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Rattlesnake Hematoxic Neuropathy - A Case Report and Literature Review
Andrew J. Kochevar, MD, MS; Phillip K. Blevins, MD
Department of Surgery/Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, MS

Pit viper bites can cause significant morbidity and mortality due to venom neurotoxins that block neuromuscular junction transmission and possible compartment syndrome if the venom is deposited subfascially.  Although an infrequent occurrence in North America, compartment syndrome as a result of rattlesnake envenomation, may be prevented by early diagnosis, optimal antivenom therapy, and possible surgical decompression; thus, avoiding the possible complication of neuropathy.  We report a case of a rattlesnake envenomation in the hand that despite receiving antivenom, led to compartment syndrome 15 hours postenvenomation and the patient required emergency fasciotomies.  Detailed neurophysiological tests and clinical examinations were performed up to 12 months postoperatively which demonstrated median neuropathy.  Earlier monitoring of subfascial pressures and using those pressures as a guide for decisions about time and dose of CroFab antivenom treatment may have prevented the onset of compartment syndrome, or identified the need for earlier surgical treatment.   However, the ultimate decision for release of compartments is clinically-based.  These results are also suggestive of a possible demyelinating type of neuropathy.  This is one of the few reports of long-term neurological damage following snake bite.  The clinical significance of this neuropathy is important and further study is required to investigate whether it persists and to see what consequences develop.

snake picture

Top and Bottom Left: The right hand of the victim is shown 15 hours after rattlesnake

envenomation; compartment syndrome was clinically demonstrated.  Bottom Right: The victim is pictured holding the skin from the rattlesnake (the snake was 2 meters in length).  

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