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Khor D, AlQasas T, Galet C, Barrash J, Granchi T, Bertellotti R, Wibbenmeyer L. Electrical injuries and outcomes: A retrospective review. Burns 2023; 49:1739-1744. [PMID: 37005139 DOI: 10.1016/j.burns.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023]
Abstract
Electrical burns (EI) differ from other burn injuries in the immediate treatment given and delayed sequelae they manifest. This paper reviews our burn center's experience with electrical injuries. All patients with electrical injuries admitted from January 2002 to August 2019 were included. Demographics; admission, injury, and treatment data; complications, including infection, graft loss, and neurologic injury; pertinent imaging, neurology consultation, neuropsychiatric testing; and mortality were collected. Subjects were divided into those who were exposed to high (>1000 volts), low (<1000 volts), and unknown voltage. The groups were compared. P < 0.05 was considered significant. One hundred sixty-two patients with electrical injuries were included. Fifty-five suffered low voltage, 55 high voltage, and 52 unknown voltage injuries. High voltage injuries were more likely to be male (98.2% vs. 83.6% low voltage vs. 94.2% unknown voltage, p = 0.015), to experience loss of consciousness (69.1% vs. 23.6% vs. 33.3%, p < 0.001), cardiac arrest (20% vs. 3.6% vs. 13.4%, p = 0.032), and undergo amputation (23.6% vs. 5.5% vs. 8.2%, p = 0.024). No significant differences were observed in long-term neurological deficits. Twenty-seven patients (16.7%) were found to have neurological deficits on or after admission; 48.2% recovered, 33.3% persisted, 7.4% died, and 11.1% did not follow-up with our burn center. Electrical injuries are associated with protean sequelae. Immediate complications include cardiac, renal, and deep burns. Neurologic complications, while uncommon, can occur immediately or are delayed.
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Affiliation(s)
- Desmond Khor
- Department of Surgery, Acute Care Surgery Division, USA
| | - Tareq AlQasas
- Department of Surgery, Acute Care Surgery Division, USA
| | - Colette Galet
- Department of Surgery, Acute Care Surgery Division, USA.
| | - Joseph Barrash
- Department of Neurology, University of Iowa, Iowa City, IA, USA
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Chakka K, Clark A, Kowalske K. We Got Your Back: Evaluating Recovery Following Spinal Cord Injury After High-Voltage Electric Burns. J Burn Care Res 2023; 44:414-418. [PMID: 36001001 DOI: 10.1093/jbcr/irac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Indexed: 11/14/2022]
Abstract
Delayed spinal cord injury (SCI) is a relatively rare consequence of high voltage electrical burns, but it holds significant implications for patient quality of life. Due to the uncommon nature of delayed SCI and variable time of onset following injury, providers are currently unable to provide a prognosis for functional recovery and optimize a therapy process tailored to treat this patient populace. In this study, we aim to better map the pattern of recovery in these patients to better inform future rehabilitation practices. A retrospective chart review of five patients who experienced delayed SCI secondary to an electrical burn was conducted. The majority of patients displayed an upward trajectory in motor function following acute hospitalization and inpatient rehabilitation, with four of the five patients able to achieve complete motor strength in multiple extremities. In addition, rehabilitation was shown to have a noticeable impact in improving functional independence in tasks related to nursing. In conclusion, the clinical and functional outcomes of these delayed SCI patients point to the need for multidisciplinary management following injury and highlight the importance of early rehabilitation in regaining function.
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Affiliation(s)
- Keerthana Chakka
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Audra Clark
- Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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3
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Abebe MW, Alem SE. Late onset quadriparesis in high voltage electrical burn – A case report. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Although uncommon, electrical injuries are associated with significant morbidity and mortality. There have been several reports of neurological sequelae secondary to electrical injury; however, the neurophysiology is still not completely understood. These neurological complications pose the greatest risk for permanent disability. We present a case of acute-onset quadriplegia after high-voltage electrical injury without radiographic evidence. Two months after the injury, the patient went on to regain partial sensorimotor function. Only a few case reports in the literature exist describing neurological recovery after electrical burn-induced quadriplegia. These cases are reviewed.
