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PubMed1995

Autonomic nervous system disorders and reflex sympathetic dystrophy in lightning and electrical injuries.

Both lightning and electrical injuries can cause autonomic nervous system (ANS) symptoms and signs (Table 1). Published descriptions of ANS involvement occurring with lightning and electrical injuries are rare. The most often reported neurologic complications of lightning injuries involve the central nervous system. ANS abnormalities have been documented with lightning, although the descriptions are scant. There is a lack of complete clinical information or ANS testing data in these cases. This is usually a result of the transient nature of ANS complications. In electrical injuries, ANS involvement is less well described than for lightning. Electrical injuries can be associated with peripheral nerve damage. As a result of peripheral nerve damage, reflex sympathetic dystrophy (RSD) may occur in patients with electrical injuries. Various treatment strategies for RSD associated with electrical injuries are found in single case reports. This article summarizes ANS involvement, predominantly in lightning injuries, and describes RSD and its treatment, predominantly in electrical injuries.

Autonomic Nervous System Diseases↗
PubMed1995

[Lightening strike injuries of the ear].

Although lightning injuries are quite common, lightning-induced damage to the middle or inner ear and to the vestibular nerve has been reported in only a very few cases. Two case reports are presented: a 22-year-old woman and a 26-year-old man who experienced lightning injuries to several body parts including the ear. Pathophysiology, diagnostic criteria and treatment are discussed.

Adult↗
PubMed2005

Neurorehabilitation of spinal cord injuries following lightning and electrical trauma.

While spinal cord injuries caused by lightning strike or electrical shock are rare, their clinical manifestations pose unique challenges to the clinician who must anticipate the interaction of multiple system involvement with the altered physiology of spinal cord injury. Spinal cord damage may be secondary to the direct effects of electrical current passing through neural tissue producing immediate or delayed impairment. Alternatively, lightning strike and electrical shock may lead to spinal cord damage due to the secondary consequences of injury such as spinal fractures sustained after a fall. In addition to effects on the spinal cord, electrical trauma may result in injury to the brain, peripheral nervous system, musculoskeletal system, skin, and cardiovascular system. This article will review the neurorehabilitation approach to this rare and challenging group of patients.

Humans↗
PubMed1995

Lightning and transportation.

It is a little-known fact that lightning casualties often involve travel or transportation. López and colleagues, in their studies on the epidemiology of lightning injuries, have reported that 10% of lightning injuries are categorized under transportation. In the majority of their cases, victims were struck while standing outside or near their vehicles during a thunderstorm. During my review of the neurologic complications of lightning injuries, I was impressed by the number of case reports in which the victim was struck while either in or near a vehicle, airplane or vessel. In this article, I shall put forth information on four aspects of lightning that relate to the danger to people traveling in vehicles, boats, and airplanes. First, I shall deal with lightning safety on ships and boats. People who enjoy recreational sailing, including the "weekend sailor" and those who enjoy fishing from a boat, should be fortified with knowledge about lightning protection. Second, I shall consider the matter of lightning strikes to aircraft. In the third section, I shall discuss the question of lightning safety in automobiles. Fourth, I shall review those cases found in my literature review in which the victim was struck while in or near a vehicle, boat, or airplane.

Adult↗
PubMed2002

Lightning-associated injuries and deaths among military personnel--United States, 1998-2001.

After flooding, lightning is the second leading cause of weather-related death in the United States; approximately 300 injuries and 100 deaths are associated annually with lightning strikes in the United States. To characterize lightning-associated injuries and deaths among U.S. Armed Forces personnel, the U.S. Army and CDC analyzed data from the Defense Medical Surveillance System (DMSS). This that the highest lightning-related injury rates during 1998-2001 occurred among male U.S. military members who were aged <40 years, single, with a high school education or less, stationed near the Gulf of Mexico or the East Coast, and in the U.S. Army. The findings suggest that the risk for lightning-associated injury depends primarily on the frequency, timing, duration, and nature of outdoor exposure to thunderstorms. Military personnel should be aware of severe weather onset and take reasonable precautions to protect themselves and their companions from exposure to lightning.

Female↗
PubMed2004

Lightning: an unusual cause of cerebellar infarction.

The neurological complications of lightning injury are not infrequent. However, scarce data are available on cerebellar infarction attributable to lightning injury. A 45 year old man was admitted to the emergency department because of lightning injury. The patient had a Glasgow coma scale score of 13/15 on arrival at hospital with accompanying dysarthria and hypotonia. Computed tomography of the head showed only a mild cerebral oedema. Ataxia was recorded on the fourth day. Magnetic resonance imaging of the head showed ischaemia predominantly in the cerebellar hemispheres bilaterally and in the parietal, temporal, and frontal lobes on the right. Anti-oedema treatment was started. The patient was discharged after seven days. After one month the patient was re-examined and found to have minimal ataxia and dysarthria. Lightning injury should not be overlooked in the aetiology and differential diagnosis of acute cerebellar ischaemic insult and relevant clinical findings in adults.

Brain Infarction↗
PubMed2005

[Emergency treatment of injuries following lightning and electrical accidents].

The pattern of injuries following electrical accidents and the treatment by emergency teams differ depending on whether exposure was to a low-voltage or high-voltage power source or to a lightning bolt. Tissue damage results from the direct effect of current on cell membranes and from conversion of electrical energy into heat. Depending on the magnitude of electrical energy and the duration of exposure, cardiac dysrhythmia, damage to nerve tissue, extensive burns and shock may occur. Multi-system injury is frequently observed, either directly related to electrical shock or secondary to concurrent trauma. Extrication of victims from the energy field must be performed under strict observance of self-protection measures for the rescuers. In high-voltage incidents the rescuers must wait at a distance until the power supply has been turned off and demonstrably grounded. Analgesia, anxiolysis and administration of crystalloid fluids are needed, especially for injuries from high-voltage power sources. Severe burns of the face and neck call for early intubation and ventilation. Monitoring is performed with pulsoximetry, blood pressure measurement and ECG, giving highest priority to the unconscious patient with cardiac and respiratory arrest. Cardio-pulmonary resuscitation (CPR) follows the international guidelines for resuscitation and may be effective after delayed onset and even after prolonged resuscitation attempts.

Cardiopulmonary Resuscitation↗