Introduction: Neurological complications following snake envenomation are uncommon, and acute ischemic stroke represents a particularly rare but potentially devastating manifestation. Because snakebite is prevalent in many tropical and subtropical regions, atypical neurological presentations may pose significant diagnostic challenges. Early recognition of vascular complications is critical, as prompt and appropriate intervention can result in favorable neurological outcomes.
Case report: A 47-year-old male presented with sudden-onset right-sided hemiparesis following a recent history of an unknown snake bite. There was no prior history of cerebrovascular disease or traditional vascular risk factors. Neurological examination revealed features consistent with an acute focal neurological deficit, along with bilateral ptosis. Neuroimaging confirmed the presence of an acute ischemic stroke. The patient was treated with timely administration of polyvalent antivenom along with supportive and neuroprotective care. Over the course of a one-week hospitalization, he demonstrated marked neurological improvement and achieved complete recovery of motor function without residual deficit at discharge.
Discussion: Ischemic stroke temporally associated with snake envenomation is an unusual and underrecognized phenomenon. Proposed mechanisms include venom-induced coagulopathy, endothelial dysfunction, vasculitis, platelet aggregation, and thrombotic occlusion of cerebral vessels, although a causal relationship cannot be firmly established from a single case. Differentiating a vascular event associated with envenomation from other neurotoxic sequelae is challenging, particularly in endemic regions where snakebites are common.
Conclusion: This case illustrates that acute ischemic stroke occurring in temporal association with snake envenomation can be reversible with early diagnosis and timely treatment. The patient achieved complete neurological recovery without residual deficit over the course of his hospitalization. Awareness of this rare presentation is crucial to ensure appropriate management and improved clinical outcomes.