{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:46:32Z","timestamp":1790628392085,"version":"4.1.0"},"reference-count":23,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2019,9,1]],"date-time":"2019-09-01T00:00:00Z","timestamp":1567296000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:p> The West African carpet viper ( Echis ocellatus) causes more deaths than any other snake in sub-Saharan Africa. Carpet viper envenomations are characterized by a venom-induced consumption coagulopathy and systemic bleeding syndrome, in addition to local symptoms of painful progressive swelling and tissue destruction. The highest mortality rate is seen in the final stages of the syndrome, which typically ends with fatal internal bleeding or hemorrhagic shock. We present 2 cases of E ocellatus envenomation with intracranial hemorrhage seen at a rural hospital in Bemb\u00e8r\u00e8k\u00e8, Benin, and describe the successful management of these patients in a limited-resource setting. In one case the patient was treated with an ineffective Indian-made antivenom before evaluation by the authors and continued to deteriorate until she was treated with effective antivenom 10 d after the bite. In both cases lumbar puncture was performed for diagnostic or therapeutic purposes with good effect, and both patients made full recoveries without sequelae. These cases demonstrate the remarkable ability of high-quality antivenoms to reverse life-threatening envenomations even in the final stages of the hemorrhagic syndrome and illustrate the dangers posed by low-quality antivenoms that have flooded the market in the developing world. <\/jats:p>","DOI":"10.1016\/j.wem.2019.04.003","type":"journal-article","created":{"date-parts":[[2019,6,20]],"date-time":"2019-06-20T12:04:11Z","timestamp":1561032251000},"page":"295-301","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Successful Management of Two Patients with Intracranial Hemorrhage due to Carpet Viper (<i>Echis ocellatus<\/i>) Envenomation in a Limited-Resource Environment"],"prefix":"10.1177","volume":"30","author":[{"given":"Jordan M.","family":"Benjamin","sequence":"first","affiliation":[{"name":"Asclepius Snakebite Foundation, Seattle, WA"},{"name":"Department of Biology, Whitman College, Walla Walla, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Philippe","family":"Chippaux","sequence":"additional","affiliation":[{"name":"Asclepius Snakebite Foundation, Seattle, WA"},{"name":"Center for the Study and Research of Malaria Associated with Pregnancy and Childhood (Cerpage), Cotonou, Benin"},{"name":"French Institute of Research for Development, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bio","family":"Tamou-Sambo","sequence":"additional","affiliation":[{"name":"D\u00e9partement de chirurgie et sp\u00e9cialit\u00e9s, Universit\u00e9 Parakou, Parakou, Benin"},{"name":"H\u00f4pital Evangelique Bemb\u00e8r\u00e8k\u00e8, Bemb\u00e8r\u00e8k\u00e8, Benin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olouch\u00e9goun Cardinal","family":"Akpakpa","sequence":"additional","affiliation":[{"name":"Centre de sant\u00e9 communal de Nikki, Parakou, B\u00e9nin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achille","family":"Massougbodji","sequence":"additional","affiliation":[{"name":"D\u00e9partement de chirurgie et sp\u00e9cialit\u00e9s, Universit\u00e9 Parakou, Parakou, Benin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,9,1]]},"reference":[{"key":"bibr1-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.01.098"},{"key":"bibr2-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0004088"},{"key":"bibr3-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1016\/S0035-9203(03)80105-0"},{"key":"bibr4-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1016\/j.inhe.2010.08.001"},{"issue":"181","key":"bibr5-j.wem.2019.04.003","first-page":"33","volume":"46","author":"Warrell D.A.","year":"1977","journal-title":"Q J Med"},{"key":"bibr6-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1186\/1471-227X-13-5"},{"key":"bibr7-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxlet.2017.08.020"},{"key":"bibr8-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003220"},{"key":"bibr9-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2015.05.012"},{"issue":"1","key":"bibr10-j.wem.2019.04.003","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s40409-018-0176-5","volume":"24","author":"Benjamin J.M.","year":"2018","journal-title":"J Ven Anim Toxins Incl Trop Dis"},{"issue":"1","key":"bibr11-j.wem.2019.04.003","first-page":"56","volume":"25","author":"Chippaux J.P.","year":"2015","journal-title":"Med Sante Trop"},{"key":"bibr12-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2007.77.538"},{"key":"bibr13-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1016\/0041-0101(74)90068-3"},{"key":"bibr14-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.7.706"},{"key":"bibr15-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-4679(02)00464-X"},{"key":"bibr16-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12095"},{"key":"bibr17-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h568"},{"key":"bibr18-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2013.01.002"},{"key":"bibr19-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2009.06.001"},{"key":"bibr20-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2007.11.006"},{"key":"bibr21-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.4314\/sjmrp.v4i1.5"},{"key":"bibr22-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1080\/20786204.2005.10873288"},{"key":"bibr23-j.wem.2019.04.003","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbagen.2005.03.011"}],"container-title":["Wilderness &amp; 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