Neuroparalytic syndrome encountered with snake bite poisoning.

Thirty seven patients with various neuroparalytic manifestations were studied. There were 25 males and 12 females aged 14 to 50 years with majority in 3rd and 4th decades. Their neurological deficits comprised of drowsiness in 12, stupor in 6, coma in 4 and convulsions in 4 patients. Ptosis was found in 22, ophthalmoplegia and pharyngeal paralysis in 12 each, facial paralysis in 9, respiratory paralysis in 8, flaccid limb paralysis in 9, respiratory paralysis in 8, flaccid limb paralysis in 16 and lock jaw in one case. History of snake bite was present in 25 cases and in the remaining 12 cases there was a history of not awakening or inability to come out of the bed in the early morning. These subjects were treated with respiratory support, antivenom serum supplemented with atropine-neostigmine combination. Recovery was dramatic in 25 cases. 6 patients died within 12 hours of hospitalization and remaining 6 patients showed improvement gradually in 2-3 days time. The importance of high index of suspicion in the early diagnosis of elapid bite poisoning as a cause of neuroparalysis has been emphasized.