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5
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Cho CH, Lee DG. Medial Lemniscus Tract Lesion After High Voltage Electrical Injury: A Case Report. Ann Rehabil Med 2017; 41:318-322. [PMID: 28503467 PMCID: PMC5426265 DOI: 10.5535/arm.2017.41.2.318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/13/2016] [Indexed: 11/05/2022] Open
Abstract
We present the case of a 33-year-old man who experienced a 10,000-V electrical shock when working with electrical wiring. He suffered third-degree burns on his scalp at the right occiput (entry wound) and on his left arm (exit would), and a second-degree burn on his left foot (exit wound). He presented with severe spasticity of both lower extremities, motor weakness with a Medical Research Council grade of 3, and sensory impairments below thoracic level 11 that included an inability to sense light touch and defects in proprioception. Initial magnetic resonance imaging (MRI) scans of his spine and brain showed no definite abnormalities. However, tractography obtained by diffusion tensor imaging of the brain showed absence of the right medial lemniscus tract. A cervical MRI scan 1 month later showed spinal cord swelling from cervical 1-5 levels, and signal changes in the lateral and posterior white matter in the axial view. After 6 months of rehabilitation, he recovered almost normal degree of motor function in his lower extremities and disappearance of spasticity. However, since the sensory impairments persisted, especially defects in proprioception, he was unable to walk independently.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
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Parvathy G, Shaji CV, Kabeer KA, Prasanth SR. High-voltage electrocution causing bulbar dysfunction. J Neurosci Rural Pract 2016; 7:453-5. [PMID: 27365968 PMCID: PMC4898119 DOI: 10.4103/0976-3147.181479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Electrical shock can result in neurological complications, involving both peripheral and central nervous systems, which may present immediately or later on. High-voltage electrical injuries are uncommonly reported and may predispose to both immediate and delayed neurologic complications. We report the case of a 68-year-old man who experienced a high-voltage electrocution injury, subsequently developed bulbar dysfunction and spontaneously recovered. We describe the development of bulbar palsy following a significant electrical injury, which showed no evidence of this on magnetic resonance imaging. High-voltage electrocution injuries are a serious problem with potential for both immediate and delayed neurologic sequelae. The existing literature has no reports on bulbar dysfunction following electrocution, apart from motor neuron disease.
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Affiliation(s)
- G Parvathy
- Department of Neurology, Government TD Medical College, Alappuzha, Kerala, India
| | - C V Shaji
- Department of Neurology, Government TD Medical College, Alappuzha, Kerala, India
| | - K A Kabeer
- Department of Neurology, Government TD Medical College, Alappuzha, Kerala, India
| | - S R Prasanth
- Department of Neurology, Government TD Medical College, Alappuzha, Kerala, India
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7
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Electrical burn causing a unique pattern of neurological injury. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e378. [PMID: 25973356 PMCID: PMC4422209 DOI: 10.1097/gox.0000000000000344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/02/2015] [Indexed: 11/25/2022]
Abstract
Neurological involvement is not uncommon in patients who sustain electrical injury. The exact mechanism of nervous system damage following electrical trauma is not fully understood. The gamut of possible neurologic manifestations following electrical injury is diverse. This case report describes a young man with a unique pattern of neurological injury following an electrical burn. The combination of brachial plexopathy, partial Horner's syndrome, and phrenic nerve palsy secondary to electrical injury has not been previously described in the literature.
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Bohórquez-López A, Gordillo-Escobar E, Egea-Guerrero JJ. [Acute spinal cord injury after severe electrical trauma]. Med Intensiva 2014; 39:383-4. [PMID: 25499905 DOI: 10.1016/j.medin.2014.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 09/08/2014] [Accepted: 09/17/2014] [Indexed: 11/24/2022]
Affiliation(s)
- A Bohórquez-López
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - E Gordillo-Escobar
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España; IBIS/CSIC, Universidad de Sevilla, Sevilla, España
| | - J J Egea-Guerrero
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España; IBIS/CSIC, Universidad de Sevilla, Sevilla, España.
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Anderson ML, O'Riordan J. Guillain-Barre syndrome-like illness in association with electrical shock injury. BMJ Case Rep 2013; 2013:bcr2013201532. [PMID: 24136915 PMCID: PMC3822204 DOI: 10.1136/bcr-2013-201532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 19-year-old man presented 4 weeks after an electrical shock injury with gradual onset limb weakness, altered sensation in the peripheries and respiratory difficulty. There was immediate tingling of the fingers following the electrical injury that persisted. He subsequently had transient facial weakness responsive to oral steroids before the development of further limb symptoms. On admission the clinical picture and investigation findings, including neurophysiology, cerebrospinal fluid examination and MRI were consistent with a Guillain-Barre syndrome. He was managed with a course of intravenous immunoglobulin and extensive physiotherapy and occupational therapy. He made an initial modest improvement but worsened again over the subsequent 4-6 weeks. Further investigation identified no ongoing active disease and he is left with a significant residual deficit.
