Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2014

Open Access 01-12-2014 | Case report

Bilateral blindness following Russell’s viper bite - a rare clinical presentation: a case report

Authors: Chandrika Jayakanthi Subasinghe, Chamara Sarathchandra, Thambyaiah Kandeepan, Aruna Kulatunga

Published in: Journal of Medical Case Reports | Issue 1/2014

Login to get access

A bstract

Introduction

Russell’s viper (Daboia russelii) is one of the most common medically important snakes reported in Sri Lanka. Its envenomation leads to significant mortality and morbidity with local, hematological, neurological and renal complications. Here we report the case of a patient who presented with bilateral blindness secondary to a bilateral posterior circulation ischemic stroke instead of the usual neurological manifestations of Russell’s viper envenomation. There were no reported cases of cortical blindness following a Russell’s viper bite. Only a few reported cases of ischemic strokes following a Russell’s viper bite were found in the literature.

Case presentation

A 54-year-old Sri Lankan woman developed bilateral blindness due to a posterior circulation infarct following Russell’s viper envenomation.

Conclusion

Ischemic stroke following a Russell’s viper bite is very rare and cortical blindness is not reported as the clinical presentation. Also, we emphasize the importance of considering the possibility of ischemic stroke in patients who develop unusual neurological manifestations following Russell’s viper envenomation.
Appendix
Available only for authorised users
Literature
1.
go back to reference De Silva A: Snake bite in Anuradhapura district. Snake. 1981, 13: 117-130. De Silva A: Snake bite in Anuradhapura district. Snake. 1981, 13: 117-130.
2.
go back to reference Kularatne SA: Epidemiology and clinical picture of the Russell’s viper (Daboia russelii russelii) bite in Anuradhapura, Sri Lanka: a prospective study of 336 patients. Southeast Asian J Trop Med Public Health. 2003, 34: 855-862.PubMed Kularatne SA: Epidemiology and clinical picture of the Russell’s viper (Daboia russelii russelii) bite in Anuradhapura, Sri Lanka: a prospective study of 336 patients. Southeast Asian J Trop Med Public Health. 2003, 34: 855-862.PubMed
3.
go back to reference Seneviratne U, Dissanayake S: Neurological manifestations of snake bite in Sri Lanka. J Postgrad Med. 2002, 48: 275-278. Discussion 278–279PubMed Seneviratne U, Dissanayake S: Neurological manifestations of snake bite in Sri Lanka. J Postgrad Med. 2002, 48: 275-278. Discussion 278–279PubMed
5.
go back to reference Aundhakar SC, Mahajan Sanket K, Mane Makarand B, Arsekar Swapnil S: Bilateral optic neuritis following Russell's viper's bite - a rare complication. Indian J Forensic Med Toxicol. 2012, 6: 178-180. Aundhakar SC, Mahajan Sanket K, Mane Makarand B, Arsekar Swapnil S: Bilateral optic neuritis following Russell's viper's bite - a rare complication. Indian J Forensic Med Toxicol. 2012, 6: 178-180.
6.
go back to reference Mustapha SK, Mubi BM, Askira BH: Bilateral blindness following snakebite. Trop Doct. 2010, 40: 117-118. 10.1258/td.2009.090429.CrossRefPubMed Mustapha SK, Mubi BM, Askira BH: Bilateral blindness following snakebite. Trop Doct. 2010, 40: 117-118. 10.1258/td.2009.090429.CrossRefPubMed
7.
go back to reference Gawarammana I, Mendis S, Jeganathan K: Acute ischemic strokes due to bites by Daboia russelii in Sri Lanka - first authenticated case series. Toxicon. 2009, 54: 421-428. 10.1016/j.toxicon.2009.05.006.CrossRefPubMed Gawarammana I, Mendis S, Jeganathan K: Acute ischemic strokes due to bites by Daboia russelii in Sri Lanka - first authenticated case series. Toxicon. 2009, 54: 421-428. 10.1016/j.toxicon.2009.05.006.CrossRefPubMed
8.
go back to reference Ameratunga B: Middle cerebral occlusion following Russel’s viper bite. J Trop Med Hyg. 1972, 75: 95-97.PubMed Ameratunga B: Middle cerebral occlusion following Russel’s viper bite. J Trop Med Hyg. 1972, 75: 95-97.PubMed
