Figure 2. “Broken neck” sign observed in a 14-year-old girl bitten by a Russell's viper in India.

Envenoming by cobras, kraits and—in some areas—by Russell's viper frequently leads to progressive descending paralysis. Looking for the broken neck sign, which is caused by paralysis of the neck flexor muscles, should be part of the routine clinical assessment of patients. In this case, neuroparalysis persisted for five days despite antivenom treatment, but without progression toward respiratory failure. Image credit: H. S. Bawaskar.