Cerebral hemorrhage associated with snakebite by Bothrops spp. juvenile: experience of two cases in an amazonian referral hospital.

Abstract

Snakes of the genus Bothrops cause most snakebites in Peru. Among its complications, intracranial hemorrhage is infrequent, but potentially lethal. We describe two cases of hemoventricle after bites by juvenile specimens (<50 cm) in Loreto. The first case corresponds to a 58-year-old male with untreated arterial hypertension, who received antivenom in fractionated doses due to shortage. On the fourth day, he presented sudden headache and loss of consciousness; tomography revealed hemorrhage in the fourth ventricle. The second case corresponds to a five-year-old child who received traditional medicine and whose first dose of antivenom was administered after four days of the bite, following a prolonged fluvial transfer. He presented severe anemia, altered sensorium, and hemorrhage in the left lateral ventricle. Both patients required intensive care, additional antivenom, and supportive measures, and were discharged without neurological deficit. These cases illustrate that delayed or insufficient access to antivenom in the Amazon can be associated with hemorrhagic complications of the central nervous system.