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.

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.

Cutaneous Manifestations of Lightning Injury: A Review of the Literature.

Lightning is a rare but potentially devastating cause of injury and mortality. The cutaneous burns associated with lightning strikes demonstrate peculiar pathognomonic signs and patterns. In this review of the literature, we discuss the epidemiology and etiology of lightning injuries, lightning compared to other forms of high voltage electrical injury, the clinical features of lightning injuries, the most common cutaneous manifestations associated with lightning strikes, and the treatment and prevention of lightning injuries. Some of the cutaneous manifestations include feathering lesions, linear burns, punctate burns, and thermal injuries. While not considered true burns, Lichtenburg figures display a unique ferning pattern. Although lightning injuries are typically superficial, transient, and resolve relatively quickly compared to other electrical burns, the ability to recognize their cutaneous manifestations may improve emergent care and life-saving measures for these victims. Additionally, superficial surface burns secondary to lightning injury do not preclude systemic injury and significant pathology may be underlying.

Emergency Cricothyrotomy in a Harsh Environment: A Case Report of Complete Airway Obstruction Following a Lightning Strike.

A lightning strike is an extreme event with the highest mortality rate among electrical injuries. Death from a lightning strike is caused by either cardiac arrest or respiratory arrest. It is rare for upper airway damage to occur, but in these cases, airway control is recommended. If transoral intubation is unsuccessful, an emergency cricothyrotomy should be considered. Our case report describes an emergency cricothyroidotomy performed in a harsh environment on a mountain 2300 m above sea level on a patient with extensive burns of his supraglottic structures, after being directly hit by a lightning strike.

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.

Neuronal desertification after a direct lightning strike: a case report.

BACKGROUND: Lightning strike is a rare but dramatic cause of injury. Patients admitted to intensive care units (ICUs) with lightning strike frequently have a high mortality and significant long-term morbidity related to a direct brain injury or induced cardiac arrest (CA). CASE PRESENTATION: A 50-year-old Caucasian man was admitted to our hospital after being struck by lightning resulting in immediate CA. Spontaneous circulation was initially restored, and the man was admitted to the ICU, but ultimately died while in hospital due to neurological injury. The computer tomography scan revealed a massive loss of grey-white matter differentiation at the fronto-temporal lobes bilaterally. Somatosensory-evoked potentials demonstrated bilateral absence of the cortical somatosensory N20-potential, and the electroencephalogram recorded minimal cerebral electrical activity. The patient died on day 10 and a post-mortem study revealed a widespread loss of neurons. CONCLUSION: This case study illustrates severe brain injury caused by a direct lighting strike, with the patient presenting an extraordinary microscopic pattern of neuronal desertification.

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 Storm, An Explosion, and Flying Rocks - An Unusual Injury due to a Lightning Strike in the Mountains.

BACKGROUND: Most injuries observed in victims of lightning strikes can be explained by electrothermal phenomena. Blast penetrating injuries caused by a lightning-strike-induced explosion of a nearby structure are rarely reported. CASE PRESENTATION: Here reported is the case of a patient with numerous mixed injuries caused by a lightning strike, including deep lacerations of both hips and thighs with rock fragments embedded in the wounds. Surgical removal of rock fragments from deep areas of the right hip and right lower leg was necessary. The cause of the formation of rock missiles was the lightning-strike-induced explosion of rock. Rapid evaporation of water enclosed in rock crevices was presumably the main force underlying the explosion. CONCLUSION: Blast penetrating injuries should be considered and excluded in all patients struck by lightning, particularly when occurring in rocky terrain. The diagnosis and treatment of such injuries can be difficult and require special preparation.

A unique case of direct lightning strike.

This is a report of death due to direct lightning strike that was witnessed, with description of the injuries. The associated clothing and jewelry were examined microscopically for lightning-related findings. For the first time, we report a lightning strike on a victim that led to crater formations in the brass clasp of the basil wood bead necklace, brass teeth, and brass button of the zipper. Blackening, fissuring, and charring of basil wood beads were noted. There was blackening and fusion of cowrie shell teeth, which were in the black thread necklace. The silver necklace chain vaporized and caused deep burns on the nape of neck. A few links of the silver chain necklace were found embedded in the clothing. All this damage provides important insight into the behavior of lightning.

Filigree burns of a lightning strike: A case series.

Lightning is the discharge of an electric charge forming in the atmosphere between the earth and clouds which travels downward in a branching pattern. It is estimated that there are some 1800 active thunderstorms at any given moment. Lightning may injure or kill a person by a direct strike, a side-flash or conduction through another object. Agricultural workers are at risk in developing and underdeveloped countries, as are those engaging in sporting activities elsewhere. Fatalities resulting from lightning strikes may not show specific symptoms at autopsy, but there may be symptoms of burns on clothes and body and fernlike marks specific to lightning strikes on their bodies. Other signs are acute kidney failure, cardiac arrhythmias and deaths, and while internal organs may show oedema, congestion, etc, this is not in itself sufficient to establish causation. When diagnosing death from a lightning strike, it is essential to examine the deceased's clothes, their external body and carry out a crime scene investigation. We report a series of three cases of death from a lightning strike in previously healthy men engaged in their daily activities.