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Analysis of high-voltage electrical spinal cord injury using diffusion tensor imaging. J Neurol 2013; 260:2876-83. [PMID: 24002417 DOI: 10.1007/s00415-013-7081-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to investigate spinal cord injury (SCI) on the basis of diffusion tensor imaging (DTI) in patients with high-voltage electrical injury. We recruited eight high-voltage electrical injury patients and eight healthy subjects matched for age and sex. DTI and central motor conduction time were acquired in both the patient and control groups. We obtained DTI indices according to the spinal cord levels (from C2 to C7) and cross-section locations (anterior, lateral, and posterior). Fractional anisotrophy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were compared between the two groups; additionally, they were compared in relation to spinal cord level and cross-section location. In the patient group relative to the control group, the FA value decreased and the MD and RD values increased in all of the regions of interest (ROI) with statistical significance (p < 0.05). In the patient group, particularly in the ROIs of the anterior spinal cord compared with the lateral and posterior spinal cords, the FA value decreased with statistical significance (p < 0.05). The DTI indices did not differ by level. DTI revealed the change of diffusion in the spinal cords of patients with high-voltage electrical injury, and corroborated the pathophysiology, myelinopathy and typical anterior spinal cord location of high-voltage electrical SCI already reported in the literature.
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11
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Huynh W, Lam A, Vucic S, Cheah BC, Clouston P, Kiernan MC. Corticospinal tract dysfunction and development of amyotrophic lateral sclerosis following electrical injury. Muscle Nerve 2010; 42:288-92. [PMID: 20589889 DOI: 10.1002/mus.21681] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The causal relationship between electrical injury and development of amyotrophic lateral sclerosis (ALS) remains controversial. We describe the case of a 25-year-old man who developed ALS after a severe electrical injury. Cerebral magnetic resonance imaging (MRI) demonstrated hyperintensities involving the corticospinal tract. Functional testing with transcranial magnetic stimulation established that the motor cortex was relatively inexcitable. In addition, there were features of denervation on electromyography and muscle biopsy that supported concomitant lower motor neuron findings and the diagnosis of ALS.
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Affiliation(s)
- William Huynh
- Multidisciplinary Motor Neuron Disease Clinical Service, Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, New South Wales, Australia
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12
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Does Voltage Predict Return to Work and Neuropsychiatric Sequelae Following Electrical Burn Injury? Ann Plast Surg 2010; 64:522-5. [DOI: 10.1097/sap.0b013e3181c1ff31] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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13
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You JS, Chung SP. Intracerebral hemorrhage following electrical head injury. THE JOURNAL OF TRAUMA 2009; 67:E72-E74. [PMID: 19088557 DOI: 10.1097/ta.0b013e3180340e1f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Je Sung You
- Department of Emergency Medicine, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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14
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Lee MY, Liu G, Kowlowitz V, Hwang JH, Lee JH, Choi KH, Lee ES. Causative factors affecting peripheral neuropathy in burn patients. Burns 2009; 35:412-6. [DOI: 10.1016/j.burns.2008.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 08/21/2008] [Indexed: 11/16/2022]
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15
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Antepohl W, Dahle C, Sjöberg F, Thorfinn J. Interleukin-8 is elevated in cerebrospinal fluid following high-voltage electrical injury with late-onset paraplegia suggesting neuronal damage at the microlevel as causative factor. Burns 2009; 36:e7-9. [PMID: 19303217 DOI: 10.1016/j.burns.2008.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 11/26/2008] [Indexed: 10/21/2022]
Affiliation(s)
- W Antepohl
- The Department of Rehabilitation Medicine, University Hospital, Linköping, Sweden
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16
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Nose and eyebrow reconstruction following electrical injury. J Burn Care Res 2009; 29:859. [PMID: 18695597 DOI: 10.1097/bcr.0b013e3181848c89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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18
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Khan MR, El Faki H. Acute cataract and optic atrophy after high-voltage electrical injury. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-007-0195-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Delayed cervical spinal cord injury after high voltage electrical injury: a case report. J Burn Care Res 2008; 28:905-8. [PMID: 17925658 DOI: 10.1097/bcr.0b013e318159a3a1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
High voltage electrical injuries usually cause devastating consequences for patients, most of which result in permanent disability. Spinal cord injury (SCI) caused by high voltage electrical injury is uncommon in the literature. We present a 29-year-old male patient who was diagnosed as having delayed SCI after high voltage electrical injury. The patient developed muscle weakness in the lower extremities with the loss of pinprick sensation below the fifth cervical spinal segment, 2 days after the high voltage electrical injury. Magnetic resonance imaging of the brain, cervical and thoracic spine was normal. Nerve conduction and needle electromyography studies were normal, except for bilateral tibial and left median somatosensory-evoked potentials. The findings on initial examination and neurophysical investigation showed incomplete cervical SCI at the C5 level. He was able to walk with a pair of canes and bilateral ankle-foot orthosis at the end of the 2-month rehabilitation. Follow-up physical and electrophysiological examination of the patient 15 months after injury showed further improvement. The patient was able to walk with a pair of canes without orthoses. Electrophysiological studies are useful instruments in the diagnosis and follow-up of these patients. Early rehabilitation is essential to obtain a favorable outcome in patients with SCI caused by high voltage electrical injury.
