Allodynia in cervical polyradiculopathy due to low-voltage electrical burn injury: A case report

@#Neuropathic pain has been described following an electrical injury, whether as an immediate response or a late-onset sequela. There is much information on high-voltage injuries in literature due to its dramatic presentation, but limited studies on low-voltage injuries. However, low-voltage injuries can be as diverse and may have symptoms varying from minimal cutaneous involvement to full-thickness injury. Significant injuries may result from multiple factors, including prolonged duration of exposure and a higher amount of current transmitted. We illustrate an atypical presentation of a low-voltage injury in a 17-year-old female. The patient had a low voltage electrical injury with no cutaneous burn noted on the affected extremity. She initially presented with allodynia, which seemed disproportionate to the clinical findings expected in a low-voltage injury. The patient underwent an electrodiagnostic study, which showed cervical polyradiculopathy (C5, C6, C7 polyradiculopathy) and neuromusculoskeletal ultrasonology, which showed enlarged right C5 nerve root. Medical management, daily physical and occupational therapies, and psychological management, were instituted, which resulted in significant improvement of the patient’s pain level and functional status. We describe the importance of the multimodal approach (medical and rehabilitation) in managing this atypical case.

Electric shock induced Purtscher-like retinopathy

The most common ocular manifestation following electric shock injury is the development of cataract. Retinal manifestations can vary from development of macular holes to retinal detachments. Purtscher-like retinopathy following electrical injury has not been reported till date. We hereby present a case of a 19-year-old electrician who presented with grossly reduced vision in the right eye of 2 months following an electric shock. The fundus of the right eye showed macular ischemic degeneration, occluded vessels, cotton-wool spots, and hemorrhages. Optical coherence tomography angiography revealed presence of capillary drop-out in the para-foveal region, which was more pronounced in the deep capillary plexus. Electric shock injury can lead to a clinical picture simulating Purtscher's retinopathy. The electrical injury leads to a more extensive damage to the deep capillary plexus as compared with the superficial plexus.

Repair of electrical wound injury in upper limbs with perforator flap pedicled with the descending branch of lateral circumflex femoral artery / 中华显微外科杂志

To investigate the clinical effect of repairing the electrical wound of upper limbs by using the perforator flap pedicled with the descending branch of lateral circumflex femoral artery. Methods From August, 2014 to July, 2018, the perforator flap pedicled with the descending branch of lateral circumflex femoral artery was used to repair the electrical wound of the upper limbs in 10 cases (11 sides), which were 9 cases (10 sides) in males, 1 case (1 side) in female. Three cases in the left side, 6 cases in the right side, and 1 case in both sides. The area of the flap was 12 cm ×6 cm-26 cm×11 cm.The arterial, venous and cutaneous nerves of the perforator flap were anastomosed with those of the recipient area, respectively. The patients were followed-up in outpatient depat-ment, including flap survival, texture, appearance, sensory recovery, donor site healing and scar hyperplasia. Results All the flaps survived without vascular crisis. Infection occurred in 1 case (1 side). The wound was healed 19 d after the operation by using effective antibiotics and dressing change. All cases were followed-up for 4-24 months after the operation. The blood supply of the flaps was good, the texture was similar to that of the recipient area, and the ap-pearance was satisfactory. There was no obvious bloat, and no ulceration of the flap was found. The anterolateral femoral cutaneous nerve was retained in the flap and anastomosed with the cutaneous nerve in the recipient area. The sensory recover to S3 in 3 flaps, S2 in 7 flaps, S1 in 1 flap. The donor site of the flap was sewn up with aesthetic treat-ment.After the operation, the donor sites presented a linear scar with a concealed position and no occurrence of oste-ofascial compartment syndrome. Conclusion The perforator flap pedicled with the descending branch of lateral cir-cumflex femoral artery has a constant anatomical position of perforator vessel, a wide excision range, abundant blood supply, a good appearance and a hidden donor site, which is a good choice for repairing the electrical wound.

Síndrome de onda J en paciente con quemadura eléctrica. ¿Causalidad o casualidad? / J wave syndrome in a patient with electrical burn. Causality or coincidence?

