title: Facial diplegia, pharyngeal paralysis, and ophthalmoplegia after a timber rattlesnake envenomation.
abstract: The timber rattlesnake, also known as Crotalus horridus, is well known to cause significant injury from toxins stored within its venom. During envenomation, toxic systemic effects immediately begin to cause damage to many organ systems including cardiovascular, hematologic, musculoskeletal, respiratory, and neurologic. One defining characteristic of the timber rattlesnake is a specific neurotoxin called crotoxin, or the "canebrake toxin," which is a potent β-neurotoxin affecting presynaptic nerves that can cause paralysis by inhibiting appropriate neuromuscular transmission. We present an unusual case of an 8-year-old boy bitten twice on his calf by a timber rattlesnake, who presented with a life-threatening envenomation and suffered multisystem organ failure as well as a prominent presynaptic neurotoxicity resulting in facial diplegia, pharyngeal paralysis, and ophthalmoplegia.
authors.affiliation: From the *Department of Neurosciences and Divisions of †Pediatric Emergency Medicine, and ‡Pediatric Critical Care, Medical University of South Carolina, Charleston, SC.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Madey
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Price
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Dobson
authors.forename: David E
authors.initials: DE
authors.lastname: Stickler
authors.forename: S David
authors.initials: SD
authors.lastname: McSwain
mesh_terms: D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D003435:Crotalid Venoms / Q000494:pharmacology / Q000506:poisoning*; D017839:Crotalus; D003439:Crotoxin / Q000494:pharmacology / Q000506:poisoning; D004155:Diphenhydramine / Q000627:therapeutic use; D004630:Emergencies; D004837:Epinephrine / Q000627:therapeutic use; D005158:Facial Paralysis / Q000209:etiology*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D017148:Infusions, Intraosseous; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy; D009469:Neuromuscular Junction / Q000187:drug effects; D009886:Ophthalmoplegia / Q000209:etiology*; D010243:Paralysis / Q000209:etiology*; D010608:Pharyngeal Diseases / Q000209:etiology*; D010949:Plasma; D017729:Presynaptic Terminals / Q000187:drug effects; D012121:Respiration, Artificial; D012206:Rhabdomyolysis / Q000209:etiology; D012909:Snake Bites / Q000150:complications* / Q000628:therapy
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments; D004155:Diphenhydramine; D003439:Crotoxin; D008775:Methylprednisolone; D004837:Epinephrine