Journal of Emergencies, Trauma, and Shock
Home About us Editors Ahead of Print Current Issue Archives Search Instructions Subscribe Advertise Login 
Users online:968   Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size   


 
 Table of Contents    
LETTER TO EDITOR  
Year : 2015  |  Volume : 8  |  Issue : 4  |  Page : 238-239
Transient paraplegia in an elderly due to lightning injury: An unusual cause


Department of Orthopaedics and Spinal Disorder Surgery - Unit 1, Christian Medical College and Hospital, Vellore, Tamil Nadu, India

Click here for correspondence address and email

Date of Web Publication7-Oct-2015
 

How to cite this article:
Gouse M, Arockiaraj J, Khanapur R, Srinivasan G. Transient paraplegia in an elderly due to lightning injury: An unusual cause. J Emerg Trauma Shock 2015;8:238-9

How to cite this URL:
Gouse M, Arockiaraj J, Khanapur R, Srinivasan G. Transient paraplegia in an elderly due to lightning injury: An unusual cause. J Emerg Trauma Shock [serial online] 2015 [cited 2020 Jan 19];8:238-9. Available from: http://www.onlinejets.org/text.asp?2015/8/4/238/166743


Sir,

Lightning injuries may present with a wide spectrum of manifestations which may range from simple burns to fatal death. They have been reported to cause a wide spectrum of neurological injuries. A 75-year-old male farmer was brought to the emergency department with complaints of inability to move both his lower limbs following a lightning injury. There was also a brief period of loss consciousness following the fall. On examination, his Glasgow Coma Scale was 15/15, and there was a 'fern pattern' [Figure 1] burn injury marks on the skin over his abdomen. Neurologically, he had complete paraplegia American Spinal Injury Association (ASIA) A in his lower limbs, with complete loss of sensations below D12 spinal level. Per rectal examination revealed absence of anal tone, perianal sensation, and voluntary anal contraction with normal bulbocavernosus reflex.
Figure 1: Clinical photograph of the patient showing 'fern pattern' seen over the left side of the abdomen extending from the left subcoastal to left inguinal region

Click here to view


Plain radiograph and agnetic resonance imaging (MRI) of thoracolumbar and lumbosacral spine was normal [Figure 2] and [Figure 3]. He gradually started demonstrating improvement in sensation and motor power in his lower limbs within 24 h period from injury and later completely normal neurology. He was able to ambulate normally and had no residual disability at 1 year follow-up.
Figure 2: Lateral view of plain radiograph lumbosacral spine with no obvious fractures/malalignment

Click here to view
Figure 3: Magnetic resonance imaging (MRI) T2-weighted sagittal view of lumbosacral spine with no mechanical compression of the cord or any significant signal changes in the spinal cord

Click here to view


Charcot defined 'keraunoparalysis' as a clinical state specific to lightning injury where the patient develops a brief paralytic state with loss of sensation and motor power affecting the lower limbs, with both sensory and motor modalities returning to normal within a few hours. [1] Different injury patterns have been described based on the pathway of the electric force through the body. [2] The above case most probably would be "step-voltage" type, as he was working outdoors during the lightning strike, he also presented with characteristic dermal changes in the trunk, as well as transient paraplegia with sparing of heart and brain. He had the transient dermal fern-pattern markings (Lichtenberg's figures) that have been considered to be pathognomonic features of the lightning injury. [3]

Complete history, clinical examination, and radiographs are warranted in patients that present with a history of a fall or being thrown away as a result of the lightning strike causing direct/indirect injuries. Cervical spine imaging should be obtained if there is evidence of loss of consciousness, confusion, spinal tenderness, or other mechanistic considerations like having been thrown or a fall. The unconscious, confused, or neurologically deteriorating patient may require a Computed Tomography (CT) or MRI to rule out associated vertebral column and/or spinal cord injuries. [4] We suggest that lightning injuries in a conscious patient with normal plain radiograph features usually do not warrant further imaging like MRI or CT scan unless there is suspicion of secondary injury.

We report this case to create awareness among orthopedic surgeons, spine surgeons, and emergency physicians about the clinical presentation of such injuries. Although many of these may present with profound neurological deficits, the majority of them will resolve fairly rapidly, and required only supportive treatment. Secondary injuries should be carefully excluded by clinical examination, with advanced radiological investigations such as CT and MRI scans being ordered in selected patients.

 
   References Top

1.
Stanley LD, Suss RA. Intracerebral hematoma secondary to lightning stroke: Case report and review of the literature. Neurosurgery 1985;16:686-8.  Back to cited text no. 1
[PUBMED]    
2.
García Gutiérrez JJ, Meléndez J, Torrero JV, Obregón O, Uceda M, Gabilondo FJ. Lightning injuries in a pregnant woman: A case report and review of the literature. Burns 2005;31:1045-9.  Back to cited text no. 2
    
3.
Glunciæ I, Roje Z, Glunciæ V, Poljak K. Ear injuries caused by lightning: Report of 18 cases. J Laryngol Otol 2001;115:4-8.  Back to cited text no. 3
    
4.
O'Keefe Gatewood M, Zane RD. Lightning injuries. Emerg Med Clin North Am 2004;22:36-403.  Back to cited text no. 4
    

Top
Correspondence Address:
Mohamad Gouse
Department of Orthopaedics and Spinal Disorder Surgery - Unit 1, Christian Medical College and Hospital, Vellore, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.166743

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed1363    
    Printed30    
    Emailed0    
    PDF Downloaded15    
    Comments [Add]    

Recommend this journal