Resumen El corazón es uno de los órganos más vulnerables en la lesión inducida por electricidad. Pueden sobrevenir varias arritmias y manifestaciones electrocardiográficas de las que destacan asistolia, fibrilación ventricular, QT prolongado, bloqueo de rama derecha, bloqueo cardiaco completo, fibrilación auricular, bradicardia y extrasístoles auriculares y ventriculares, entre otras. El síndrome de onda J es un espectro de alteraciones eléctricas cardiacas que se distingue por la existencia de ondas J (ondas de Osborn) y riesgo elevado de fibrilación ventricular. Las afecciones que incluye este síndrome se distinguen por características comunes en lo referente a sus bases celulares y iónicas, factores de riesgo y patrones evolutivos. El objetivo de este artículo es describir el caso de un paciente que tuvo manifestaciones electrocardiográficas de síndrome de onda J asociado con quemadura eléctrica, su causalidad o casualidad y revisar la bibliografía relacionada con esta interesante entidad electrocardiográfica.

Abstract Heart is one of the most vulnerable organs in electrical injury. Various arrhytmias and electrocardiographic manifestations develop at the time of injury, these include asystole, ventricular fibrillation, QT-prolongation, right bundle branch block, complete AV block, auricular fibrillation, bradicardia and ventricular extrasystoles. J wave syndrome is a spectrum of electrical cardiac alterations characterized by the appearance of J waves (Osborn wave) with a risk of ventricular fibrillation. These entities share a similar ionic and cellular basis, risk factors and similar outcomes. The aim of this report is to describe a 23-year old patient who developed J wave syndrome associated to electrical injury, its causality or fortuity and review the literature related to this interesting electrocardiographic entity.

Delayed ST-Segment Elevation after Electrical Injury Mimicking Acute Myocardial Infarction: A Case Study.

Electrical injury can cause cardiac problems and various electrocardiographic (ECG) changes. It has been suggested that an electrical current may permanently damage the cardiac conduction tissue and predispose to late dysrhythmia. Less serious delayed transient ECG changes have also been described after electrical injury, such as ST segment elevation. In the emergency department, a patient who has chest pain and ECG changes should be investigated through his history about any previous electrical injury, so that we can differentiate myocardial infarction and other cardiac problems mimicking it.Here, we report a man with delayed ST Segment Elevation due to electric shock. Although he had frankly normal coronary arteries by coronary angiography, myocardial infarction was objectively evident by cardiac enzymes & electrocardiography. He was discharged in good health with non-specific electrocardiographic changes.

Peripapillary retinal thermal coagulation following electrical injury.

In this study, we have presented the case report of a 20 year old boy who suffered an electric injury shock, following which he showed peripapillary retinal opacification and increased retinal thickening that subsequently progressed to retinal atrophy. The fluorescein angiogram revealed normal retinal circulation, thus indicating thermal damage to retina without any compromise to retinal circulation.

The Incidence and Risk Factors of Psychiatric Complications in Electrical Injury

PURPOSE: Electrical injuries may cause many psychiatric complications such as depression, acute stress disorder, post-traumatic stress disorder (PTSD), etc. The purpose is to search the incidence of psychiatric complications in electrical injury and to compare its associated risk factors with other burn and trauma. METHODS: We reviewed the medical records of 709 electrically injured patients who were admitted to Hanil General Hospital from 2002 to 2007. Psychiatric complications were defined as depression, acute stress disorder and PTSD according to DSM-IV. We sorted the medical records into demographics, hospitalization, electrical voltage, injured type, extent or site of burn and type of amputation. RESULTS: Total incidence of psychiatric complications was 27.5% (Depression; 15.8%, acute stress disorder or PTSD; 17.6%). High voltage injured patients had psychiatric complications 2.38 times higher than low voltage. Incidence of psychiatric complications were 1.83 times in 6~10% of BSA, 2.01 times in 11~20% and 2.41 times in 21~30% higher than in 0~5% of BSA. If the site of burn included face, psychiatric complications occurred 1.96 times more than other sites. Patients with history of minor and major amputation showed 2.39 and 7.70 times incidence of psychiatric complications, respectively. CONCLUSION: The risk factors of psychiatric complications were high voltage electrical injury, facial burn, extent of burn and history of amputation. If the patients have risk factors, earlier psychiatric consultation may help to manage the psychiatric complications of electrical injury.

