Bilateral Cerebellar Infarctions Following Russell’s Viper (Daboia russelii) Envenoming: A Rare Case Report from Sri Lanka

Most snakebites in Sri Lanka are caused by Russell’s viper. Daboia russelii, one of Sri Lanka’s medically most important snakes, typically cause local swelling, coagulopathy, neurotoxicity and acute kidney injury. Cerebral infarction is a recognised but rare complication of Russell’s viper envenoming, and posterior circulation involvement is particularly uncommon.
We report the case of a 43-year-old man bitten by a Sri Lankan Russell’s viper who subsequently developed bilateral cerebellar infarctions. He initially presented with features of both local and systemic envenomation and received prompt administration of Snake Venom Anti-Serum. On the second day of admission, he developed a severe occipital headache. Computed tomography of the brain revealed bilateral cerebellar infarctions.
This case underscores a rare neurological complication of Russell’s viper bite and highlights the importance of early recognition and neuroimaging in patients who develop new, severe headaches or neurological symptoms following Russell’s’ viper envenomation.