Binocular Diplopia After A Snakebite

Yıl 2021, Cilt: 12 Sayı: 3, 79 - 81, 18.08.2021

Fatih Çalışkan , Celal Katı , Hızır Ufuk Akdemir , Yıldıray Çelenk

https://doi.org/10.33706/jemcr.882234

Öz

A snakebite is an injury caused by a bite from a snake, often resulting in puncture wounds inflicted by animal’s fangs and sometimes resulting in envenomation. Venom may cause a complex condition that can be local damage, neuromuscular dysfunction, or systemic vascular damage leading to hemolysis. The main cause of mortality and morbidity in snake bites is neurotoxicity, and the main cause of neurotoxicity is sudden neuromuscular paralysis. Synthesis, packaging, transport, and release of the neurotransmitter acetylcholine in the presynaptic field, blockade of postsynaptic nicotinic acetylcholine receptors, acetylcholine esterase inhibition, muscarinic effects of some snake toxins, and inhibition of voltage-gated calcium gates, changes in the neuromuscular junction after snakebite can explain neuromuscular paralysis secondary to the snake bite. We present a case, with bilateral diplopia and ptosis after snakebite, that was recovered after the use of anticholinesterase therapy and antivenom.

Anahtar Kelimeler

diplopia, snake bites, antivenins, cholinesterase inhibitors

Teşekkür

All authors thank the immortal friend and colleague, Prof. Dr. Kemal Balcı (1971-2019), for his support in the patient management and the academic field.

Kaynakça

• Ranawaka UK, Lalloo DG, de Silva HJ. Neurotoxicity in snakebite-the limits of our knowledge. PLoS Negl Trop Dis. 2013;10;7(10):e2302.
• Ferdinands M, Seneviratne J, O'Brien T, White O. Ophthalmoplegia in tiger snake envenomation. J Clin Neurosci. 2006;13(3):385-8.
• Seneviratne U, Dissanayake S. Neurological manifestations of snake bite in Sri Lanka. Journal of postgraduate medicine. 2002;48(4):275-8.
• Lee SW, Jung IC, Yoon YH, Hong SH, Han KS, Choi SH, et al. Anticholinesterase therapy for patients with ophthalmoplegia following snake bites: report of two cases. Journal of Korean medical science. 2004;19(4):631-3.
• Dart RC, White J. Reptile bites. In: Tintinalli J, editor in chief. Tintinalli’s Emergency medicine: A comprehensive study guide. 8th Edition ed. New York: McGraw-Hill; 2016. p. 1379–1383.
• Lalloo DG, Trevett AJ, Korinhona A, Nwokolo N, Laurenson IF, Paul M, et al. Snake bites by the Papuan taipan (Oxyuranus scutellatus canni): paralysis, hemostatic and electrocardiographic abnormalities, and effects of antivenom. The American journal of tropical medicine and hygiene. 1995;52(6):525-31.
• Ranawaka UK, Lalloo DG, de Silva HJ. Neurotoxicity in Snakebite—The Limits of Our Knowledge. PLoS Negl Trop Dis. 2013;7(10): e2302. doi:10.1371/journal.pntd.0002302.
• Sung C, Hah M. A case of extraocular muscle paresis by viper bite. J Korean Ophthalmol Soc. 1981;22:261-3.
• Ahuja V, Chander A, Sawal N. The role of pyridostigmine in recovery from motor paralysis in a snakebite patient with an allergic reaction to anti-snake venom. Tropical Doctor. 2020;50(3):238-239. doi:10.1177/0049475519896942.