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PubMed2005

Neurorehabilitation of behavioral disorders following lightning and electrical trauma.

Neurobehavioral problems after lightning and electrical injuries are diverse. Commonly reported are decreased cognitive function, pain syndromes, depression, posttraumatic stress disorder, and significant alterations in social and work roles. While the problems resemble those following other kinds of accidents, the injury scenarios for lightning and electrical trauma are unique, and seem to invite more skepticism and controversy in medical and legal realms when the survivors seek help. Studies of lightning and electrical injuries have identified disabling neuropsychiatric changes for some survivors, often persistent and occasionally progressive, that appear weakly related to litigation status, inconsistently related to injury scenarios, and likely influenced by individual premorbid emotional and coping patterns. Standards of care in the fields of brain injury, behavioral medicine, and psychotherapy can inform rehabilitation strategies. Proper assessment is important, as well as an individualized approach to treatment. Multidisciplinary intervention focuses on managing symptoms, learning compensatory skills, providing psychosocial support, and preventing maladaptive behaviors. It has been therapeutic for some patients to become activists for better awareness and prevention.

Adaptation, Psychological↗
PubMed1991

Successful management of an adult lightning victim using intracranial pressure monitoring.

Serious central nervous system injuries after lightning strikes are fortunately rare. Optimal neurological and neurosurgical management has not been firmly established. We describe the successful neurological resuscitation and critical care management using intracranial pressure monitoring of an adult who sustained a lightning strike. The role of intracranial pressure monitoring in this setting is discussed.

Coma↗
PubMed1997

Injury by electrical forces: pathophysiology, manifestations, and therapy.

The pathogenesis and pathophysiologic features of electrical injury are more complex than once thought. The relative contributions of thermal and pure electrical damage depend on the duration of electric current passage, the orientation of the cells in the current path, their location, and other factors. If the contact time is brief, nonthermal mechanisms of cell damage will be most important and the damage is relatively restricted to the cell membrane. When contact time is much longer, however, heat damage predominates and the whole cell is affected directly. These parameters also determine the anatomic tissue distribution of injury. Damage by Joule heating is not known to be dependent on cell size, whereas larger cells are more vulnerable to membrane breakdown by electroporation. Cells do survive transient plasma membrane rupture under appropriate circumstances or if therapy is instituted quickly. If membrane permeabilization is the primary cellular pathologic condition, then injured tissue may be salvageable and the challenge for the future is to identify a technique to reseal the damaged membranes promptly. Present standards of care for electrical injury require a fully staffed and well-equipped intensive care unit, available operating suites, and the availability of the full range of medical specialists. Major teaching hospitals with burn centers may be the ideal setting for the treatment of an electrical trauma victim. After the initial resuscitation, efforts are directed primarily towards preventing additional tissue loss mediated through the compartment syndrome, compressive neuropathies, or the presence of necrotic tissue. Renal and cardiac failure caused by the release of intracellular muscle contents into the circulation must be prevented. Attention can then be directed towards maximizing tissue salvage and preventing late skeletal and neuromuscular complications. Reconstructive procedures that transfer healthy tissue from a distance are necessary to optimize the functional value of the remaining tissue. Finally, unless the patient is rehabilitated psychologically, the real benefit from other sophisticated care will not be fully realized. These goals are important throughout the acute care of the patient. In the future, new guidelines for treating electrical trauma will be based on a clearer understanding of the relevant pathophysiologic features. These strategies will rely on improved diagnostic imaging and on reversing the fundamental problem of cell membrane damage. Moreover, complex biochemical and organ system pathophysiologic interactions will require careful management. If successful, research efforts presently underway should improve the prognosis of victims after electrical trauma.

Burns, Electric↗
PubMed1992

[A rare case of "secondary" drowning].

The Authors present a case of a young man who drowned in sea water after the shock caused by a lightening that fell close to him as the swam. The Authors discuss and analyze the effects of the two events (drowning and lightening) which developed similar cerebral injuries but with a different origin.

Adolescent↗
PubMed1989

Electric shock and associated injuries.

Electrical current can affect every organ system in the body as a result of heating, electrogenic changes and vascular injury. The clinical features following electric shock are variable and can simulate crush or thermal injuries.

Accidents, Occupational↗
PubMed1988

Delayed myelopathy following lightning strike: a demyelinating process.

Although the clinical findings in over 30 cases of delayed myelopathy after electrical injury have been described, there are scanty reports of the pathology of the spinal cord in such cases. We report a case in which progressive myelopathy presented 1 month after electrical injury by lightning strike and death occurred 4 months after injury. The spinal cord showed widespread demyelination of white matter from the medulla to just above the conus medullaris. This consisted of selective degeneration of myelin sheaths without inflammation or injury to axons, other cord components, or nerve roots. Infarction of more circumscribed segments of the thoracic cord where demyelination was greatest was probably due to edema associated with myelin degeneration, causing cord swelling limited by the pia mater. Raised pressure within the cord then resulted in secondary infarction.

Adult↗
PubMed1995

Deaths and injuries as a result of lightning strikes to aircraft.

Aircraft are at risk of being struck by lightning or triggering lightning as they fly through clouds. Commercial and private airplanes have been struck, with resultant deaths and injuries to passengers and crew. We were interested in learning how large a problem existed to the American public from lightning strikes to airplanes. We analyzed data from the National Transportation Safety Board (NTSB) on lightning-related accidents in the United States from 1963-89. NTSB recorded 40 lightning-related aircraft accidents. There were 10 commercial airplane accidents reported, 4 of which were associated with 260 fatalities and 28 serious injuries. There were 30 private aircraft accidents that accounted for 30 fatalities and 46 serious injuries. While lightning remains a potential risk to aircraft passengers and crew, modern airplanes are better equipped to lessen the dangers of accidents due to lightning.

Accidents, Aviation↗
PubMed2000

Electric injury, part III: cardiac monitoring indications, the pregnant patient, and lightning.

A number of publications have presented recommendations for prolonged cardiac monitoring after electric injury. These recommendations are combined in this article to make criteria for monitoring that agree with the recommendations of most studies. It is generally agreed that cardiac monitoring is not needed unless there is an abnormal electrocardiogram or other suggestion of acute problems. Electric injury in pregnancy is also discussed, with recommendations for fetal monitoring after electric and mechanical trauma. Reports of fetal death after minor electric injury to the mother are described. Finally, selected aspects of lightning injury are described, including neurologic and vascular effects. This is the final article of a 3-part series on electric injury.

Adult↗
PubMed2001

High tension electrical injury from a telephone receiver.

A high tension (13000 V) electrical injury to a young man from telephone receiver is described. The current entered the telephone circuit due to contact with a high tension live wire running close to the telephone wire 2 km away from the site of incidence.

Adult↗
PubMed1996

Lichtenberg figures.

The majority of cutaneous injuries seen in victims struck by lightning are superficial and heal without sequelae. Common cutaneous findings associated with lightning strike include punctate full-thickness burns, linear charring, and contact burns from overlying metal objects. Branching or ferning marks are an uncommon and unusual cutaneous manifestation. These ferning patterns are called Lichtenberg figures. Similar-appearing electrical phenomena were first noted by an 18th-century physicist of the same name. A case report with review of the literature is presented. The histopathologic features of the figures are described for the first time.

Adult↗