Erectile Dysfunction and Permanent Bladder Areflexia Following Montivipera Bornmuelleri Snakebite

Lebanese viper (Montivipera bornmuelleri) is a well-known venomous snake that inhabits the middle eastern region, famous for its hypercoagulable properties and cytotoxic effects. The daunting neurological dysfunction caused by other snakebites remains unreported in this particular species of middle eastern vipers. We describe a case of a 31-year-old male patient who presented with right leg Montivipera bornmuelleri snakebite. He initially suffered from decreased level of consciousness and generalized tonic-clonic seizure, followed by right leg motor weakness, as well as urinary incontinence and dribbling, with complete erectile dysfunction and anesthesia over the groin area, while preserving the sensation at the level of the anus. Brain and spinal magnetic resonance imaging, electromyography, and laboratory tests were all normal. Urodynamic study showed complete bladder areflexia. The patient initiated intermittent bladder catheterization, with no improvement of his symptoms. To our knowledge, this is the first case of neurological dysfunction brought by the famous Lebanese venomous snake.