Early Morning Neuroparalytic Syndrome

Abstract

Snake bite is a common problem seen in the rural parts of India and is associated with a high rate of mortality due to their re- lated toxicity. Neurotoxicity from the elapid bite may manifest as the early morning neuroparalytic syndrome (EMNS) or even as Locked in syndrome. Determining the types of toxicity in the patient is based on el inical signs and laboratory findings or by direct examination of the snake. Patients presenting as EMNS do not have bite marks on their body and hence the diagnosis may be complicated. A 14 year old girl presented with a tingling sensation over her body who later developed respiratory failure is reported here. She was treated with a standard regimen of anti-snake venom (ASV) and atropine - neostigmine along with other supportive measures. She made a remarkable recovery with the above treatment and hence it is essential to consider a possibility of elapid envonomation in these patients presenting with acute neuroparalysis in snake bite endemic areas.