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20
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Yurt RW. Burns and Inhalation Injury. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Kingsly Paul M, Dhanraj P, Gupta A. Recovery after spinal cord injury due to high tension electrical burns: a 5-year experience. Burns 2007; 34:888-90. [PMID: 17904747 DOI: 10.1016/j.burns.2007.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 04/11/2007] [Indexed: 10/22/2022]
Affiliation(s)
- M Kingsly Paul
- Department of Plastic Surgery, Christian Medical College, Vellore, Tamilnadu, India.
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22
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Ryan CM. Neurological manifestations of electrical trauma. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2004:5437-9. [PMID: 17271576 DOI: 10.1109/iembs.2004.1404519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Some degree of neurological impairment is often found in patients following electrical injury. A wide range of neurological impairments can occur including peripheral neuropathies, chronic pain syndromes, brain injury and rarely severe paralytic syndromes. Outcome is difficult to accurately predict. The symptoms can present immediately or be delayed in onset. They can also be temporary, permanent or get progressively worse with time. The neurological impairment resulting from the current often comprises a substantial proportion of the morbidity associated with such injuries. It is known that electrical current can cause nerve injury, however, the primary etiology of such damage is yet to be elucidated. An unusual case of transient paralysis after high voltage burn associated with severe hypokalemia provides unique insight into a potential mechanism for nerve injury following electrical trauma.
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Affiliation(s)
- C M Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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23
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Baqain E, Haertsch P, Kennedy P. Complete recovery following a high voltage electrical injury associated with delayed onset of quadriplegia and multiple cranial nerves dysfunction. Burns 2004; 30:603-5. [PMID: 15302431 DOI: 10.1016/j.burns.2004.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2004] [Indexed: 11/24/2022]
Affiliation(s)
- Eyad Baqain
- Department of Plastic and Reconstructive Surgery and Burn Surgery, Concord Repatriation Hospital, Sydney, NSW, Australia
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24
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Parashar A, Chittoria R, Nanda V. Extrapyramidal symptoms following electrical burns--a case report. Burns 2004; 30:402-4. [PMID: 15145203 DOI: 10.1016/j.burns.2003.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2003] [Indexed: 11/21/2022]
Affiliation(s)
- A Parashar
- Department of Plastic Surgery, PGIMER, Chandigarh 160012, India.
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Dasgupta RA, Schulz JT, Lee RC, Ryan CM. Severe hypokalemia as a cause of acute transient paraplegia following electrical shock. Burns 2002; 28:609-11. [PMID: 12220923 DOI: 10.1016/s0305-4179(02)00063-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Transient lower extremity paralysis has been previously reported following high voltage electrical injury. The following case report describes an unusual presentation of transient acute flaccid lower extremity paralysis following a high voltage electrical injury associated with profound hypokalemia and acid/base abnormalities similar to the periodic paralysis syndrome. The patient's symptoms resolved with correction of severe hypokalemia. Potential mechanisms for a metabolic neuromuscular disorder induced by electrical injury are proposed.
