title: Severe envenomation by Cerastes cerastes viper: an unusual mechanism of acute ischemic stroke.
abstract: Cerebral complications after snake bites--particularly ischemic complications--are rare. Very few cases of cerebral infarction resulting from a viper bite have been reported, and we call attention to this uncommon etiology. We discuss 3 authenticated reports of acute ischemic cerebrovascular accidents after 3 typical severe envenomations by Cerastes cerastes vipers. The 3 patients developed extensive local swelling and life-threatening systemic envenomation characterized by disseminated intravascular coagulopathy, increased fibrinolysis, thrombocytopenia, microangiopathic hemolytic anemia, and acute renal failure. This clinical picture involved atypical neurologic manifestations. These patients had either low Glasgow Coma Scale (GCS) or hemiparesis within hours to 4 days after being bitten, and they were found to have computed tomographic evidence of single or multiple ischemic (nonhemorrhagic) strokes of small- to large-vessel territories of the brain. One patient had good clinical recovery without neurologic deficits. Thrombotic complications occurred an average of 36 hours after being bitten, and their importance depends on the degree of envenomation. The possible mechanisms for cerebral infarction in these cases include generalized prothrombotic action of the venom (consumptive coagulopathy), toxin-induced vasculitis, and endothelial damage.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Mohammed VI's University-Hospital of Marrakech, Cadi Ayyad University, Marrakech, Morocco. Electronic address: r-houssam@hotmail.com.
authors.forename: Houssam
authors.initials: H
authors.lastname: Rebahi
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Mohammed VI's University-Hospital of Marrakech, Cadi Ayyad University, Marrakech, Morocco.
authors.forename: Hicham
authors.initials: H
authors.lastname: Nejmi
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Mohammed VI's University-Hospital of Marrakech, Cadi Ayyad University, Marrakech, Morocco.
authors.forename: Taoufik
authors.initials: T
authors.lastname: Abouelhassan
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Mohammed VI's University-Hospital of Marrakech, Cadi Ayyad University, Marrakech, Morocco.
authors.forename: Khadija
authors.initials: K
authors.lastname: Hasni
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Mohammed VI's University-Hospital of Marrakech, Cadi Ayyad University, Marrakech, Morocco.
authors.forename: Mohamed-Abdenasser
authors.initials: MA
authors.lastname: Samkaoui
mesh_terms: D000328:Adult; D000818:Animals; D001778:Blood Coagulation Disorders / Q000139:chemically induced; D001921:Brain / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020767:Intracranial Thrombosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012909:Snake Bites / Q000150:complications*; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D017819:Viperidae