Delayed cervical spinal cord injury after high voltage electrical injury: a case report

We Got Your Back: Evaluating Recovery Following Spinal Cord Injury After High-Voltage Electric Burns

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.

Advances in forensic diagnosis of electric shock death in the absence of typical electrical marks

Electrical injury is a relatively uncommon but potentially devastating form of multi-system injury with high morbidity and mortality. In common electric injury cases, it is usually difficult to find characteristic changes of electric injury in major organs by using routine histopathological test methods unless there are landmark traces of electric injury, known as electric marks. How to determine electric shock death, especially in the absence of typical electrical marks on the body surface in some cases (which account for about two-thirds of electric injury cases), remains a challenging problem in forensic practice. Our summary shows that many current related studies have focused their efforts to find characteristic histopathological changes in major organs of the body caused by electric injury. Based on the results obtained through comparison of the literature, we find that it may be more urgent and important to find the optimal autopsy or sampling sites in cases with no typical electric marks, knowing that these sites may often reflect the most significant histopathological changes of electric injury, for instance anatomy and sampling of the anterior wrist and the medial malleolus in cases involving the hand-to-foot electric circuit pathway. In this article, we make a summary of advances in identification methods of electric injury, hoping that it could provide some new insights for further research in this field.

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

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.

Medial Lemniscus Tract Lesion After High Voltage Electrical Injury: A Case Report

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.

Brain hemorrhage after electrical burn injury: Case report and probable mechanism

Background:

High-voltage electric injury may induce lesion in different organs. In addition to the local tissue damage, electrical injuries may lead to neurological deficits, musculoskeletal damage, and cardiovascular injury. Severe vascular damage may occur making the blood vessels involved prone to thrombosis and spontaneous rupture.

Case Description:

Here, we present the case of a 39-year-old male who suffered an electrical burn with high tension wire causing intracranial bleeding. He presented with an electrical burn in the parietal area (entry zone) and the left forearm (exit zone). The head tomography scan revealed an intraparenchimatous bleeding in the left parietal area. In this case, the electric way was the scalp, cranial bone, blood vessels and brain, upper limb muscle, and skin. The damage was different according to the dielectric property in each tissue. The injury was in the scalp, cerebral blood vessel, skeletal muscle, and upper limb skin. The main damage was in brain’s blood vessels because of the dielectric and geometric features that lead to bleeding, high temperature, and gas delivering.

Conclusion:

This is a report of a patient with an electric brain injury that can be useful to elucidate the behavior of the high voltage electrical current flow into the nervous system.