Alleged snake bite with fatal antemortem aspiration: A diagnostic conundrum

The determination of the cause of death in the alleged snake bite deaths presents a great challenge for autopsy surgeons at autopsy. Unwitnessed bites, improper history, unavailable clinical records, and absent bite marks on the external examination often impact the assessment of snakebite deaths by autopsy surgeons. This is even more complicated when the snake bite involves an unusual or obscure site, for example, the scalp. It is often encountered in neurotoxic snake bites which are associated with minimal or no local findings at the bite site. We describe a case of an alleged snake bite on the head, wherein the relatives of the deceased old lady claimed that the cobra bit her on the vertex region of the scalp before being brought dead to the hospital. However, significant life-threatening conditions such as fatal myocardial infarction and antemortem aspiration of food up to the terminal bronchiole were found at the autopsy rather than evidence of snakebite. The role of autopsy surgeons in such cases is described in this report.