Middle Cerebral Artery Territory Ischemic Infarction Secondary to Russell’s Viper Envenomation: A Case Report

In tropical countries such as Sri Lanka, snake envenomation represents a significant public health concern. Russell's viper is one of the venomous snakes, causing local and systemic manifestations. Ischemic stroke following Russell's viper bite is rare and is underreported. We describe a case of a 40-year-old previously healthy man who developed a left middle cerebral artery territory infarction following a Russell's viper bite, despite the timely administration of snake antivenom. Non-contrast computed tomography (NCCT) brain revealed left-sided middle cerebral artery territory ischemic infarction. Evaluation for stroke excluded common aetiologies, including atherosclerosis, cardiac embolism, and primary vasculitis. This suggests that the most plausible mechanism for the infarction is toxin-induced vasculitis and endothelial injury.