All the published
case series of SSV bite in Sri Lanka failed to report any life threatening bleeding manifestations such as retoperitoneal, plero-pericardial or intracranial bleeding [4-6]. Fatalities due to SSV envenoming have not been reported in Sri Lanka. Therefore, in contrast to other countries SSV envenoming in Sri Lanka is regarded as nonlethal and moderate venomous. Here we report a 19 year old healthy boy who developed left massive temporo-parietal intra cerebral hemorrhage following SSV envenoming. Our case is the first case of intracerebral bleeding following saw- scaled viper envenoming in Sri Lanka. Pathophysiology of venom induced consumptive coagulopathy is discussed in order to understand #selleck chemicals keyword# the resultant coagulopathy from this envenoming. Case presentation Inhibitors,research,lifescience,medical A 19 years old healthy boy was bitten by a snake in his left foot while he was walking in his garden. The killed snake was brought to the hospital and identified as Echis carinatus (Figure 1) by the attending medical officer and one of the authors (CAG). On admission to the local hospital, Inhibitors,research,lifescience,medical there was mild local bleeding at the bite site, but there was no clinical evidence of systemic envenoming. Three hours after the bite he had developed progressive
headache and his blood was found to be incoagulable by the 20 minutes Whole blood clotting test (20WBCT). He was treated immediately with 10 vials of polyvalent antivenom serum (AVS) Vins Bioproduct, raised against Indian Daboia russelii, Echis carinatus, Naja naja and Bungarus caeruleus venoms, each vial was dissolved in 10 ml of sterile water and diluted with 200 ml of normal saline to a total volume Inhibitors,research,lifescience,medical of 300 ml and was infused intravenously over an hour to restore
the coagulability. Despite of restoration of coagulability, the headache persisted throughout without any demonstrable neurological deficit. Figure 1 Example of a live saw- scaled viper. Following day, he had developed right sided complete ptosis with fixed dilated pupil. On detection of these neurological features the boy was immediately transferred Inhibitors,research,lifescience,medical to the University Medical unit, National Hospital of Sri Lanka. Levetiracetam On admission to our unit, his Glasgow Coma Scale (GCS) was 13/15. Cranial nerve examination confirmed right sided complete ptosis with fixed dilated pupil. Fundoscopic examination failed to revealed papilloedema. Upper and lower limbs were neurologically normal. His blood pressure was 130/80 mm Hg with pulse rate of 66 beats/min and respiratory rate was 14/min. There was no evidence of external bleeding. The blood was coagulable by 20WBCT. The urgent non-contrast CT brain showed a massive left temporo-parietal region intra-cerebral haemorrhage with intra-ventricular extension (Figure 2). His vital parameters and GCS were monitored regularly. Figure 2 Non-contrast CT brain showing a massive left temporo-parietal region intra-cerebral haemorrhage.