Brainstem Infarction Following Snake Bite

ABSTRACT

Bleeding complications of central nervous system following snake bite are well known. However, nonhemorrhagic manifestations such as ischemic stroke are extremely rare. As far as we know, only four such instances involving middle cerebral artery territory have ever been reported in the literature up to now. A 53-year-old farmer noted right side motor weakness and severe dysarthria 3 hours after a snake bite on right middle finger. Magnetic resonance T2WI showed high signal intensity on left pontine region extending to basal surface and bilateral tegmentum of the pons. He had neither atherogenic risk factors nor cardiogenic embolic sources. Laboratory findings were within normal limits except for mild consumptive coagulopathy. Cerebral angiogram revealed abrupt occlusion of proximal basilar artery. We report a case of brainstem infarction caused by a Korean viper (Agkistrodon blomhoffii brevicaudus) bite and discuss possible mechanisms for cerebral infarction.