Lightning strike­induced cauda equina syndrome: a case report.

Peripheral nerve injuries after being struck by lightning have been documented. Here, we report a case of cauda equina syndrome induced by lightning. A 27-year-old man presented with numbness, a burning sensation in the saddle region, and increased urinary urgency after being struck by lightning. He had absent Achilles reflexes and paresthesia in the saddle region upon neurological examination, and magnetic resonance imaging of the spine was normal. Electrophysiological studies indicated involvement of bilateral L5, S1, and S2 myotomes and revealed cauda equina lesions. 
Peripheral nerve injury induced by lightning is rare, and the evaluation of people with neurological complaints using electromyography will help determine the true incidence.

A 15-year review of lightning deaths in Germany-with a focus on pathognomonic findings.

Lethal accidents caused by lightning are divided into observed and unobserved events. Pathognomonic or characteristic findings are often overlooked during external postmortem examination. Classical mistakes may be made which may often lead to an incorrect diagnosis. An analysis of 270 fatalities was performed on a historical collection of the Committee for Lightning Conductor Construction for the United Economic Area e. V. (ABBW) on lethal accidents due to lightning that occurred in Germany for the period 1951-1965. Furthermore, a selective literature research was carried out. The aim of the study was to analyze the death scene, the clothing, and the victim. The authors focused on chief findings which were relevant to the correct diagnosis of "death by lightning." Both Lichtenberg figures and singed body hair were considered pathognomonic for a lightning strike. The question arose as to whether Lichtenberg figures, for example, represented the finding that most often led to the correct diagnosis. Of the 270 lightning-struck victims from the case collection, 129 (47.8%) had singed body hair and 25 (9.3%) had Lichtenberg figures. A comparison of the frequency of the two reported findings, singed body hair versus Lichtenberg figures, has only been performed in the literature for case numbers below 40. This study is the first evaluation of a relatively large number of lethal accidents due to lightning. Singed body hair was reported more frequently in lightning-struck victims than Lichtenberg figures. This study showed that singed body hair is probably more diagnostically important than Lichtenberg figures.

Delayed Death Due to Lightning: An Autopsy Case Report Highlighting Diagnostic and Medicolegal Issues.

The incidences of lightning strikes are not infrequent. The electric discharge of the lightning strike produces extreme heat and high amperage current, but fatality is reported in only about 10% to 30% of lightning cases. The spectrum of injuries due to lightning strikes can vary from no external injuries to typical external injuries. Merely the presence of superficial injuries due to lightning should not be considered sufficient to dismiss the case as non-serious. Rather clinicians should be wary of internal damage due to the effect of the lightning current as well as delayed complications of the lightning which can be fatal. Similarly, during an autopsy, the forensic pathologist should also investigate for the changes/damage in the internal organs due to the effect of lightning current. The present case reports the incidence of death due to delayed complications of a lightning strike which primary doctors initially overlooked. This case also discusses the histopathological changes in the internal organs due to lightning which can be helpful in the autopsy diagnosis of lightning, particularly in cases with no external or nonspecific injuries.

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.

A 9-year retrospective review of lightning deaths from the Eastern Anatolian Region of Turkey.

In this study, deaths from lightning strikes in Eastern Turkey revealed distinct patterns in lifestyle and physical injury. Farmers, sailors, and those engaged in outdoor sports are all at risk of being struck by lightning. Death from a lightning strike is associated with cardiovascular and central nervous system damage. This study examines cases of autopsies that were performed on bodies that had suffered a lightning strike, including sociodemographic data, burns on the body, injured regions, histopathological findings, and causes of death. This retrospective evaluation included 17 cases. The cases comprised 88.2% males and 11.8% females, with a mean age of 41.5 years. The person's occupation was farmer in 29.4% of the cases and shepherd in 70.6%. Their deaths occurred most frequently in the summer months. Deaths associated with lightning strikes are more frequent in east of Turkey than in other regions, as agriculture and livestock are common sources of income. The majority of the victims among the cases were males working outside because of their occupations. Histopathologically, subarachnoid fresh bleeding was seen in five cases, subpleural fresh bleeding in the lungs in five cases, and interlobular rupture in the lungs in three cases. Deaths associated with lightning strikes have been correlated with a low level of education in this subject. This study is the largest case study of deaths associated with lightning strikes in Turkey.

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.

Unusual Lichtenberg figures in a lightning strike's victim: Case report and literature review.

Lichtenberg figures are pathognomonic markings commonly described as transient pink-red fractal pattern marks on the skin of people struck by a lightning. Their nature and the underlying physiopathology are still largely unknown. Here we describe a Lichtenberg figure in a 45-year-old woman who died due to a lightning strike during a thunderstorm. On autopsy, five days after the fatal event, she presented atypical green Lichtenberg figures on the skin of her abdomen. This appearance has not previously been described in the scientific literature, so a review of literature was done to support our observation.

Injuries and deaths from lightning.

This paper reviews recent academic research into the pathology of trauma of lightning. Lightning may injure or kill in a variety of different ways. Aimed at the trainee, or practicing pathologist, this paper provides a clinicopathological approach.

Lightning injuries in Northern Ireland.

