Hydrocephalus in snake bite: a rare manifestation with review of literature

Snake bites are pretty common in the rural farming population of India. Approximately 300 species of snakes are considered medically significant by the WHO. Snake bites can be venomous or non-venomous. The toxins present in the saliva of the snake are called venom, which can cause detrimental effects on the human body, the reason being multiple enzymes and molecules that act on various tissues of the human body. The toxin can be neurotoxins or hematotoxins, or it can also have a mixed effect as well. Intracranial manifestations due to snake bites are not quite common. They may have varied manifestations, like intracranial bleeds, infarcts, and hydrocephalus.

Case summary

We present to you a 9-year-old boy who came with a history of viper snake bite 2 months back on his left foot. The vipers have hematotoxins. The boy developed local swelling of left foot with areas of necrosis. Clot retraction test was of viper bite. He developed altered sensorium and respiratory distress for which he was kept on mechanical ventilation and tracheostomy was done. His sensorium did not improve over the period of 2 months. On imaging, he was found to have communicating hydrocephalus with multifocal resolving hemorrhages in bilateral fronto-parieto-occipital regions. A medium-pressure VP shunt was placed for the hydrocephalus. The general condition gradually improved over a period with GOSE score of 4 at 6 months follow-up.

Intracranial manifestations of snake bites are considered to be rare. They may present with life-threatening intracranial bleeds where intervention has to be done as soon as possible. Strong suspicion of intracranial complications should be present as most of the patients may have a subclinical presentation or may present late. Hydrocephalus in snake bites is a rare incidence.