Cerebrovascular accidents related to snakebites in the Amazon—two case reports

The objective of this case series was to describe 2 patients presenting with subarachnoid hemorrhage with hydrocephalus and hemoventricle after a snakebite caused by presumed Bothrops ssp. Both cases occurred in the municipality of Guajará (Amazonas state), Western Brazilian Amazon. Both cases featured delay in administration of serum therapy, which may have contributed to the emergence of complications such as stroke. Patient 1 was admitted to hospital 16 h after the snakebite occurred. Before receiving antivenom, testing showed the patient as having unclottable blood. She developed hemorrhagic stroke (a subarachnoid hemorrhage with hydrocephalus and hemoventricle). On the seventh day, she was discharged from hospital. Patient 2 arrived at the hospital 3 d after the snakebite occurred and presented with unclottable blood. He had a stroke (right frontoparietal hemorrhage, intraparenchymal hemorrhage already open to the ventricle) and died on the eighth day after the snakebite. Delay in seeking health care after snake envenomation can result in worse outcome.
Keywords
snakes;  Viperidae;  lancehead;  cerebrovascular stroke;  blood coagulation

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Sachett JAG, Silva AM, Dantas AWCB, Dantas TR, Colombini M, Moura-Da-Silva AM, et al. Cerebrovascular accidents related to snakebites in the Amazon—two case reports. Wilderness Environ. Med.. 2020 Aug;1-7. doi:10.1016/j.wem.2020.04.009.
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