Steroid-responsive delayed multifocal encephalopathy following vasculotoxic snakebite with serial MRI evolution: a case report.
Joni Mondal, Ritwik Ghosh, Rabisankar Biswas et al.
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Case in brief
A 49-year-old woman developed delayed multifocal encephalopathy following a Russell's viper snakebite, initially presenting with vasculotoxic envenoming and acute kidney injury. Seven days post-recovery, she exhibited neurological symptoms including dysarthria and ataxia. MRI revealed multifocal hyperintensities without acute vascular changes. Treatment with high-dose intravenous methylprednisolone resulted in significant clinical and radiological improvement within weeks.
What made this case unusual
The case illustrates a delayed immune-mediated encephalopathy following snakebite, a rare complication not typically associated with viper envenomation.
Diagnostic / clinical pearl
Clinicians should be alert to the possibility of delayed neurological symptoms after snakebite, necessitating prompt MRI and cerebrospinal fluid analysis.
Why it matters
Recognizing this potential complication can lead to timely intervention with corticosteroids, which may significantly improve patient outcomes.