1.Locked-in Syndrome Following a King Cobra (Ophiophagus hannah) Envenomation
Ahmad Khaldun I ; Mohd Fyzal B ; Soo CI ; Yeap BT ; Mohamed Faisal AH
Medicine and Health 2017;12(2):357-362
		                        		
		                        			
		                        			Theincidence of envenoming from king cobra, Ophiophagus hannah in human is relatively rare. Its venom acts on the postsynaptic region of the neuromuscular junction  causing  descending  flaccid  paralysis.  Locked-in  syndrome  is  a  clinical state of inability to provide motor response in a conscious patient. Many reported cases  of  locked-in  syndrome  following  neurotoxic  snake-bite  mimics  brain death. We report a case of a middle aged man who presented with progressive neurological deficit following a king cobra bite over his right arm. He had local and systemic neurotoxic envenoming.  His condition deteriorated, and was intubated and  ventilated  in  the  emergency  department.  He  received  a  total  of  33  vials  of the Ophiophagus  hannah  monospecific  antivenom  and  subsequently  recovered well with no neurological deficit. Retrospectively, he was able to recall the events and  while  he  was  lying  paralysed  and  intubated  under  minimal  sedation  in  the intensive  care  unit.  He  described  it  as  a  terrifying  and  painful  experience.  This case highlights the rare presentation of locked-in syndrome following a systemic envenoming from a king cobra bite. It is important to differentiate neurotoxic snake envenoming  lock-in  syndrome  from  brain  dead.  Patients  are  unable  to  respond to  physical  pain  and  require  adequate  analgesia.  A  patient  suffering  this  highly distressing experience may require psychological support.
		                        		
		                        		
		                        		
		                        	
            
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