{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:02:06Z","timestamp":1790002926559,"version":"4.0.1"},"reference-count":8,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,1]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Snakebites frequently cause venom-induced consumption coagulopathy (VICC). While bleeding is common, ischaemic stroke from large-vessel occlusion (LVO) is rare. The coexistence of LVO and active VICC creates a therapeutic paradox, as reperfusion therapies risk catastrophic haemorrhage. We report a woman in her mid-60s who developed left-sided hemiplegia 6\u2009hours after a suspected viper bite. Investigations revealed profound VICC and an acute right middle cerebral artery (M1) occlusion. Due to extreme bleeding risks, standard reperfusion therapies\u2014intravenous thrombolysis and mechanical thrombectomy\u2014were contraindicated. Management prioritised rapid venom neutralisation using polyvalent anti-snake venom and supportive care. Once coagulation parameters normalised, cautious antiplatelet therapy was initiated, resulting in partial neurological recovery. This case highlights a rare clinical dilemma where modern stroke treatments are unsafe due to venom-induced coagulopathy, emphasising the necessity of individualised, risk-balanced management when ischaemic and haemorrhagic risks collide.<\/jats:p>","DOI":"10.1136\/bcr-2026-273987","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:15:52Z","timestamp":1790000152000},"page":"e273987","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Large vessel occlusion stroke in venom-induced consumption coagulopathy after viper envenomation"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1614-8397","authenticated-orcid":false,"given":"Aditya","family":"Aryan","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, King George\u2019s Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8890-2918","authenticated-orcid":false,"given":"Devansh","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, King George\u2019s Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharique","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, King George\u2019s Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, King George\u2019s Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"2026092107151624000_19.9.e273987.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003220","article-title":"Current treatment for venom-induced consumption coagulopathy resulting from snakebite","volume":"8","author":"Maduwage","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"key":"2026092107151624000_19.9.e273987.2","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14591"},{"key":"2026092107151624000_19.9.e273987.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0013789","article-title":"Strokes following snakebite envenomations: A systematic review and individual patient data meta-analysis","volume":"19","author":"Almeida","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"key":"2026092107151624000_19.9.e273987.4","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2025.e42779","article-title":"Cerebrovascular events induced by venomous snake bites: A systematic review","volume":"11","author":"Vasconez-Gonzalez","year":"2025","journal-title":"Heliyon"},{"key":"2026092107151624000_19.9.e273987.5","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000211"},{"key":"2026092107151624000_19.9.e273987.6","doi-asserted-by":"crossref","first-page":"611","DOI":"10.4103\/ijccm.IJCCM_455_17","article-title":"Acute Reversible Ischemic Stroke after Snake Bite","volume":"22","author":"Sahoo","year":"2018","journal-title":"Indian J Crit Care Med"},{"key":"2026092107151624000_19.9.e273987.7","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000015684","article-title":"Acute cerebral infarction following a Trimeresurus stejnegeri snakebite: A case report","volume":"98","author":"Zeng","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"2026092107151624000_19.9.e273987.8","doi-asserted-by":"crossref","first-page":"4321","DOI":"10.18203\/2320-6012.ijrms20253184","article-title":"Non-hemorrhagic stroke following venomous snakebite: a case series","volume":"13","author":"Devadas","year":"2025","journal-title":"Int J Res Med Sci"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-273987","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:15:53Z","timestamp":1790000153000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-273987"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":8,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,21]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-273987"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-273987","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}