title: Catastrophic acute ischemic stroke after Crotalidae polyvalent immune Fab (ovine)-treated rattlesnake envenomation.
abstract: We report 2 cases of catastrophic ischemic stroke after Crotalidae polyvalent immune Fab (ovine)-treated rattlesnake envenomation, 1 fatal and the other resulting in significant permanent disability. It is possible these serious adverse events may have been related to venom factor(s), an interaction between venom and antivenom, occult patient blood dyscrasia, or to random unrelated events. We present the rationale for each possibility, and submit the experiences to elicit alternate postulation and communication of similar presentations.
authors.affiliation: Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, NC. Electronic address: seanbushmd@gmail.com.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Bush
authors.affiliation: Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA.
authors.forename: Graham G
authors.initials: GG
authors.lastname: Mooy
authors.affiliation: Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA.
authors.forename: Tammy H
authors.initials: TH
authors.lastname: Phan
mesh_terms: D000293:Adolescent; D000818:Animals; D000997:Antivenins / Q000009:adverse effects* / Q000627:therapeutic use; D017839:Crotalus; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012909:Snake Bites / Q000188:drug therapy*; D020521:Stroke / Q000139:chemically induced* / Q000503:physiopathology*
chemical_list: D000997:Antivenins; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments
keywords: antivenom; rattlesnake; snakebite; stroke; venom