Delayed Intracranial Hemorrhage Following Viper Snakebite: A case report from Nepal

Abstract BACKGROUND: Intracerebral hemorrhage following viper envenomation is a rare and serious complication, often linked to venom‑induced consumption coagulopathy. This case report highlights delayed-onset hemorrhagic stroke after a viper bite in a setting with limited anti venom efficacy. CASE PRESENTATION: A previously healthy adult patient sustained a viper bite and initially had mild local signs. Systemic evaluation was unremarkable. After 16 hours, the patient developed depressed consciousness and non‑reactive pupils. Laboratory investigations revealed prolonged PT, a PTT, thrombocytopenia, and positive 20‑minute whole blood clotting test, consistent with coagulopathy. CT imaging confirmed intracranial hemorrhage. In absence of effective species‑specific antivenom, the patient was managed conservatively with fresh frozen plasma to correct coagulopathy. Supportive care was provided. The patient survived with no neurological deficits and stabilized coagulation parameters. CONCLUSION: This case illustrates that intracerebral hemorrhage is a rare yet serious complication of pit viper envenomation. It highlights the role of supportive care, including FFP, in managing venom-induced coagulopathy where species specific antivenom is not available. Early recognition and treatment can lead to favorable neurological recovery.