Snake bite mimicking brain death

Joseph John¹ , Bahubali D Gane¹ , Nishad Plakkal¹ , Rajeswari Aghoram² and Sowmya Sampath¹

¹Department of Pediatrics, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry 605 014, India

²Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry 605 006, India

author email corresponding author email

Cases Journal 2008, 1:16doi:10.1186/1757-1626-1-16


Published:	12 June 2008

Abstract

A 6 year old girl woke up with pain and increasing swelling over the left hand and difficulty in breathing. On examination, she had swelling of the left forearm and hand, flaccid quadriparesis and was in respiratory failure requiring mechanical ventilation. Two clean puncture wounds were identified on the left thumb. A provisional diagnosis of snake bite with severe envenomation was made and she was given anti snake venom therapy. Over a period of about 4 hours her weakness progressed. She became areflexic, developed internal and external ophthalmoplegia and loss of other brain stem reflexes mimicking brain death. Mechanical ventilation was continued despite features suggestive of brain stem dysfunction. About 36 hours after ventilation she showed a flicker of movement of her fingers and gradually the power improved. She was weaned off the ventilator and extubated after 5 days. External ophthalmoplegia is an established association with cobra envenomation, but, this combination of internal and external ophthalmoplegia can mimic brain death and pose a dilemma to the caregivers regarding continuation of therapy.