Acute Ischemic Stroke Following Snakebite: A Case Report

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.