Skip to main content

A Case of Neurotoxicity Following Envenomation by the Sidewinder Rattlesnake, Crotalus cerastes

Abstract

Introduction

North American rattlesnake envenomations typically result in local tissue injury and hematologic derangements. Neurotoxicity is uncommon but when present often manifests as fasciculations and paresthesias. Neurotoxicity following Sidewinder (Crotalus cerastes) envenomation has not been previously reported.

Case Report

A 56-year-old man bitten on the right foot developed painful paresthesias, weakness and fasciculations of the right lower extremity, and involuntary muscle contractions of the anterior thigh. Local tissue effects and hemotoxicity never developed. The patient was discharged 5 days after the bite with resolution of fasciculations but continued to have right-sided weakness. The snake was identified as a Sidewinder, C. cerastes, by the patient and two independent herpetologists.

Conclusion

This is the first reported case of a Sidewinder rattlesnake envenomation resulting in neurotoxicity.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Clark RF, Williams SR, Nordt SP et al (1997) Successful treatment of Crotalid-induced neurotoxicity with a new polyspecific Crotalid fab antivenom. Ann Emerg Med 30:54–57

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Jansen PW, Perkin RM, Van Stralen D (1992) Mojave rattlesnake envenomation: prolonged neurotoxicity and rhabdomyolysis. Ann Emerg Med 21:322–325

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Brick JF, Gutmann L, Brick J et al (1987) Timber rattlesnake venom-induced myokymia: evidence for peripheral nerve origin. Neurology 37:1545–1546

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Lovecchio F, Pizon AF, Wallace KL et al (2005) Myokymia after snake envenomation in Arizona. Wilderness Environ Med 16:116–117

    PubMed  Article  Google Scholar 

  5. 5.

    Richardson WH, Goto CS, Gutglass DJ et al (2007) Rattlesnake envenomation with neurotoxicity refractory to treatment with crotaline Fab antivenom. Clin Tox 45:472–475

    CAS  Article  Google Scholar 

  6. 6.

    Vohra R, Cantrell FL, Williams SR (2008) Fasciculations after rattlesnake envenomations. Clin Tox 46:117–121

    CAS  Article  Google Scholar 

  7. 7.

    Brennan TC. 2008; http://www.reptilesofaz.org/Snakes-Subpages/h-c-cerastes.html Accessed November 14, 2013.

  8. 8.

    Arizona Game and Fish Department. 2013; http://www.azgfd.gov/w_c/arizona-rattlesnakes.shtml#4 Accessed November 14, 2013.

  9. 9.

    Wingert WA, Chan L (1988) Rattlesnake bites in southern California and rational for recommended treatment. West J Med 148:37–44

    CAS  PubMed Central  PubMed  Google Scholar 

  10. 10.

    Bush SP, Siedenburg E (1999) Neurotoxicity associated with suspected Southern Pacific rattlesnake (Crotalus viridis helleri) envenomation. Wild Env Med 10:247–249

    CAS  Article  Google Scholar 

  11. 11.

    French WJ, Hayes WK, Bush SP et al (2004) Mojave toxin in venom of Crotalus helleri (Southern Pacific Rattlesnake): molecular and geographic characterization. Toxicon 44:781–791

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Wooldridge BJ, Pineda G, Banuelas-Ornelas JJ et al (2001) Mojave rattlesnakes (Crotalus scutulatus scutulatus) lacking the acidic subunit DNA sequence lack Mojave toxin in their venom. Comp Biochem Phys 130:169–179

    CAS  Article  Google Scholar 

  13. 13.

    CroFab® Crotalidae Polyvalent Immune Fab (ovine). Prescribing information. http://www.fda.gov/downloads/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/FractionatedPlasmaProducts/ucm117573.pdf Accessed November 14, 2013.

Download references

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Adam R. Bosak.

Electronic supplementary material

Online Resource 1

Fasciculations of the anterior thigh following envenomation by a Sidewinder rattlesnake (Crotalus cerastes) (MOV 13094 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bosak, A.R., Ruha, AM. & Graeme, K.A. A Case of Neurotoxicity Following Envenomation by the Sidewinder Rattlesnake, Crotalus cerastes . J. Med. Toxicol. 10, 229–231 (2014). https://doi.org/10.1007/s13181-013-0373-0

Download citation

Keywords

  • Neurotoxicity
  • Sidewinder
  • Rattlesnake
  • Crotalus cerastes
  • Envenomation