal status epilepticus. MRI of the brain suggested posterior reversible leukoencephalopathy. He recovered completely within 2 days with visual impairments while recovering. Within next 1 month, his antihypertensives were tapered completely. MRI of the brain, repeated after 3 months, confirmed complete resolution. CONCLUSIONS: This patient highlights the fact that posterior reversible leukoencephalopathy can be a late complication of Indian krait bite secondary to autonomic instability with systemic hypertension.
BACKGROUND: Neurological manifestations of elapid snakebites include neuromuscular paralysis and cerebrovascular complications. Autonomic manifestations are observed in almost two third of patients following moderate to severe envenomation. PATIENT SUMMARY: A 10-year-old boy presented with acute onset flaccid quadriparesis with encephalopathy, cranial neuropathy, and respiratory failure after bite of a common Indian krait. He also had features of autonomic instability in the form of hypertension and variable heart rate. Within 10 days, he was weaned from the ventilator and discharged on multiple oral antihypertensives. Within a week, he returned with focal status epilepticus. MRI of the brain suggested posterior reversible leukoencephalopathy. He recovered completely within 2 days with visual impairments while recovering. Within next 1 month, his antihypertensives were tapered completely. MRI of the brain, repeated after 3 months, confirmed complete resolution. CONCLUSIONS: This patient highlights the fact that posterior reversible leukoencephalopathy can be a late complication of Indian krait bite secondary to autonomic instability with systemic hypertension.
Authors: Ahmed Mustafa Ibrahim; Tarek Talaat ElSefi; Maha Ghanem; Akram Muhammad Fayed; Nesreen Adel Shaban Journal: Case Rep Neurol Med Date: 2017-04-10