Case Report

Acute Ischemic Stroke Following Snakebite: A Case Report

Abstract

Snakebite envenomation is associated with a wide spectrum of complications, ranging from local tissue damage to life-threatening systemic effects. This case report describes a rare presentation of acute ischemic stroke in a 77-year-old man following envenomation by a suspected Montivipera raddei albicornuta in northwestern Iran. The patient initially presented with right lower limb cellulitis, thrombocytopenia,
coagulopathy, and acute kidney injury. Within six hours, he developed left-sided hemineglect, hemiparesis, hemifacial weakness, dysarthria, and a decreased level of consciousness. Neuroimaging revealed a non-hemorrhagic infarct localized to the right parietal lobe within the distribution of the middle cerebral artery. This
case underscores the potential for thrombotic events, including ischemic stroke, in the context of venom-induced disseminated intravascular coagulation (DIC). It also highlights the need to reassess the efficacy and dosing strategies of available antivenoms and to establish protocols for early identification of thrombotic events following envenomation in high-risk snakebite patients.

[1] World Health Organization. Snakebite envenoming [Internet]. Geneva: World Health Organization; 2023 [cited 2025 Oct 3]. Available from: https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming
[2] Dehghani R, Fathi B, Shahi MP, Jazayeri M. Ten years of snakebites in Iran. Toxicon. 2014;90:291-8. https://doi.
org/10.1016/j.toxicon.2014.08.063
[3] Huang YK, Chen YC, Liu CC, Cheng HC, Tu AT, Chang KC. Cerebral complications of snakebite envenoming: case studies. Toxins (Basel). 2022;14(7):1-10. https://doi.org/10.3390/toxins14070436
[4] Vasconez-Gonzalez J, Delgado-Moreira K, Izquierdo-Condoy JS, Noboa-Lasso MdL, Gamez-Rivera E, Lopez-Molina MB, et al. Cerebrovascular events induced by venomous snake bites: a systematic review. Heliyon. 2025;11(4):e42779. https://doi.org/10.1016/j.heliyon.2025.e42779
[5] Kim JS, Yang JW, Kim MS, Han ST, Kim BR, Shin MS, et al. Coagulopathy in patients who experience snakebite. Korean
J Intern Med. 2008;23(2):94-100. https://doi.org/10.3904/kjim.2008.23.2.94
[6] Cañas CA. Brainstem ischemic stroke after Bothrops atrox snakebite. Toxicon. 2016;120:124-7. https://doi.
org/10.1016/j.toxicon.2016.08.005
[7] Pal J, Mondal S, Sinha D, Ete T, Chakraborthy A, Nag A, et al. Cerebral infarction: an unusual manifestation of viper
snake bite. Int J Med Sci. 2014;2:1180-3. https://doi.org/10.5455/2320-6012.ijrms20140836
[8] Chani M, Abouzahir A, Haimeur C, Kamili ND, Mion G. [Ischaemic stroke secondary to viper envenomation in
Morocco in the absence of adequate antivenom]. Ann Fr Anesth Reanim. 2012;31(1):82-5. https://doi.org/10.1016/j.
annfar.2011.08.022
[9] Ittyachen AM, Jose MB. Thalamic infarction following a Russell’s viper bite. Southeast Asian J Trop Med Public Health.
2012;43(5):1201-4.
[10] Vale TC, Leite AF, Hora PR, Coury MI, Silva RC, Teixeira AL. Bilateral posterior circulation stroke secondary to a
crotalid envenomation: case report. Rev Soc Bras Med Trop. 2013;46(2):255-6. https://doi.org/10.1590/0037-8682-1667-
2013
[11] Narang SK, Paleti S, Azeez Asad MA, Samina T. Acute ischemic infarct in the middle cerebral artery territory following a Russell’s viper bite. Neurol India. 2009;57(4):479-80. https://doi.org/10.4103/0028-3886.55594
[12] Dehghani R, Monzavi SM, Mehrpour O, Shirazi FM, HassanianMoghaddam H, Keyler DE, et al. Medically important snakes and snakebite envenoming in Iran. Toxicon. 2023;230:107149. https://doi.org/10.1016/j.toxicon.2023.107149
[13] Thomas L, Chausson N, Uzan J, Kaidomar S, Vignes R, Plumelle Y, et al. Thrombotic stroke following snake bites
by the “Fer-de-Lance” Bothrops lanceolatus in Martinique despite antivenom treatment: a report of three recent
cases. Toxicon. 2006;48(1):23-8. https://doi.org/10.1016/j.toxicon.2006.04.007
Files
IssueVol 10 No 2 (2025): March-April QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/crcp.v10i2.19902
Keywords
Snake Bite Ischemic stroke Antivenom Disseminated intravascular coagulation Montivipera raddei albicornuta

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Taghilou D, Soleymani R, Alizadeh F, Mohammad nezhad F, Aghaei S. Acute Ischemic Stroke Following Snakebite: A Case Report. CRCP. 2025;10(2):79-82.