Haemorrhagic Stroke Complicating Systemic Envenomation in Snake Bite: A Case Report and Literature Review

Abstract

Introduction: Snakebite is a neglected tropical public health problem that is common in Nigeria. The occurrence of haemorrhagic stroke following snakebite envenomation is a rare medical emergency. Aim: To describe the neurological complications that occurred after snakebite envenomation. Methodology: This is a hospital-based case report of a 17-year woman who presented at the Emergency unit of Benue State University Teaching Hospital Makurdi Benue State Nigeria 18 days after snake bite with 10 days of progressive loss of consciousness and associated difficulty in opening the right eye, weakness of the left hemi-body, weeping spells and difficulty in swallowing with no background cardiovascular risk factor. She had been managed by a traditional medicine healer immediately after the snakebite. Results: At presentation, she had Glasgow Coma Scale of 7/15, restlessness, and mildly pale with weeping spell and a healed scar on her right leg. Other neurological examinations revealed right ptosis, right oculomotor nerve palsy, upper motor neuron type of left facial nerve palsy (multiple cranial nerve palsies), aphasia and crossed hemiplegia indicating Weber’s syndrome (midbrain stroke syndrome).  She made good clinical recovery of her neurologic deficits. Conclusion: Our report highlights the need to suspect and exclude haemorrhagic stroke in victims presenting with loss of consciousness and lateralizing signs using brain CT scan. Public enlightenment is needed to enhance early presentation following snakebite.