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Stroke following Bothrops spp. snakebite

From the Department of Neurology (Dr. Mosquera) and Toxicology Service (Drs. Idrovo and Tafur), Luis Vernaza Hospital; and Department of Neurological Sciences (Dr. Del Brutto), Hospital–Clínica Kennedy, Guayaquil, Ecuador.

Address correspondence and reprint requests to Oscar H. Del Brutto, MD, Air Center 3542, PO Box 522970, Miami, FL 33152-2970; e-mail: odbrutto{at}telconet.net

Objective: To determine the prevalence and subtypes of cerebrovascular complications of Bothrops spp. snakebites.

Methods: The authors studied 309 consecutive patients bitten by Bothrops spp. who attended a large general hospital. Special emphasis was placed on the time elapsed between the bite and admission to the hospital, clinical manifestations, laboratory findings, severity of envenomation, CT findings, and outcome.

Results: Eight of 309 patients (2.6%) developed a cerebrovascular event. Six presented >8 hours after being bitten, and all had clinical and laboratory evidence of severe envenoming. CT revealed intracranial bleeding in seven patients and multiple brain infarcts in one. Hemorrhages were located in the subcortical white matter of the cerebral hemispheres in five patients, in the cerebellum in one, and in the subarachnoid space in one. All patients with intracranial hemorrhage had a bleeding disorder, and the patient with cerebral infarcts may have had angiitis. Five of the eight patients died despite therapy, and the remaining three had irreversible sequelae.

Conclusions: The prevalence of cerebrovascular complications related to Bothrops spp. bites is 2.6%. Intracranial hemorrhages are more frequent than cerebral infarcts. The prognosis of these patients is poor.

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