Journal of Family Medicine and Primary Care

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

A rare case of quadriparesis


Himmatrao Saluba Bawaskar, Pramodini Himmatrao Bawaksar 
 Bawaskar Hospital and Clinical Research Center, Mahad Raigad, Maharashtra, India

Correspondence Address:
Himmatrao Saluba Bawaskar
Bawaskar Hospital and Clinical Research Center, Mahad Raigad - 402 301, Maharashtra
India




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


How to cite this URL:
Bawaskar HS, Bawaksar PH. A rare case of quadriparesis. J Family Med Prim Care [serial online] 2019 [cited 2019 Sep 17 ];8:1292-1292
Available from: http://www.jfmpc.com/text.asp?2019/8/3/1292/254929


Full Text



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

1Pandey AK, Sharma S, Upadhyay V. A rare case of quadriparesis. J Family Med Prim Care 2019;8:302-4.
2Bawaskar HS, Bawaskar PH. Profile of snake bite envenoming in western Maharashtra. Trans Roy Soc Trop Med Hyg 2002;96:79-84.
3Bawaskar HS, Bawaskar PH. Snake bite, cocktail and girl with stomachache. Lancet 2008;371:696.
4Bawaskar HS, Bawaskar PH. Snake bite envenoming. Lancet 2019;392:131-2.
5Bawaskar 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.
6Bawaskar HS, Bawaskar P, Bawaksar PH. Diagnosis of reversible coma. Lancet 2015;385:1178.
7Bawaskar HS, Bawaskar PH, Bawaskar PH. Premonitory signs and symptoms of envenoming by common krait (Bungarus caerileus). Trop Doct 2014,44:82-5.