title: Intracranial haemorrhages associated with venom induced consumption coagulopathy in Australian snakebites (ASP-21).
abstract: Intracranial haemorrhage (ICH) is a rare life-threatening consequence of venom induced consumption coagulopathy in snake-bite. It is unclear why certain patients haemorrhage. We aimed to investigate ICH in snake envenoming. Cases of venom-induced consumption coagulopathy from July 2005-June 2014 were identified from the Australian Snakebite Project, a prospective multicentre cohort of snake-bites. Cases with venom-induced consumption coagulopathy were extracted with data on the snake-bite, clinical effects, laboratory investigations, treatment and outcomes. 552 cases had venom-induced consumption coagulopathy; median age, 40 y (2-87 y), 417 (76%) males, 253 (46%) from brown snakes and 17 died (3%). There were 6/552 (1%) cases of ICH; median age, 71 y (59-80 y), three males and five from brown snakes. All received antivenom and five died. All six had a history of hypertension. Time to onset of clinical effects consistent with ICH was 8-12 h in four cases, and within 3 h in two. Difficult to manage hypertension and vomiting were common. One patient had a normal cerebral CT on presentation and after the onset of focal neurological effects a repeat CT showed an ICH. ICH is rare in snake-bite with only 1% of patients with coagulopathy developing one. Older age and hypertension were associated with ICH.
authors.affiliation: Clinical Toxicology Research Group, University of Newcastle, Newcastle, Australia.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Berling
authors.affiliation: Centre for Clinical Research in Emergency Medicine, University of Western Australia, Perth, Australia.
authors.forename: Simon G A
authors.initials: SG
authors.lastname: Brown
authors.affiliation: Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Ferdi
authors.initials: F
authors.lastname: Miteff
authors.affiliation: Clinical Toxicology Research Group, University of Newcastle, Newcastle, Australia; Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Levi
authors.affiliation: Clinical Toxicology Research Group, University of Newcastle, Newcastle, Australia. Electronic address: geoff.isbister@gmail.com.
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Isbister
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D001315:Australia; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy*; D004546:Elapid Venoms / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012909:Snake Bites / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000997:Antivenins; D004546:Elapid Venoms
keywords: Consumption coagulopathy; Haemorrhage; Intracranial hemorrhages; Snake bites; Snake envenoming