{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T20:01:13Z","timestamp":1772740873998,"version":"3.50.1"},"reference-count":26,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Snakebite envenomation is an endemic problem in tropical countries like Nepal. Deaths from envenomation are preventable through robust management systems and widespread public awareness. This case report describes a case of a 16-year-old boy from the Terai region of Nepal who presented with acute bilateral ptosis, head lag, and inability to elicit protrusion of his tongue after a krait bite. The patient was managed with antivenom, mechanical ventilation, and supportive care. Early neurological recovery after krait-bite envenomation is generally expected in victims who receive timely antivenom along with intensive supportive care. As usual, recovery of ptosis, tongue protrusion, and head lag occurred within a week; however, residual weakness in all limbs persisted for months. Gradual onset and offset of neurological symptoms are often characteristic of krait bites. Delayed neurological recovery after krait-bite envenomation is uncommon as illustrated in this case.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0555","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T17:33:35Z","timestamp":1768930415000},"page":"593-595","source":"Crossref","is-referenced-by-count":0,"title":["Delayed Recovery of Quadriplegia after a Krait Bite"],"prefix":"10.4269","volume":"114","author":[{"given":"Shambhu","family":"Khanal","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Lumbini Provincial Hospital, Butwal, Nepal;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savita","family":"Aryal","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Universal College of Medical Sciences, Bhairahawa, Nepal;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalpana","family":"Neupane","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Lumbini Provincial Hospital, Butwal, Nepal;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prakash","family":"Bhattarai","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Lumbini Provincial Hospital, Butwal, Nepal;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Buddha","family":"Rayamajhi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Bhim Hospital, Bhairahawa, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nandu Prasad","family":"Pathak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Lumbini Provincial Hospital, Butwal, Nepal;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Snakebite Envenoming.","year":"2023"},{"key":"b2","series-title":"J Sci Soc","first-page":"147","article-title":"Identification and management of snake bite in Asia: A narrative review","volume":"50","author":"Rathinasamy","year":"2023"},{"key":"b3","series-title":"Toxicon","first-page":"1","article-title":"Unusually prolonged neuromuscular weakness caused by krait (Bungarus caeruleus) bite: Two case reports","volume":"193","author":"Gupta","year":"2021"},{"key":"b4","series-title":"East Mediterr Health J","first-page":"909","article-title":"Systematic review and meta-analysis of global prevalence of neurotoxic and hemotoxic snakebite envenomation","volume":"28","author":"Suhita","year":"2022"},{"key":"b5","series-title":"Lancet Glob Health","first-page":"e398","article-title":"Snakebite epidemiology in humans and domestic animals across the Terai region in Nepal: A multicluster random survey","volume":"10","author":"Alcoba","year":"2022"},{"key":"b6","series-title":"J Family Med Prim Care","first-page":"386","article-title":"Dramatic neuromuscular paralysis following occult snakebites: An awareness for the primary care physician","volume":"11","author":"Mehta","year":"2022"},{"key":"b7","series-title":"Trop Doct","first-page":"82","article-title":"Premonitory signs and symptoms of envenoming by common krait (Bungarus caeruleus)","volume":"44","author":"Bawaskar","year":"2014"},{"key":"b8","series-title":"Cureus","first-page":"e20280","article-title":"Fight or flee: An interesting case of snakebite with delayed recovery","volume":"13","author":"Kadirvelu","year":"2021"},{"key":"b9","series-title":"Am J Trop Med Hyg","first-page":"145","article-title":"Effectiveness of rapid transport of victims and community health education on snake bite fatalities in rural Nepal","volume":"89","author":"Sharma","year":"2013"},{"key":"b10","series-title":"PLoS Negl Trop Dis","first-page":"e0008727","article-title":"Interventions for the management of snakebite envenoming: An overview of systematic reviews","volume":"14","author":"Bhaumik","year":"2020"},{"key":"b11","series-title":"Am J Trop Med Hyg","first-page":"234","article-title":"Impact of snake bites and determinants for fatal outcomes in southeastern Nepal","volume":"71","author":"Sharma","year":"2004"},{"key":"b12","article-title":"National Guidelines for Snakebite Management in Nepal.","year":"2019"},{"key":"b13","series-title":"Trans R Soc Trop Med Hyg","first-page":"351","article-title":"Neurophysiological findings in patients 1 year after snake bite induced neurotoxicity in Sri Lanka","volume":"104","author":"Bell","year":"2010"},{"key":"b1","article-title":"Snakebite Envenoming.","year":"2023"},{"key":"b2","series-title":"J Sci Soc","first-page":"147","article-title":"Identification and management of snake bite in Asia: A narrative review","volume":"50","author":"Rathinasamy","year":"2023"},{"key":"b3","series-title":"Toxicon","first-page":"1","article-title":"Unusually prolonged neuromuscular weakness caused by krait (Bungarus caeruleus) bite: Two case 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caeruleus)","volume":"44","author":"Bawaskar","year":"2014"},{"key":"b8","series-title":"Cureus","first-page":"e20280","article-title":"Fight or flee: An interesting case of snakebite with delayed recovery","volume":"13","author":"Kadirvelu","year":"2021"},{"key":"b9","series-title":"Am J Trop Med Hyg","first-page":"145","article-title":"Effectiveness of rapid transport of victims and community health education on snake bite fatalities in rural Nepal","volume":"89","author":"Sharma","year":"2013"},{"key":"b10","series-title":"PLoS Negl Trop Dis","first-page":"e0008727","article-title":"Interventions for the management of snakebite envenoming: An overview of systematic reviews","volume":"14","author":"Bhaumik","year":"2020"},{"key":"b11","series-title":"Am J Trop Med Hyg","first-page":"234","article-title":"Impact of snake bites and determinants for fatal outcomes in southeastern Nepal","volume":"71","author":"Sharma","year":"2004"},{"key":"b12","article-title":"National Guidelines for 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