DÄ internationalArchive12/2008Lightning Strike – Mechanisms of Energy Transfer, Cause of Death, Types of Injury: Effects on the Nervous System

Correspondence

Lightning Strike – Mechanisms of Energy Transfer, Cause of Death, Types of Injury: Effects on the Nervous System

Dtsch Arztebl Int 2008; 105(12): 224. DOI: 10.3238/arztebl.2008.0224a

Kleiter, I

LNSLNS We thank Zack et al. for their comprehensive review of the mechanisms and sequelae of lightning injuries. The effects of lightning strike on the nervous system, however, require some clarification and additional information, since injuries to the nervous system are the most common and momentous cause of long-term problems in survivors (1).

When the resistance of the skin is broken during lightning strike, the body is exposed to a short pulse of direct current; tissues with low electrical resistance such as the vascular and nervous system are particularly affected. Acute lesions are not always detectable, even when modern imaging techniques are used. In contrast to injuries caused by alternating current, internal burns are extremely rare (1). In principle, all parts of the nervous system can be affected - not only the cranial nerves and the peripheral nervous system (2). Apart from transient, qualitative and quantitative impairment of consciousness and the pathognomonic keraunoparalysis (lightning paralysis) - a paresis and impaired sensitivity of the extremities of unclear etiology that usually lasts less than an hour - structural lesions may be found in the CNS, e.g. the visual cortex (3) or the myelon (1, 2).

The consequences of lightning injuries to the peripheral nervous system are less well documented. However, the multitude of autonomous disorders that have been described in case reports together with pathophysiological considerations of a particular vulnerability of non-myelinated nerve fibers suggests an involvement of the peripheral nervous system.

The etiology of the common subacute neurological and psychiatric deficits is not clear. These range from non-specific complaints, such as chronic fatigue and disrupted sleep, to clearly defined disorders like depression, post-traumatic stress disorder and cognitive deficits, which restrict the patient's quality of life (2, 3).

The conclusion is that all survivors of lightning strikes should be given neurological-psychiatric aftercare and eventually rehabilitation. A systematic study of the neurological, neurophysiological, and neuropsychological sequelae of lightning injuries is currently being conducted at the Department of Neurology, University of Regensburg.
DOI: 10.3238/arztebl.2008.0224a


Corresponding authors
Dr. med. Ingo Kleiter
PD Dr. med. Wilhelm Schulte-Mattler
Prof. Dr. med. Berthold Schalke
Universität Regensburg
Klinik und Poliklinik für Neurologie im Bezirksklinikum
Universitätsstr. 84
93053 Regensburg, Germany
1.
O'Keefe Gatewood M, Zane RD: Lightning injuries. Emerg Med Clin North Am 2004; 22: 369–403.
2.
Cherington M: Neurologic manifestations of lightning strikes. Neurology 2003; 60: 182–5.
3.
Kleiter I, Luerding R, Diendorfer G, Rek H, Bogdahn U, Schalke B: A lightning strike to the head causing a visual cortex defect with simple and complex visual hallucinations. J Neurol Neurosurg Psychiatry 2007; 78: 423–6.
1. O'Keefe Gatewood M, Zane RD: Lightning injuries. Emerg Med Clin North Am 2004; 22: 369–403.
2. Cherington M: Neurologic manifestations of lightning strikes. Neurology 2003; 60: 182–5.
3. Kleiter I, Luerding R, Diendorfer G, Rek H, Bogdahn U, Schalke B: A lightning strike to the head causing a visual cortex defect with simple and complex visual hallucinations. J Neurol Neurosurg Psychiatry 2007; 78: 423–6.

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