INTRODUCTION: Lightning injuries are uncommon in Northern Ireland (NI) with scarce reports detailing incidence and local experience. We present a case study of 3 patients involved in a single lightning strike with a review of the incidence of similar injuries in the province. METHODS: Data from TORRO's National Lightning Incidents Database between 1987 and 2016 (30 years) were searched to identify victims of lightning injuries in NI. Information on 3 patients with lightning injuries that were managed in our regional burns and plastic surgery service was collected and examined. A supplementary search in hospital records was conducted over the last 20 years to identify additional data. RESULTS: Prior to our study, 6 victims of lightning injuries were identified of whom 5 survived and 1 died. Our 3 patients comprised of 2 children and 1 accompanying adult. All survived but the adult suffered cardiac arrest and required a prolonged period of cardiopulmonary resuscitation. CONCLUSION: While lightning injuries are rare in NI, this is the first report of more than one person affected by a single lightning incident in the province. In our limited experience, immediate public response and prolonged cardiopulmonary resuscitation efforts facilitated by automated defibrillators result in a favourable outcome.

Electrical Injuries in Animals: Causes, Pathogenesis, and Morphological Findings.

Electrical injuries in animals occur most often accidentally. They comprise contact to various forms of currents, including alternating, rotary, or direct currents. Depending on various parameters of the current (including the type of circuit, voltage, current and duration of exposure) and conditions of the animal (such as wet or dry hair coat and pathway of current through the body), lesions may be absent or may include early or localized development of rigor mortis, signs of acute circulatory failure, or severe thermoelectrical burns. Such burns may present as external current marks, singed hair or feathers, metallization of the skin, or occasionally internal electroporation injury resulting in muscle necrosis, hemolysis, vascular damage with thrombosis, injury to brain and spinal cord, or skeletal fractures. Furthermore, lightning strikes occur regularly in grazing animals, which have greater risk of death from step potentials (ground current) in addition to direct strike and contact injury. Such cases may have no lesions, external signs of linear or punctate burns, keraunographic markings, or exit burns on the soles of the hooves or the coronary bands. Besides detailed information about the circumstances at the location where the animal was found, electrical injuries in animals require a thorough morphological workup, including additional investigations in conjunction with certain knowledge about the possible lesion spectrum.

Lightning related fatalities in livestock: veterinary expertise and the added value of lightning location data.

Although lightning strike is an important cause of sudden death in livestock on pasture and among the main reasons why insurance companies consult an expert veterinarian, scientific information on this subject is limited. The aim of the present study was to provide objective information on the circumstantial evidence and pathological findings in lightning related fatalities (LRF), based on a retrospective analysis of 410 declarations, examined by a single expert veterinarian in Flanders, Belgium, from 1998 to 2012. Predictive logistic models for compatibility with LRF were constructed based on anamnestic, environmental and pathological factors. In addition, the added value of lightning location data (LLD) was evaluated. Pathognomonic singe lesions were present in 84/194 (43%) confirmed reports. Factors which remained significantly associated with LRF in the multivariable model were age, presence of a tree or open water in the near surroundings, tympany and presence of feed in the oral cavity at the time of investigation. This basic model had a sensitivity (Se) of 53.8% and a specificity (Sp) of 88.2%. Relying only on LLD to confirm LRF in livestock resulted in a high Se (91.3%), but a low Sp (41.2%), leading to a high probability that a negative case would be wrongly accepted as an LRF. The best results were obtained when combining the model based on the veterinary expert investigation (circumstantial evidence and pathological findings), together with the detection of cloud-to-ground (CG) lightning at the time and location of death (Se 89.1%; Sp 66.7%).

[Lightnings--danger while practising sport]. / Blyskawice--zagrozenie podczas uprawiania sportu.

Certain kinds of sporting disciplines are connected with a high risk of the lightning strike. Although most injuries are non-fatal, the transient or permanent damages of the nervous and ciruculatory systems or other internal organs are common. The concomitant psychological trauma may also be crucial. Various cases could be avoided by following simple safety rules. Wide educational programmes how to act during the stormy weather and elaboration of "stormy guidelines" should concern both sportsmen and people responsible for events safety.

"Thunderstruck": penetrating thoracic injury from lightning strike.

Lightning strike victims are rarely presented at an emergency department. Burns are often the primary focus. This case report describes the improvised explosive device like-injury to the thorax due to lightning strike and its treatment, which has not been described prior in (kerauno)medicine. Penetrating injury due to blast from lightning strike is extremely rare. These "shrapnel" injuries should however be ruled out in all patients struck by lightning.

Using an alternate light source to detect electrically singed feathers and hair in a forensic setting.

Mortality due to electrical injury in wildlife may occur in the form of lightning strike or power line contact. Evidence of electrical contact may be grossly obvious, with extensive singeing, curling, and blackening of feathers, fur, or skin. Occasionally, changes may be subtle, owing to lower current or reduced conductivity, making a definitive diagnosis of electrocution more difficult. We describe the use of an alternate light source in the examination of cases of lightning strike and power line contact in wildlife, and the enhanced detection of changes due to electrical currents in the hair and feathers of affected animals. Subtle changes in the wing feathers of 12 snow geese and 1 wolf that were struck by separate lightning events were made obvious by the use of an alternate light source. Similarly, this technique can be used to strengthen the evidence for power line exposure in birds.

[Electropathology in Vienna, an exhibition on accident prevention]. / Die Elektropathologie in Wien - eine Sammlung zur Unfallverhütung.

Since 1906, there is, apart from the period 2000-2009, in Vienna, a collection about the processes and consequences of accidents involving electricity. The purpose of this collection is to raise awareness of the dangers, and the presentation of appropriate safety devices. Both in the case of industrial accidents and leisure accidents, the risk source of electrical power is not negligible. Due to the different vulnerable groups, the availability of prevention work is difficult. The concept of the electro-pathological collection in Vienna has taken this into account.