Electroencephalographic abnormalities in patients with snake bites.

Electroencephalograms (EEGs) were obtained for 26 patients with snake bite to observe the cerebral impact of snake venom. All snakes were identified; 19 (73%) were Russell's vipers, one (4%) was a common cobra, five (19%) were hump-nosed vipers, and one (4%) was a dog-faced fresh water snake. The EEG was abnormal in 25 patients (96%) and these results included all the snake species identified. The EEG abnormalities observed were reduced alpha activity, increased theta/beta activity or sharp waves (grade 1), sharp waves or spikes and slow waves (grade 2), or diffuse delta activity (grade 3). Grade 1 changes occurred in 16 patients (62%), grade 11 in eight patients (31%), and grade 111 in one patient (4%). Thus, grade 2 and 3 changes, which were moderately severe to severe abnormalities, occurred in nine patients (35%). One patient had acute renal failure and two others had mild jaundice and hyponatremia. These three patients had EEG abnormalities that were similar to those observed in the remaining 22 patients. The altered EEG, suggestive of an encephalopathy, appeared within hours of the bite and persisted for several days without clinical neurologic effects. The changes were seen mainly in the temporal lobe. Similar changes occurred in both patients with and without antivenom therapy. It appeared that the EEG abnormalities are a consequence of the effects of venom from the bites of a variety of snakes.