Delayed Spinal Cord Injury Following Low Voltage Electrical Accident

Although the prediction of a delayed spinal cord injury after a low voltage electrical accident is difficult, we present a young paraplegic man who had delayed spinal cord injury after a low voltage electrical accident while working. Because the passage of an electric current is variable, the tissues far distant from the point of entry may be damaged, including the spinal cord. Low voltage itself is not a safe.

Application of Brain Computerized Tomography to High Voltage Electrical Burns

PURPOSE: High voltage electrical injuries can cause many complications of central nervous system. We tried to define the indication range of brain CT (computerized tomography) in high voltage electrical injuries. METHODS: We performed a retrospective analysis of 51 high voltage electrical injured patients who were confirmed by brain CT, they had visited our emergency department from January 2005 to December 2007. All patients were classified by brain CT findings, presences of combined injuries and neurologic symptoms. RESULTS: 48 patients were confirmed normal in brain CT findings. 3 patients had brain lesions that were associated with secondary trauma. There was no abnormal CT finding in the 23 patients who did not have loss of consciousness, falling and combined injuries. CONCLUSION: If patient with electrical injury did not have neurologic symptoms or sufficient mechanical force, brain CT is not recommended. The results of this study may help emergency physicians to avoid unnecessary brain CT examination in the emergency triage to a high voltage electrical injury patients.

The Reviews of Electrical Injury on Respiratory System: Analysis for Patients Who Had Pulmonary Function Test

PURPOSE: Although not common, electrical injury may cause severe visceral injury. Injury severity depends on the amperage, the pathway of current through the victim's body, and the duration of contact with sources. Respiratory arrest is one of the common causes of acute death in serious electrical injury. But there are no specific injuries to the lungs or the airways directly attributable to electrical injury. Survivors of electrical injury may develop respiratory complications as a result of their injury or treatment. The purpose of this study is to review one institution's experience with electrical injury that may affect respiratory system. METHODS: From 2002 to 2007, 566 patients admitted to our institute were identified with electrical injury. Of these, 37 survived patients who had performed the spirometry were enrolled retrospectively. We analyzed the characteristics of electrical injury, clinical courses including respiratory complications and the findings of pulmonary function tests in the patients with electrical injury. RESULTS: The extent of the burn wounds ranged from 1% to 55% of total body surface area (mean, 16.19+/-17.83%). Of these injuries, 32 (86.5%) were high voltage (> or =1,000 V) and 3 (8.1%) were low voltage (<1,000 V). All patients were men and work-related, with the most common occupations being electricians (45.9%) and construction workers (37.8%). The average hospital stay was 111.3+/-78.9 (range, 8 to 430) days. The most common injury site of entry and exit was hand (37.8%) and upper extremity (21.6%) or foot (21.6%). Acute lung injury (2.7%), pleural effusion (21.6%), atelectasis (8.1%) and pneumonia (8.1%) were developed during the admission periods. In recovery phase of these injuries, most spirometric values showed near normal ranges of the percent predicted. CONCLUSION: Through the analysis of 37 electrical injury cases, we could identify that some respiratory complications and pulmonary functions following electrical injury.

The study for expression of PEG-3 in rats’ cardiac muscle after electrical injury by the method of immunohistochemistry / 重庆医科大学学报

Objective:To study the expression of PEG-3 in cardiac muscle after electrical injury in order to find the time dependablity and the discrimination for the antemortem electrified and postmotorm electrified.Metheds:The animals were devided into two groups:the negative group and the experimental group.The experimental group were devided into three groups again:the electrical injury group,the electrouction group and the group of electrical shock after death.The electrical injury group is for 0h、3h、6h、12h、24h、3d、6d、12d,the electrouction group is for 0h、1h、3h、6h、12h,and the group of electrical shock after death is for 0h、0.5h、1h、3h,the control group is for 0h、0.5h、1h、3h、6h、12h.After all these we should get the cardiac tissue at the propotional time,and then dye it by the method of HE and immunohistochemistry.Then we can gain the conclusion through the method of semiquantitative analysis.Results:The expression of PEG-3 increased in heart injury early,it may be a useful molecular index to diagnose heart injury induced by electric force.In additional,the rule of PEG-3 expression was changed following time,which may help to estimate the injury interval in forensic EI field.We can also discriminate the the electrouction group and the postmotorm electrified group,because there are only extremely tenuous positive staining for the group of electrical shock after death.Conclusion:PEG-3 can diagnose the electrical injury and discriminate the electrical injury,weather it formed at antemortem or postmortem.

