Neurotoxicity

Neuromuscular paralysis is a less common effect of snake envenoming than coagulopathy (fewer than 10% of cases). It presents as a progressive descending flaccid paralysis, characterised by:

• early ptosis
• extraocular muscle weakness (diplopia, blurred vision)
• bulbar weakness (dysphagia)
• progressive respiratory muscle paralysis
• peripheral weakness.

Antivenom may prevent the development and progression of neurotoxicity, but rarely reverses it. Spontaneous recovery occurs over a period of days to weeks.