Cutaneous manifestations of lightning strike – variability in Lichtenberg figures

Thunder storm mortality: Issues of medicolegal concern

Thunderstorms refer to atmospheric disturbances that are associated with electrical discharges in the form of lightning, with acoustic effects from thunder. They involve the rapid upward movement of warm, moist air which then cools and condenses creating typical cumulonimbus clouds with precipitation. Thunderstorms range in severity but are usually associated with heavy rains, winds and sometimes sleet, hail and snow. If the intensity of a storm increases there may be tornadoes or cyclones. In cases with lightning strikes and minimal or no rain there is an associated risk for the development of quite devastating wild (bush) fires. Lightning strikes may also be associated with the development, or an exacerbation, of potentially lethal natural cardiac or respiratory diseases.

Lichtenberg figures-morphological findings

Following a witnessed lethal lightning strike of an adult male who was standing outside in a storm, numerous Lichtenberg figures were identified upon external examination of the body. Sectioning across multiple areas of linear erythema in the figures showed no subcutaneous hemorrhage. This was later confirmed on histology which showed only subtle dermal capillary dilatation with no interstitial hemorrhage or inflammation in these areas. The only areas of interstitial hemorrhage were present in adjacent scattered punctate burns from arcing. The documented resolution of Lichtenberg figures within hours would be more in keeping with temporary functional capillary dilatation, shown in this case, rather than with tissue alteration by interstitial hemorrhage or inflammation.

Electrocution - post-mortem presentations, problems and pitfalls

Deaths due to electrocution occur when there has been passage of an electric current through the body. Lethal mechanisms may involve the heart with ventricular fibrillation, or the respiratory muscles or brainstem respiratory centres with respiratory paralysis/cessation. The size of the current that flows through the body is directly dependent on the potential difference of the circuit and the resistance of the tissues. The majority of deaths are accidental, with suicides being less common and homicides being very rare. Problems arising in the evaluation of cases include situations where electrocution has clearly occurred from the scene findings, but no injuries are detectable at autopsy, or when electrical burns are found at autopsy with no defective equipment/circuitry identified at the death scene.

Lichtenberg Figures: How a Cutaneous Sign Can Solve Suspicious Death Cases

Lightning is a natural weather phenomenon that occurs most commonly during the summer months in the afternoon or early evening. Lightning strikes can cause accidental deaths. In developed countries, lightning fatalities occur almost exclusively outdoors. Deaths from lightning may be in remote places with no witnesses. Forensic pathologists may not be able to reach the scene of death because it is too hazardous or inaccessible. Bodies may have neither evidence of skin burns nor torn areas on their clothes. The presumption of accidental death may be difficult to prove. We present 3 cases in which neither the examination of the death scene nor the examination of the bodies by those who attested to the death were performed. The bodies were transported to the morgue for a forensic autopsy because the deaths were considered suspicious. Physicians who attest to death in open spaces during weather that could produce lightning should actively search for Lichtenberg figures, which are considered irrefutable proof of fatal lightning in such settings. They should also photograph them and submit them as evidence. Nevertheless, physicians should keep in mind that Lichtenberg figures are not considered pathognomonic of lightning because some skin manifestations may mimic them.

The various pathological manifestations of a lightning strike exemplified in a single four-fatality incident - A case report and review of a literature

The lightning strike is one of leading cases of weather-related death worldwide. We present an unusual case of four fatality-lightning strike with various pathological manifestations. All victims died from a single lightning strike in the mountains that also caused injury to 156 other people. All victims had mechanical damage and rock damage that are typical for lightning strikes in the mountainside. Another lesions indicative of lightning strike and electrical damage were, among others: burnt and torn clothes (all cases) current marks (Cases 1, 2 and 3) and Lichtenberg figures along with flashover marks on Case 1. In the review we described the pathophysiological mechanisms of lightning-induced lesions and injuries and epidemiological trends of lightning-strike deaths. Our study exemplifies various manifestations of lightning strikes on forensic examination and underlines the necessity to take lightning strike into consideration when investigating open-air deaths of unclear origin.

Investigation of the skin lesions in lightning strike death

Lightning strike-related deaths are unusual, and the victim bodies can present different lesions due to the different injury mechanisms associated with this event. Since the post mortem assessment can be challenging, the evaluation of the characteristics of the skin lesions becomes fundamental to reconstruct the event. Due to the paucity of literature on this topic, the authors report the case of a 59-year-old man found dead near his home after a thunderstorm. Initially considered a murder by gunshot, the autopsy revealed the typical lightning strike lesions, also known as Lichtenberg figures. The adequate interpretation of the autopsy data and the histological evidences allowed to reconstruct the death dynamic and to relate it to a lightning strike. The main lesions due to lightening are here reported and discussed in order to provide a workflow for the identification of lightening as cause of death in unwitnessed cases.