9.
go back to reference Narang SK, Paleti S, Azeez Asad MA, Samina T: Acute ischemic infarct in the middle cerebral artery territory following a Russell's viper bite. Neurol India. 2009, 57: 479-480. 10.4103/0028-3886.55594.CrossRefPubMed Narang SK, Paleti S, Azeez Asad MA, Samina T: Acute ischemic infarct in the middle cerebral artery territory following a Russell's viper bite. Neurol India. 2009, 57: 479-480. 10.4103/0028-3886.55594.CrossRefPubMed
10.
go back to reference Prijatelj P, Jenko Praznikar Z, Petan T, Krizaj I, Pungercar J: Mapping the structural determinants of presynaptic neurotoxicity of snake venom phospholipases A2. Toxicon. 2008, 51: 1520-1529. 10.1016/j.toxicon.2008.03.031.CrossRefPubMed Prijatelj P, Jenko Praznikar Z, Petan T, Krizaj I, Pungercar J: Mapping the structural determinants of presynaptic neurotoxicity of snake venom phospholipases A2. Toxicon. 2008, 51: 1520-1529. 10.1016/j.toxicon.2008.03.031.CrossRefPubMed
11.
go back to reference Mukherjee AK: Characterization of a novel pro-coagulant metalloprotease (RVBCMP) possessing alpha-fibrinogenase and tissue haemorrhagic activity from venom of Daboia russelli russelli (Russell’s viper): evidence of distinct coagulant and haemorrhagic sites in RVBCMP. Toxicon. 2008, 51: 923-933. 10.1016/j.toxicon.2007.12.008.CrossRefPubMed Mukherjee AK: Characterization of a novel pro-coagulant metalloprotease (RVBCMP) possessing alpha-fibrinogenase and tissue haemorrhagic activity from venom of Daboia russelli russelli (Russell’s viper): evidence of distinct coagulant and haemorrhagic sites in RVBCMP. Toxicon. 2008, 51: 923-933. 10.1016/j.toxicon.2007.12.008.CrossRefPubMed
12.
go back to reference Warrell DA: Snake venoms in science and clinical medicine 1. Russell’s viper: biology, venom and treatment of bites. Trans R Soc Trop Med Hyg. 1989, 83: 732-740. 10.1016/0035-9203(89)90311-8.CrossRefPubMed Warrell DA: Snake venoms in science and clinical medicine 1. Russell’s viper: biology, venom and treatment of bites. Trans R Soc Trop Med Hyg. 1989, 83: 732-740. 10.1016/0035-9203(89)90311-8.CrossRefPubMed
13.
go back to reference Hung DZ, Wu ML, Deng JF, Yang DY, Lin-Shiau SY: Multiple thrombotic occlusions of vessels after Russell’s viper envenoming. Pharmacol Toxicol. 2002, 91: 106-110. 10.1034/j.1600-0773.2002.910303.x.CrossRefPubMed Hung DZ, Wu ML, Deng JF, Yang DY, Lin-Shiau SY: Multiple thrombotic occlusions of vessels after Russell’s viper envenoming. Pharmacol Toxicol. 2002, 91: 106-110. 10.1034/j.1600-0773.2002.910303.x.CrossRefPubMed
14.
go back to reference Nakamura M, Abe S, Kinukawa N: Aortic medial necrosis with or without thrombosis in rabbits treated with Russell’s viper venom and angiotensin II. Atherosclerosis. 1997, 128: 149-156. 10.1016/S0021-9150(96)05995-3.CrossRefPubMed Nakamura M, Abe S, Kinukawa N: Aortic medial necrosis with or without thrombosis in rabbits treated with Russell’s viper venom and angiotensin II. Atherosclerosis. 1997, 128: 149-156. 10.1016/S0021-9150(96)05995-3.CrossRefPubMed
15.
go back to reference Nakamura M, Tanaka M, Oumi M, Yamamoto T, Higo T, Yamawaki T, Miyata K: Late results of acute medial necrosis in rabbit aorta. J Atheroscler Thromb. 2000, 6: 42-48. 10.5551/jat1994.6.42.CrossRefPubMed Nakamura M, Tanaka M, Oumi M, Yamamoto T, Higo T, Yamawaki T, Miyata K: Late results of acute medial necrosis in rabbit aorta. J Atheroscler Thromb. 2000, 6: 42-48. 10.5551/jat1994.6.42.CrossRefPubMed
Metadata
Title
Bilateral blindness following Russell’s viper bite - a rare clinical presentation: a case report
Authors
Chandrika Jayakanthi Subasinghe
Chamara Sarathchandra
Thambyaiah Kandeepan
Aruna Kulatunga
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2014
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/1752-1947-8-99

Other articles of this Issue 1/2014

Journal of Medical Case Reports 1/2014 Go to the issue