title: Complex regional pain syndrome following viper-bite.
abstract: Complex regional pain syndrome (CRPS) may occur following fractures, surgery or different trauma. Development of CRPS following snake-bite has only been published in three reports (from Turkey, Nepal and Korea), although snake bites occur frequently world-wide. There has been no report from Western Europe. Vipera Berus is a common snake in European countries and the only venomous snake in Norway. We here describe the development of CRPS in a young woman as a consequence of a viper bite (Vipera Berus) in the right arm.
  
  
  
  We performed a clinical investigation (inspection, measurement of skin temperatures, sensory and motor evaluation) of the patient six months following the viper-bite, measurement of thermal thresholds (quantitative sensory testing, QST), measurement of resting sweat output (RSO) and quantitative sudomotor axon reflex (QSART) from both arms.
  
  
  
  The patient fulfilled the Budapest criteria for a CRPS-condition, with continuous pain and symptoms and findings of autonomic dysfunction. In addition, we found elevated thresholds of warmth and cold, evidence of an affection of afferent A-delta and C-fibres as well as an affection of the efferent sympathetic sudomotor C-fibres by QSART. An increased RSO-volume was in inverse relationship to the decreased QSART result.
  
  
  
  It is important to be aware of viper-bite as a possible eliciting event for CRPS for early diagnosis and treatment of a patient. As long-lasting pain and oedema are known complications, it is probable that CRPS after viper-bites previously may have been underdiagnosed. As many patients are unaware of being bit, viper bite should be considered in cases of unexplained sudden pain and swelling of a limb.
authors.affiliation: Section of Clinical Neurophysiology, Department of NeurologyOslo University Hospital-Rikshospitalet, Oslo, Norway.
authors.forename: Inge Petter
authors.initials: IP
authors.lastname: Kleggetveit
authors.affiliation: Askim Medical Center, Askim, Norway.
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Skulberg
authors.affiliation: Section of Clinical Neurophysiology, Department of NeurologyOslo University Hospital-Rikshospitalet, Oslo, Norway.
authors.forename: Ellen
authors.initials: E
authors.lastname: Jørum
mesh_terms: D000818:Animals; D020918:Complex Regional Pain Syndromes / Q000209:etiology*; D005260:Female; D006801:Humans; D012909:Snake Bites / Q000150:complications*; D055815:Young Adult
keywords: Complex regional pain syndrome; Hyperalgesia; QSART; QST; Viper-bite