Occult Snake Bite: A Neurological Dilemma

Emmanuel Paul ^[2] | Mahesh Chavan | Hansraj Kamble

Abstract: Introduction: Occult snakebites, wherein patients are unaware of the bite and fang marks are absent, have been reported in kraits, an endemic neurotoxic snake belonging to the Elapidae family. Owing to a lack of snake bite history and unavailability of specific diagnostic tests, severe envenomation presents a challenge for physicians, unless they are aware of it and a high level of suspicion is maintained. Case report: A 17 years old male presented with complaints of sudden onset of both lower limb weakness, pain in both legs and low back pain of 1 day duration. Blood investigations done including complete blood count, liver and renal function tests, serum electrolytes were within normal limit. Csf study and MRI brain with whole spine screening were done and were within normal limit. Nerve conduction study was also done and was within normal limit. Patient was suspected to be having occult snake bite and was given Antisnake venom, Inj. Neostigmine along with Inj. Atropine and patient was drastically improved. Discussion: Krait bites are sometimes painless and occur during the night. Often, a history of snakebite and visible fang marks are absent. Patients usually experience symptoms like abdominal pain, nausea, vomiting, and malaise. This is followed by ptosis, external ophthalmoplegia, distal muscle weakness, and lastly diaphragmatic and respiratory muscle involvement. Respiratory failure is the most common cause of death. Autonomic dysfunction leads to internal ophthalmoplegia thus mimicking brain death. Conclusion: Occult snake bite Owing to a lack of snakebite history and unavailability of specific diagnostic tests, the diagnosis presents a challenge for practicing physicians, unless they maintain a high degree of suspicion.

Keywords: Occult bite, Krait, ASV, Neostigmine

Edition: Volume 12 Issue 6, June 2023,

Pages: 1305 - 1306