Journal of Acute Care

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VOLUME 3 , ISSUE 1 ( January-April, 2024 ) > List of Articles


A Rare Case of Medial Medullary Syndrome Following Neuroparalytic Snakebite: A Case Report

Prannoy George Mathen, Navneet Sharma, Deba Prasad Dhibar

Keywords : Case report, Hypoglossal nerve palsy, Infarction, Medial medullary syndrome, Snakebite, Tracheostomy

Citation Information : Mathen PG, Sharma N, Dhibar DP. A Rare Case of Medial Medullary Syndrome Following Neuroparalytic Snakebite: A Case Report. 2024; 3 (1):26-27.

DOI: 10.5005/jp-journals-10089-0093

License: CC BY-NC 4.0

Published Online: 30-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Neuroparalytic snake envenomation is a commonly reported emergency in India and other tropical countries. We report a young male with no prior comorbidities, who presented with acute quadriparesis with bulbar involvement following snake bite. He was intubated in the emergency department (ED) for airway protection and was treated with polyvalent anti-snake venom (ASV) and shifted to medical intensive care unit (ICU), where he was treated supportively and gradually weaned off from ventilator after successful spontaneous breathing trial (SBT). Postextubation he was diagnosed to have hypoglossal palsy, and subsequently was re-intubated in view of suspected aspiration. A diffusion weighted magnetic resonance imaging (DW-MRI) revealed bilateral medial medullary infarct. MR-Angiogram revealed no abnormalities. All other causes for young stroke were ruled out. He underwent percutaneous tracheostomy and was treated with antiplatelets, statin, neurorehabilitation. He was later discharged home with good neck holding and limb power of 4/5 in all four limbs. This rare case reaffirms that acute stroke in a young individual from a tropical country should rise the suspicion of snake envenomation after ruling out other causes, among the treating acute care physicians.

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