Neurological and neuropsychological consequences of electrical and lightning shock: review and theories of causation

Abstract

Injuries from lightning and electrical injuries involve multiple systems of the body, however neurological symptoms are very widely reported. A disabling neuropsychological syndrome is also noted. This paper presents a comprehensive review of neurological and neuropsychological symptoms. Partial theories of causation for these injuries have been advanced, however, there is no convincing explanation for both delay in onset of symptoms and also the genesis of the neuropsychological syndrome. A theory of causation is proposed which satisfies both these constraints. This theory suggests circulating hormones such as cortisol, together with nitric oxide and oxidant free radicals from glutamatergic hyper-stimulation, act on tissues remote from the injury path including the hippocampus. This theory opens a research path to explore treatment options.

Neurological and neurourological complications of electrical injuries

“…Vascular damage from electrical injury leading to vascular spasm, neuronal ischaemia, and ischaemia in the tissues supplied by the damaged vessels immediately after the trauma. Remaining chronic ischaemia after the initial injury, which slowly but steadily harms the tissue it supplies, and a chronic inflammatory reaction of vascular endothelial cells due to free radicals resulting from oxidative stress, have been hypothesised as causes of the delay in onset of symptoms [10,11]. 2.…”

Effects of electrical injury on musculoskeletal system: a case report

“…4 Delayed neurological complications due to low voltage electrical injury are rarely reported. 5,6 As long -term effect patient may develop depression and mild psychological effects requiring early detection and management. 7…”

Wilderness Neurology

“…Neurologic findings in lightning strikes range from benign to fatal, and encompass central, cerebellar, and cranial nerve abnormalities, autonomic nervous system changes, spinal cord injuries, paralysis, and/or peripheral nervous system findings. 34,35 Cerebral edema can develop rapidly. Direct cortical damage as well as intracranial hemorrhage can be associated with lightning strikes.…”

“…34 Cranial nerve localization with facial palsy, bulbar symptoms with dysphagia, diplopia, and abnormal lingual sensation have also been described. 34,36 Keraunoparalysis, an immediate and transient paralysis with associated lack of pulse, pallor, and cyanosis may be observed on scene. Although sometimes confused with compartment syndrome, keraunoparalysis is transient and does not warrant fasciotomy.…”

“…Neuropsychologic deficits are commonly reported by victims; problems may include difficulties with cognitive function, memory, concentration, emotional instability, insomnia, visuospatial reasoning, visual reaction times, and verbal memory. 34 The skin is commonly involved in lightning strikes. The pathognomonic Lichtenberg figure is a fern-like pattern of erythema, not to be confused with a burn.…”