Ischemic and Hemorrhagic Stroke Consequent to Snake Bite

Snakebite remains a major cause of morbidity and mortality in rural India, particularly due to viper envenomation. While hemorrhagic complications are common, ischemic stroke following viper bite is rare, and concurrent ischemic and hemorrhagic lesions are exceptionally uncommon. We report a case of a 45-year-old male who developed multiple cerebral and cerebellar infarcts with secondary hemorrhagic conversion following a viper bite. The patient presented with vomiting, headache, and diplopia two hours after being bitten on the right foot. Laboratory findings revealed thrombocytopenia, prolonged clotting time, and elevated D-dimer levels. MRI showed multiple acute infarcts at watershed zones in bilateral cerebral and cerebellar hemispheres, with secondary hemorrhagic conversion in the right parieto-occipital region (PCA territory). The patient was managed with intravenous fluids, antibiotics, and anti-snake venom (ASV), followed by antiplatelet therapy after coagulation normalization. Early administration of ASV and careful monitoring led to clinical recovery. This case highlights the rare occurrence of concurrent ischemic and hemorrhagic stroke following viper envenomation and emphasizes the importance of timely diagnosis and intervention to prevent fatal outcomes.