History of Avalanches in the Eastern Spanish Pyrenees.

Avalanches have caused injuries and deaths in mountain areas throughout history. We have examined the historical effects of avalanches on communities in the eastern Spanish Pyrenees. Surviving written records began in the year 1444 when an avalanche destroyed the village of Gessa. Many other avalanches since then have destroyed houses and other buildings and have caused injuries and deaths. In the 20th and 21st centuries, many villages evolved from agrarian areas to destinations for winter sports. The first known deaths during winter recreation likely occurred in 1930. Because of avalanche mitigation efforts, including relocating settlements, physical barriers, avalanche control measures, efforts to increase avalanche awareness, and avalanche warnings, avalanches now seldom affect inhabited areas in the eastern Spanish Pyrenees. Avalanche injuries and fatalities are now mainly limited to backcountry skiers and others traveling out of bounds near avalanche-controlled ski resorts.

Isolated Ptosis Following a Vipera aspis Bite.

In Spain, snakebites are uncommon medical emergencies that cause barely 100 hospitalizations annually. Most of the venomous bites are by snakes of the Viperidae family. Venom from Vipera snakes is reported to have cytotoxic and hematotoxic effects, and neurological effects have also been described. Ptosis (cranial nerve III palsy) is the most common sign, although any cranial nerve can be affected. We describe isolated ptosis, which was very likely after a Vipera aspis bite in the East Catalonian Pyrenees. No antivenom was administered. The ptosis resolved spontaneously within 10 h. Although neurologic findings are usually mild, they indicate a moderate or severe envenomation. Treating snakebites can be challenging for clinicians, especially when there are uncommon clinical manifestations. A toxicologist at a poison center should be consulted to help guide management. Development of local protocols may provide clinical support.