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LETTER TO EDITOR
Year : 2019  |  Volume : 8  |  Issue : 3  |  Page : 1292  

A rare case of quadriparesis


Bawaskar Hospital and Clinical Research Center, Mahad Raigad, Maharashtra, India

Date of Web Publication27-Mar-2019

Correspondence Address:
Himmatrao Saluba Bawaskar
Bawaskar Hospital and Clinical Research Center, Mahad Raigad - 402 301, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_87_19

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How to cite this article:
Bawaskar HS, Bawaksar PH. A rare case of quadriparesis. J Family Med Prim Care 2019;8:1292

How to cite this URL:
Bawaskar HS, Bawaksar PH. A rare case of quadriparesis. J Family Med Prim Care [serial online] 2019 [cited 2019 Nov 12];8:1292. Available from: http://www.jfmpc.com/text.asp?2019/8/3/1292/254929



Sir,

We read with interest the case of “quadriparesis” published in your esteem journal.[1] At the same time, we felt sorry to note the clinical manifestations of krait bite that include the history of a person who woke up in the middle of the night due to abdominal colic from floor bed published long back.[2] Subsequently, the symptoms such as vomiting, mild sweating, and progressive descending paralysis confirmed the envenoming by krait.[3] In such a situation, there is no need to investigate the victims unnecessarily to rule out Central nervous system (CNS) manifestations.[4] Krait venom is rich in beta-bungarotoxin, which destroys the presynaptic neuromuscular receptors that result in an irreversible block. Recovery depends upon the regeneration of new receptors which may take more than 1 week.[2],[3] Dilated nonreacting pupil seen from the elapid bite did not indicate the irreversible brain damage or coma. Authors mentioned that the patient was unconscious.[5] Because of the paralysis, the victim could not express though he was fully conscious, as venom did not cross the blood–brain barrier. Moreover, the anoxic comatose patient could not be recovered completely. One can note the fine movement of frontalis muscle by asking the patient to look upward.[6] The authors felt that this is a rare case, being not aware of published data,[7] and a chapter on snake bite in API Textbook of Medicine.

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pandey AK, Sharma S, Upadhyay V. A rare case of quadriparesis. J Family Med Prim Care 2019;8:302-4.  Back to cited text no. 1
  [Full text]  
2.
Bawaskar HS, Bawaskar PH. Profile of snake bite envenoming in western Maharashtra. Trans Roy Soc Trop Med Hyg 2002;96:79-84.  Back to cited text no. 2
    
3.
Bawaskar HS, Bawaskar PH. Snake bite, cocktail and girl with stomachache. Lancet 2008;371:696.  Back to cited text no. 3
    
4.
Bawaskar HS, Bawaskar PH. Snake bite envenoming. Lancet 2019;392:131-2.  Back to cited text no. 4
    
5.
Bawaskar HS, Bawaskar PH, Bawaskar PH. Pathophysiology of dilatation of pupils due to scorpion and snake envenomation and its therapeutic value. Indian J Popthalmol 2017;65:67-70.  Back to cited text no. 5
    
6.
Bawaskar HS, Bawaskar P, Bawaksar PH. Diagnosis of reversible coma. Lancet 2015;385:1178.  Back to cited text no. 6
    
7.
Bawaskar HS, Bawaskar PH, Bawaskar PH. Premonitory signs and symptoms of envenoming by common krait (Bungarus caerileus). Trop Doct 2014,44:82-5.  Back to cited text no. 7
    




 

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