Cerebral hemorrhage associated with snakebite by Bothrops spp. juvenile: experience of two cases in an amazonian referral hospital.

Juvenile Bothrops specimens (less than 50 cm) caused intraventricular hemorrhage in two patients in Loreto, Peru.

• Both cases involved bites by juvenile specimens under 50 cm in length.
• Both patients developed hemoventricle (intraventricular hemorrhage), a rare and potentially lethal complication.
• Intracranial hemorrhage is described as an infrequent but potentially lethal complication of Bothrops envenomation.
• Cases were managed at an Amazonian referral hospital.

A 58-year-old male with untreated hypertension who received fractionated antivenom doses due to shortage developed fourth ventricle hemorrhage on day four post-bite.

• The patient had untreated arterial hypertension as a comorbidity.
• Antivenom was administered in fractionated doses due to supply shortage rather than as a complete therapeutic regimen.
• On the fourth day post-bite, the patient presented with sudden headache and loss of consciousness.
• Tomography revealed hemorrhage in the fourth ventricle.
• The patient required intensive care, additional antivenom, and supportive measures, and was discharged without neurological deficit.

A five-year-old child who received only traditional medicine initially and whose first antivenom dose was delayed four days due to prolonged river transport developed left lateral ventricle hemorrhage.

• The child received traditional medicine instead of antivenom immediately after the bite.
• First antivenom dose was administered after four days, following a prolonged fluvial (river) transfer.
• Clinical presentation included severe anemia, altered sensorium, and hemorrhage in the left lateral ventricle.
• The child required intensive care, additional antivenom, and supportive measures, and was discharged without neurological deficit.

Both patients were discharged without neurological deficit despite severe central nervous system hemorrhagic complications.

• Both cases required intensive care unit admission.
• Both required additional antivenom doses beyond initial treatment.
• Both required supportive measures in addition to antivenom.
• Neither patient retained neurological deficit at discharge, despite intraventricular hemorrhage.

Delayed or insufficient antivenom access in the Amazon region was identified as a factor associated with hemorrhagic central nervous system complications from Bothrops snakebite.

• Causes of delayed or insufficient antivenom included antivenom supply shortage (Case 1) and prolonged fluvial transport time combined with initial use of traditional medicine (Case 2).
• Snakes of the genus Bothrops cause most snakebites in Peru.
• Both cases experienced a four-day delay before adequate antivenom treatment was established.
• The cases illustrate systemic access barriers to antivenom in the Amazonian context.