Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 2 2025 10 15 79 82 Dariush Taghilou Clinical Toxicology, Department of Internal Medicine, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Reyhaneh Soleymani Department of Neurology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Fatemeh Alizadeh Department of Internal Medicine, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Farzaneh Mohammad nezhad Department of Neurology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Shalaleh Aghaei Department of Internal Medicine, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. 2025 07 18 2025 09 08 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. https://crcp.tums.ac.ir/index.php/crcp/article/view/1074 https://crcp.tums.ac.ir/index.php/crcp/article/download/1074/722