Delayed Recovery of Quadriplegia after a Krait Bite

Snakebite envenomation is an endemic problem in tropical countries like Nepal. Deaths from envenomation are preventable through robust management systems and widespread public awareness. This case report describes a case of a 16-year-old boy from the Terai region of Nepal who presented with acute bilateral ptosis, head lag, and inability to elicit protrusion of his tongue after a krait bite. The patient was managed with antivenom, mechanical ventilation, and supportive care. Early neurological recovery after krait-bite envenomation is generally expected in victims who receive timely antivenom along with intensive supportive care. As usual, recovery of ptosis, tongue protrusion, and head lag occurred within a week; however, residual weakness in all limbs persisted for months. Gradual onset and offset of neurological symptoms are often characteristic of krait bites. Delayed neurological recovery after krait-bite envenomation is uncommon as illustrated in this case.