Keraunoparalysis: What a neurosurgeon should know about it?

Lightning Strike Injuries

Lightning is a common environmental hazard, and is a significant cause of global injury and death. Care and evaluation should follow general trauma guidelines, but several unique aspects of lightning injuries necessitate deviations from standard care that can improve survival and overall outcomes. When evaluating lightning strike patients, some common injury patterns are pathognomonic for lightning strikes and easy to recognize, while others are subtle and require heightened awareness. While most lightning-related injuries resolve spontaneously, some may have significant long-term symptoms. Anticipatory guidance and specialty referral may be needed for appropriate follow-up, evaluation, and treatment.

Seizure, A Shocking Effect of a Lightning Strike on Aerodrome: A Case Report

Lightning injuries have a high morbidity and mortality because of the electrical effects on the circulatory, respiratory, and central nervous systems. Most lightning-related deaths occur immediately after injury due to fatal arrhythmias or respiratory failure. We describe the case of a patient who experienced a seizure and respiratory distress secondary to a lightning strike and how our team was able to stabilize and transport the patient. Ultimately, in this particular case study, the patient survived with minimal residual neurologic and hemodynamic effects. Based on this clinical vignette, we review the pathophysiology of lightning injuries and the predictive factors of positive outcomes in such unusual accidents.

A shocking injury: A clinical review of lightning injuries highlighting pitfalls and a treatment protocol

INTRODUCTION

Lightning strikes have high morbidity and mortality rates. Thousands of fatalities are estimated to be caused by lightning worldwide, with the number of injuries being 10 times greater. However, evidence of lightning injuries is restricted to case reports and series and nonsystematic reviews. In this clinical review, we systematically select, score, and present evidence regarding lightning injuries.

MATERIAL AND METHODS

We performed a systematic search for reviews and guidelines in the PubMed, Embase (OvidSP), MEDLINE (OvidSP), and Web of Science databases. All publications were scored according to the Levels of Evidence 2 Table of the Oxford center for Evidence-Based Medicine. The reviews were also scored using the scale for the quality assessment of narrative review articles (SANRA) and guidelines from the Appraisal of Guidelines for Research & Evaluation (AGREE II).

RESULTS

The search yielded 536 articles. Eventually, 56 articles were included, which consisted of 50 reviews, five guidelines and one overview. The available reviews and guidelines were graded as low to moderate evidence. Most damage from lightning injuries is cardiovascular and neurological, although an individual can experience complications with any of their vital functions. At the scene, initial treatment and resuscitation should focus on those who appear to be dead, which is called the reverse triage system. We proposed an evidence-based treatment protocol for lightning strike patients.

CONCLUSION

It is vital that every lightning strike patient is treated according to standard trauma guidelines, with a specific focus on the possible sequelae of lighting injuries. All emergency healthcare professionals should acknowledge the risks and particularities of treating lighting strike injuries to optimize the care and outcomes of these patients. Our evidence-based treatment protocol should help prehospital and in-hospital emergency healthcare practitioners to prevent therapeutic mismanagement among these patients.

A Case of Keraunoparalysis: A Bolt from the Blue

Keraunoparalysis is a catastrophic but fortunately totally reversible neuroparalysis of the limbs occurring due to a lightning strike. One such case with transient right hemiparesis along with a brief account of the pathophysiology of this unique neurologic problem has been presented here.

Environmental Neurologic Injuries

PURPOSE OF REVIEW

This article discusses neurologic complications resulting from environmental injuries and the treatment modalities for these conditions.

RECENT FINDINGS

Recent advances include improved management of altitude sickness. Relatively uncommon conditions, such as keraunoparalysis (lightning-induced paralysis) and high-pressure neurologic syndrome, are areas of ongoing study.

SUMMARY

Environmental injuries may be associated with serious neurologic sequelae. This article reviews thermal and electrical injuries as well as injuries related to aviation, altitude, and diving. Recognition of signs and symptoms of such complex injuries and exposures will permit accurate diagnoses and improved outcomes.