Neurosurgical consult for snake bit in Ethiopia

Artist rendition of Ethiopian puff adder about to bite the leg of a passer by. His CT of the brain upon presentation to Ayder Hospital, Mekelle University showed multiple sites of intracranial hemorrhage. 
A case from 2019 in Mekelle, Ethiopia at Ayder Hospital. A neurosurgical consult for snake bit (not too common) causing brain hemorrhage.
This 21 year old man was bitten in the foot by an unknown viper, we latter determined it was most likely an Ethiopian puff adder, three days before being referred to our university hospital for sudden onset of coma after two days in a local hospital without antivenom. On arrival he was bleeding from all orifices and the intravenous site. Platelet count showed no countable platelets and bleeding time was not measurable. On seeing him he had no brain function but agonal respiration. We could not save him.
There a few case reports in Africa of similar nature usually occurring on the third day or so after the bite. I had not seen this in Ethiopia before but many people often do not seek treatment and assume they are going to die. It is imperative that victims of viper snake bit seek treatment at a university hospital with antivenom and advanced capabilities. He came too late for us to save.