Multiple Bilateral Ischemic Strokes Following Russell's Viper Bite in a Young Woman: A Rare Case Report

Snakebite remains a major public health problem in India. Ischemic stroke is an uncommon but potentially serious neurological complication of snake envenomation. Russell's viper (Daboia russelii), which is widely distributed across the Indian subcontinent, causes hemotoxic envenomation and may produce coagulopathy and vascular endothelial injury, potentially contributing to cerebral ischemia. We report a 39-year-old woman from Andhra Pradesh who developed multiple bilateral acute ischemic infarcts involving the frontoparietal lobes, caudate nucleus, centrum semiovale, corona radiata, corpus callosum, bilateral cerebellar hemispheres, and vermis following a Russell's viper bite. She presented with acute left hemiparesis and visual impairment, with concurrent acute kidney injury (AKI). Despite extensive infarction involving multiple vascular territories, she experienced substantial neurological improvement and was discharged after 11 days. Possible mechanisms include venom-associated endothelial injury, vasculopathy, and disturbances of hemostasis. This case highlights the importance of considering cerebrovascular complications in patients presenting with neurological deficits after viper envenomation.