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Affiliation(s)
- R A Dasgupta
- Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, Bigelow 1302, Boston 02114, USA
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26
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27
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Tredget EE, Shankowsky HA, Tilley WA. Electrical injuries in Canadian burn care. Identification of unsolved problems. Ann N Y Acad Sci 1999; 888:75-87. [PMID: 10842620 DOI: 10.1111/j.1749-6632.1999.tb07943.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Over the past decade, the Firefighters' Burn Treatment Unit of the University of Alberta Hospital in Edmonton, Alberta, Canada, has treated 1399 inpatients suffering from thermal injury. Regional burn care is provided in a 10-bed intensive care unit with 18 plastic surgery reconstructive beds for a large referral region of central and northern Alberta, portions of the Northwest Territories, and neighboring provinces of British Columbia and Saskatchewan. Of the total burn inpatients during this period, 74 electrical injuries were treated (5.3% of all admissions): 71 were males (95.9%) and 3 females (4.1%). The mean age of all patients was 33.9 +/- 12.6 years (range 1-67). Compared to our general population of thermally injured patients, those with electrical injuries had smaller injuries [9.9 +/- 12.9% TBSA (range 1-65) versus 15.1 +/- 10.1], shorter length of hospitalization [18.6 +/- 7.3 days (range 1-80) versus 26.2 +/- 0.8], and substantially lower mortality once reaching the hospital (0% versus 4%). Electrical injuries were classified as flash in 30 cases, contact in 42 cases, and lightning in 2 cases; 74.3% of injuries occurred during work-related activities. A total of 118 operative procedures were performed during the acute admission (1.6 procedures per patient), including 19 amputations: 12 in the upper and 7 in the lower extremity. The mean time of amputation was 9.3 +/- 5.3 days after admission. In contact injuries of the upper extremity, 14 patients suffered amputations or neurologic injury that required reconstruction with free tissue transfers and nerve grafts. Long-term functional outcome of these patients using sensory testing, the Jebsen-Taylor hand function test, and wound coverage has revealed that these patients have substantial persistent sensory impairment of their upper extremities postinjury despite reconstruction, although many remain active and functional with acceptable wound coverage. Based on our analysis of electrical injury as it presents to one typical Canadian burn unit, our patients suffer limb loss on a delayed basis, which leads to substantial morbidity. Reconstruction of the upper extremity with microsurgical techniques after profound electrical injury has provided acceptable coverage, but in many instances is associated with poor or marginal sensory recovery limiting reemployment options for patients with upper extremity electrical burns. Further understanding of the cellular biology of delayed tissue loss after electric injury would offer the potential for reduction in amputation rate and improvement in functional outcome and overall morbidity.
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Affiliation(s)
- E E Tredget
- Firefighters' Burn Treatment Unit, University of Alberta Hospital, Edmonton, Canada
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Abstract
OBJECTIVE To analyse the incidence, diagnosis and outcome of spinal cord injury in patients with electrical injuries. PATIENTS AND METHODS Retrospective analysis of patients with electrical injuries admitted to our Intensive Care Burn Unit over a 5 year period. Among 435 admissions, 57 (13.1% of all admissions) were electrical injuries, due to either electrical flash (n = 34) or high voltage (n = 23). Two cases (8.6% of high voltage injuries) presented signs of spinal cord injury. Both cases presented an acute transverse myelopathy, involving the pyramidal tract, the posterior cords and the spinothalamic tract, causing a pyramidal syndrome with abnormal sensation and involvement of posterior cords, one with paraplegia and the other one with quadriplegia. Diagnoses were made 1 and 2 weeks after admission, respectively, when sedation was discontinued and neurological signs could be appreciated. Computerised axial tomography and nuclear magnetic resonance were normal in both cases at the moment of diagnosis. Both patients experienced a slow but progressive improvement of their neurological condition, and remain presently in a rehabilitation program 15 and 18 months after trauma. DISCUSSION Our cases illustrate (i) that damage to the spine is not infrequent after electrical injury, (ii) the difficulty in making the diagnosis of spinal cord injury after electrical trauma, and (iii) the importance of early diagnosis to define neurological prognosis and start available therapies as soon as possible.
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Affiliation(s)
- J M Arévalo
- Servicio de Cirugía Plástica y Quemados, Hospital Universitario de Getafe, Madrid, Spain
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29
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Abstract
From January 1993 to December 1997, 179 patients with electrical injuries were admitted to our burn unit. There were 55 patients with high-tension injuries and 124 patients with low-tension injuries. A high incidence of amputation (42%) is one of the characteristic sequelae of high-tension injuries, but no patients in this group of burns died. Early and serial debridement of necrotic tissue is our treatment of preference. The patient needs extensive rehabilitation and psychiatric support.
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Affiliation(s)
- V García-Sánchez
- Department of Plastic and Reconstructive Surgery and Burns Center, Vall D'Hebron Hospital, Barcelona, Spain
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30
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Rükcblick auf 20 Jahre Erfahrung in der Behandlung von Starkstromverbrennungen — ein Spiegelbild der Entwicklung der Wiederherstellungschirurgie. Eur Surg 1999. [DOI: 10.1007/bf02619797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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