A case of Peripheral Neuropathy After High Electrical Injury / 대한산업의학회지

BACKGROUND: With increasing industrial development, opportunities are growing to contact electricity in the workplace or home. Therefore, the risk of electrical accident has been increased gradually. In general, electrical injuries involve the extremities and result in amputation or severe disability of limbs. Delayed spinal cord injury and peripheral neuropathies following electrical accidents are extremely rare. CASE REPORT: A 32-year-old man with 10 years working experience at a CRT-monitor manufacturer with repetitive exposures to high voltage current visited our hosipital. He complained of left leg weakness and atrophy, and intermittent pain. The symptoms were progressive. Other symptoms occurred such as nocturia, hesitancy, and weak urinary stream. We examined the patient and conducted EMG, L-spine MRI, neurometer test, isokinetic strength test, and physical examination. The results showed neural injuries due to anterior horn lesions or compression of the left femoral nerve pathway, with a consequent diagnosis of neurogenic bladder.

The gene expression profiles in cardiac muscles by DNA microarray after electrical injury / 第三军医大学学报

Objective To study the gene expression profiles in cardiac muscles at the early phase after electrical injury. Methods The total RNA in both injured group and control group were isolated and hybridized with BioStar-40 cDNA microarray that contains 4 096 genes or expressed sequence tags (EST) randomly selected from a rat cDNA library. Results A total of 71 genes or ESTs were differently expressed in the cardiac muscles in 3 h after electrical injury with 35 up-regulated genes or ESTs and 36 down-regulated genes or ESTs. Some of these genes were involved in coagulation, inflammation, signal transduction and cell homeostasis. Conclusion The genomic response to heart electrical injury is complex and a great number of genes involved in this pathophysiological process. The analysis of differently expressed genes is helpful to learn the molecular mechanisms of heart electrical injury.

Polarized change of epithelia of skin on electrical injury and burn / 重庆医科大学学报

0.05).But there were obvious differences between each electrically injured groups and each burned groups(P

Neuropathic Pain Model Induced by Electrical Injury of Sciatic Nerve in Rats

OBJECTIVE: The purpose of this study was to develop a new neuropathic pain model in rat. METHOD: Twenty Sprague-Dawley adult male rats, 10 for control and 10 for experimental, were anesthetized and their sciatic nerves were exposed. In an experimental group, exposed nerve was injured with 10 volts electrical current for 10 seconds. The mechanical and thermal allodynia and pain behavior were evaluated in pre-electrical injury and post-injury 1, 2, 3 days, 1, 2, 3, 4, 6 and 8 weeks. The mechanical allodynia was evaluated by the frequency of response to 5 stimulations of von Frey hairs (4.31 and 4.56) and the thermal allodynia was tested by withdrawal latency to stimulation with radiant heat. Spontaneous pain behavior (paw shaking, paw elevation) was observed for 5 minutes in the cage. RESULTS: The experimental group exhibited significantly higher withdrawal frequency to mechanical stimulation: from post-injury 3 days to 6 weeks for von Frey hair 4.31 and from 2 days to 4 weeks for von Frey hair 4.56 (p<0.05). There was no difference between two groups in withdrawal latency to radiant heat stimulation. The experimental group showed spontaneous pain behavior but control group did not. In electron microscopic finding, prominent myelin destruction and axonal sprouting were observed in experimental group. CONCLUSION: These results suggest that a new neuropathic pain model can be made by 10 volts electrical injury for 10 seconds to rat sciatic nerve.

Electrical injury in Thai children: Its epidemiology and prevention.

Electrical current can affect every organ system in the body as a result of heating eletrogenic changes. The clinical features following electric injury are described as local and general lesions. Electrical burns were common local electrical injury and mostly involved the hand. Fourty nine percent of electrical shock or loss or consciousness were found in this series which were general lesion; one of them was presented with brain lesion and recovered after 6 month-follow up. The incidence and causes of injury in various age-groups were as the following: the children under 3 years old placed their finger in the wall sockets; 4-6 years old put in or pulled cord plug; the 7-12 years old handled the faulty electrical equipment; the children over 12 years mostly began labour life that got electrical injury during working in an unsafe place and with carelessness. Electrical burns caused deformity, most common with the upper extremities. A proper, safe electrical equipment should necessarily be developed by the government, especially the cord plug and wall socket.