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Electrical and Lightning Injury

PATHOLOGY

High Voltage electric shock or lightning stroke can cause damage to the central nervous system, motor neurons, or peripheral nerves. Lesions can involve the brain or the spinal chord. If a lesion involves the spinal chord, myelomalacia can result without any change in the blood vessels, inflammation or gliosis. Similarly in the brain, non-specific lesion occur, and gray matter could be affected. When death occurs from acute injury, cerebral lesions seem to be dominated by the effects of anoxia and cardiac arrest., with edema, perivascular hemmorhage, and neuronal loss.

PATHOGENESIS

The method of injury is not clear. Researchers have stated that resistance to the flow of electric current is lower in neural tissue than in other organs of the body. Accordingly, the subsequent syndromes result from the effects of high-voltage electricity on neural cells. Demyelination does not appear to be the result of vascular injury, and it remains unclear why the symptoms are immediate in most patients, but delayed in some. It is also unclear why different parts of the nervous system are affected in different victims.

EPIDEMIOLOGY

In the past, electrocution was the result of accidents in the home or at work. As technology advances, many of these accidents have been avoided but still account for about 1000 deaths per year in the United States; 100 deaths per year are attributed to strikes of lightning. These lightning strikes can occur at work (farming, roofing, ranching) or during outdoor activities (camping, hiking, water sports).

SYMPTOMS AND SIGNS

Among survivors, the initial signs occur immediately after the shock and may be temporary. Unconsciousness and amnesia are common, and there may be transient paralysis of limbs or paresthesia. Cerebral infarction may occur from arrhythmia and embolization. Days or weeks later, progressive disorders can begin to develop, resembling one or several syndromes, such as parkinsonism, cerebellar disorders, myelopathy, spinal muscular atrophy, or sensorimotor peripheral neuropathy. Because cases are uncommon, it is difficult to determine whether reported cases are consequences of the electric shock or are a coincidental occurrence of two conditions.

TREATMENT

The onset of these syndromes can only be treated symptomatically because no specific treatment exists. However, the acute attention is directed to the cardiac disorder. Brain injury rehabilitation can help in the long term.