[Keraunoparalysis after lightning injury with transient ischaemia and paralysis of an extremity].

Keraunoparalysis is a transient paralysis of the extremities, which results from close contact with lightning. In this case report, a 58-year-old man came in close contact with a bolt of lightning. His left foot was pulseless, pale, cold and with absence of capillary refill. His symptoms were initially interpreted as arterial occlusion, and therefore bypass surgery and even amputation were considered. However, his symptoms resolved within hours. Therefore, clinicians must consider keranoparalysis as a differential diagnosis in patients struck by lightning.

The Dangerous Life of a Storm Chaser: A Lightning Strike Injury Causing Serious Injury.

Lightning strikes to people are rare events that cause significant injuries and mortality when they do occur. We describe an uncommon case of a storm chaser in Oklahoma who was struck by lightning who suffered cutaneous burns, bilateral tympanic membrane ruptures, as well as pulmonary edema, which is an atypical finding in survivors. This case report highlights several injury patterns seen in lightning strike cases and provides evidence that these patients should be managed at a center with multidisciplinary services available.

Cardiac Arrest Secondary to Lightning Strike: Case Report and Review of the Literature.

Lightning strike injuries, although less common than electrical injuries, have a higher morbidity rate because of critical alterations of the circulatory system, respiratory system, and central nervous system. Most lightning-related deaths occur immediately after injury because of arrhythmia or respiratory failure. We describe the case of a pediatric patient who experienced cardiorespiratory arrest secondary to a lightning strike, where the Advanced Cardiac Life Support and Basic Life Support chain of survival was well executed, leading to return of spontaneous circulation and intact neurological survival. We review the pathophysiology of lightning injuries, prognostic factors of favorable outcome after cardiac arrest, including bystander cardiopulmonary resuscitation, shockable rhythm, and automatic external defibrillator use, and the importance of temperature management after cardiac arrest.

Lightning-strike-induced acute lung injury: a case report.

Lightning strike is an environmental electrical injury with high rates of morbidity and mortality. Lightning strike injuries are also considered to be high-voltage injuries. Respiratory injuries associated with lightning strikes include pulmonary edema, pulmonary contusion, acute respiratory distress syndrome, and pulmonary hemorrhage. In addition to direct damage, the affected patients are also exposed to secondary trauma; similarly, many other mechanisms associated with lightning injury have the same risk. It will therefore always be a rational approach to evaluate patients as multiple trauma patients. In this case report, a 19-year-old patient was admitted to the emergency department with amnesia, disorientation, shortness of breath, abdominal pain complaints and lung contusion, and myopathy signs as a result of a lightning strike in open terrain. The patient had a blood pressure of 80/50 mmHg, a heart rate of 110/min, and oxygen saturation of 85%. Bilateral lung contusion and pleural effusion were detected on the computerized tomography of the thorax. In addition, global cardiac hypokinesia and the 20%-25% ejection fraction were detected on echocardiography. The central nervous system and abdominal scans were normal. The patient was admitted to the intensive care unit and treated with supportive oxygen, intravenous hydration, antibiotics, systemic steroids, and invasive cardiac monitoring. On the 10th day of admission to the hospital, the patient was discharged with clinical and radiological improvement. On the 20th day after discharge, tomography scans showed no thoracic pathologic findings.

'Thunder bolts and lightning': survival and neurorehabilitation following out of hospital cardiac arrest secondary to lightning strike.

BACKGROUND: There is a limited evidence base to inform patient management following lightning-induced injuries. CASE REPORT: A 36-year-old right-handed Caucasian male struck by lightning while outdoors suffered an out-of-hospital cardiac arrest with a recorded 50-min interval before the restoration of spontaneous circulation. Multiple life threatening injuries were sustained and a profound peripheral neuropathy developed. Cognitively, he was remarkably intact. We document his acute admission and his recovery during an inpatient stay in a UK-based Neurorehabilitation Unit. CONCLUSION: Intensive neurorehabilitation in this case improved functional independence and facilitated neuropsychological recovery, to the point that our patient was discharged to independent living. This case offers some support to the hypothesis that the electrical activity of a lightning strike can be both cardioprotective and neuroprotective, and that prolonged cardiopulmonary resuscitation is warranted in such cases.

Acute Inferior Myocardial Infarction Caused by Lightning Strike.

Lightning strike is an infrequent natural phenomenon with serious medical complications, like multiple organ damage, and it is associated with increased risk of mortality. Cardiovascular complications are among the most hazardous complications of lightning strike. Lightning strike can cause various serious consequences ranging from electrocardiographic changes to death. We reported a 21-year-old patient with no cardiovascular risk factors struck by lightning and presented by inferior ST elevated myocardial infarction (MI). The patient was followed up in the intensive care unit and MI complication did not develop during follow-up. The patient was lost due to multi-organ failure after 20 hours. AydinF, Turgay YildirimO, DagtekinE, Huseyinoglu AydinA, AksitE. Acute inferior myocardial infarction caused by lightning strike. Prehosp Disaster Med. 2018;33(6):658-659.