The envenomations by viper bites are frequent and constitute the prerogative of rural areas in Morocco, as in the tropical countries of Asia, the Maghreb, and sub-Saharan Africa. Children are often more affected than adults, with morbidity and mortality which makes it a major public health problem. The physiopathological mechanisms associated with it are complex, resulting in a wide variety of clinical presentations among which coagulation disorders are prominent, involving all devices either individually or in the context of systemic involvement (Intravascular coagulation disseminated). We report the case of a 62-year-old patient, with no pathological history, victim of envenomation by the bite of a viper, quickly taken to the emergency room and immediately taken care of, who secondarily presented a sudden worsening of his neurological state related to an intracerebral hemorrhage documented by the brain CT-Scan, in a context of disseminated intravascular coagulation. Despite the speed and quality of the treatment, the patient died within 24 hours.
Cite this paper
Belhachmi, A. , Imoumby, F. N. , Imbunhe, N. , Dokponou, Y. C. H. , Igombe, S. R. A. and Gazzaz, M. (2021). Intracerebral Hemorrhage Secondary to Envenomation by Viper Bite: Case Report and Review of the Literature. Open Access Library Journal, 8, e7495. doi: http://dx.doi.org/10.4236/oalib.1107495.
Broderick, J.P., Brott, T., Tomsick, T., Miller, R. and Huster, G. (1993) Intracerebral Hemorrhage More than Twice as Common as Subarachnoid Hemorrhage. Journal of Neurosurgery, 78, 188-191. https://doi.org/10.3171/jns.1993.78.2.0188
An, S.J., Kim, T.J. and Yoon, B.-W. (2017) Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update. Journal of Stroke, 19, 3-10. https://doi.org/10.5853/jos.2016.00864
Pinho, F.M.O. and de Almeida Burdmann, E. (2001) Fatal Cerebral Hemorrhage and Acute Renal Failure after Young Bothrops jararacussu Snake Bite. Renal Failure, 23, 269-277. https://doi.org/10.1081/JDI-100103499
Bartholdi, D., Selic, C., Meier, J. and Jung, H. (2004) Viper Snakebite Causing Symptomatic Intracerebral Haemorrhage. Journal of Neurology, 251, 889-891.
https://doi.org/10.1007/s00415-004-0446-8
Ghezala, H.B. and Snouda, S. (2015) Accident vasculaire cérébral hémorragique mortel suite à une envenimation par une vipère à corne en Tunisie. The Pan African Medical Journal, 21, Article No. 156.
https://doi.org/10.11604/pamj.2015.21.156.6401
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546793/
El Hattimy, F., Fouad, C., Soulaymani, A. and Bencheikh, R. (2016) Envenimations Ophidienne chez l’enfant au Maroc: Aspects épidémiologiques, et facteurs de risque. Research Fr, 3, 1513.
Marrakchi, N., Zingali, R.B., Karoui, H., Bon, C. and el Ayeb, M. (1995) Cerastocytin, a New Thrombin-Like Platelet Activator from the Venom of the Tunisian Viper Cerastes cerastes. Biochimica et Biophysica Acta (BBA)-General Subjects, 1244, 147-156. https://doi.org/10.1016/0304-4165(94)00216-K
Sprivulis, P. and Jelinek, G.A. (1995) Fatal Intracranial Haematomas in Two Patients with Brown Snake Envenomation. Medical Journal of Australia, 162, 215-216. https://doi.org/10.5694/j.1326-5377.1995.tb126029.x
Premawardhena, A.P., De Silva, C.E., Fonseka, M.M.D., Gunatilake, S.B. and De Silva, H.J. (1999) Low Dose Subcutaneous Adrenaline to Prevent Acute Adverse Reactions to Antivenom Serum in People Bitten by Snakes: Randomised, Placebo Controlled Trial. BMJ, 318, 1041-1043. https://doi.org/10.1136/bmj.318.7190.1041
Palangasinghe, D.R., Weerakkody, R.M., Dalpatadu, C.G. and Gnanathasan, C.A. (2015) A Fatal Outcome Due to Pulmonary Hemorrhage Following Russell’s Viper Bite. Saudi Medical Journal, 36, 634-637. https://doi.org/10.15537/smj.2015.5.10691
Rathnayaka, R.N., Ranathunga, P.N. and Kularatne, S.A.M. (2019) Systemic Bleeding Including Pulmonary Haemorrhage Following Hump-Nosed Pit Viper (Hypnale hypnale) Envenoming: A Case Report from Sri Lanka. Toxicon, 170, 21-28.
https://doi.org/10.1016/j.toxicon.2019.09.009
Hoskote, S.S., Iyer, V.R., Kothari, V.M. and Sanghvi, D.A. (2009) Bilateral Anterior Cerebral Artery Infarction Following Viper Bite. Journal of the Association of Physicians of India, 57, 67-69.
Pal, J., Mondal, S., Sinha, D., Ete, T., Chakraborthy, A., Nag, A., et al. (2014) Cerebral Infarction: An Unusual Manifestation of Viper Snake Bite. International Journal of Medical Sciences, 2, 1180-1183.
https://doi.org/10.5455/2320-6012.ijrms20140836
Narang, S.K., Paleti, S., Asad, M.A. and Samina, T. (2009) Acute Ischemic Infarct in the Middle Cerebral Artery Territory Following a Russell’s Viper Bite. Neurology India, 57, 479-480. https://doi.org/10.4103/0028-3886.55594
Gouda, S., Pandit, V., Seshadri, S., Valsalan, R. and Vikas, M. (2011) Posterior Circulation Ischemic Stroke Following Russell’s Viper Envenomation. Annals of Indian Academy of Neurology, 14, 301-303. https://doi.org/10.4103/0972-2327.91957
Deepu, D., Hrishikesh, S., Suma, M.T. and Zoya, V. (2011) Posterior Fossa Infarct Following Viper Bite: A Paradox. Journal of Venomous Animals and Toxins including Tropical Diseases, 17, 358-360.
https://doi.org/10.1590/S1678-91992011000300017
Ittyachen, A.M. and Jose, M.B. (2012) Thalamic Infarction Following a Russell’s Viper Bite. Southeast Asian Journal of Tropical Medicine and Public Health, 43, 1201-1204.
Monteiro, F.N.P., Kanchan, T., Bhagavath, P., Kumar, G.P., Menezes, R.G. and Yoganarasimha, K. (2012) Clinico-Epidemiological Features of Viper Bite Envenomation: A Study from Manipal, South India. Singapore Medical Journal, 53, 203-207.
Phillips, R.E., Theakston, R.D.G., Warrell, D.A., Galigedara, Y., Abeysekera, D., Dissanayaka, P., et al. (1988) Paralysis, Rhabdomyolysis and Haemolysis Caused by Bites of Russell’s Viper (Vipera russelli pulchella) in Sri Lanka: Failure of Indian (Haffkine) Antivenom. QJM: An International Journal of Medicine, 68, 691-715.
Sharma, N., Chauhan, S., Faruqi, S., Bhat, P. and Varma, S. (2005) Snake Envenomation in a North Indian Hospital. Emergency Medicine Journal, 22, 118-120.
https://doi.org/10.1136/emj.2003.008458
