Abstract

Snakebite envenomation remains a major public health problem in tropical regions [1,4] and can rarely present with severe neuroparalysis mimicking brain death. Neurotoxic bites, particularly from elapid snakes, contain α- and β-neurotoxins that disrupt neuromuscular transmission, leading to descending paralysis, bulbar involvement, and respiratory failure. In severe cases, paralysis may cause absent brainstem reflexes, a phenomenon referred to as pseudo–brain death [7-9]. Such presentations are diagnostically challenging, especially when patient history is unclear and neuroimaging, EEG, and CSF analysis are normal. We report a case of a 34-year-old male presenting with unexplained coma and absent brainstem reflexes, who showed complete neurological recovery following empirical administration of anti-snake venom (ASV) and supportive care. This case highlights the importance of high clinical suspicion for neurotoxic envenomation in patients with unexplained coma, even in the absence of local signs or clear history.