KEJANG PADA GIGITAN ULAR BERBISA

The venomous snakes often make a fatal clinical problem. Snake bites In Indonesia are common, but there is no epidemiology data. Report from Komodo island in Nusatenggara there were fewer than 20 people death per year caused by snake bites. Patient with venomous snake bites have neurotoxic, myotoxyc and hematotoxyc manifestation. The patients have mild up to severe sign and symptoms at seriously as fang marks, with or without local pain and swelling, hemorrhagic, coagolopathy, respiratory paralysis, seizure, shock and suddent death. Patient with venomous snake bites must have full comprehensif examination especially hematologic and neurologic aspect. Clinical sign and symptoms not always immedietly present, that could delayed the diagnose.
We report a patient with generalized seizure with repiratory paralysis and coagulopathy caused by venomous snake bites which having neurotoxic and hematotoxic process. EEG showed epileptiform wave. EMG showed a positive Harvey-Masland test causes miastenic reaction respons. Brain MRI showed multiple infarction in cerebral peduncle, thalamus and basal ganglia. Treatment with fenitoin and valproat acid controlled seizure significantly; ventilator for respiratory support; freshfrozenplasma (FFP) and Thrombocyt Concentrate (TC), transfusion to manage the hematotoxic effect. Patient was discharged with good outcome.