Right Hemispheric Leukoencephalopathy as an Incidental Finding Following a Lightning Strike

Jera Kruja; Altin Kuqo; Serla Grabova; Arben Rroji; Gentian Vyshka

doi:10.3889/oamjms.2016.141

Authors

Jera Kruja Department of Neurology, Neurosurgery and Psychiatry, Faculty of Medicine, University of Medicine in Tirana
Altin Kuqo Department of Neurology, Neurosurgery and Psychiatry, Faculty of Medicine, University of Medicine in Tirana
Serla Grabova Department of Neurology, Neurosurgery and Psychiatry, Faculty of Medicine, University of Medicine in Tirana
Arben Rroji Department of Radiology, University Hospital Centre â€œMother Theresaâ€, Tirana
Gentian Vyshka Faculty of Medicine, University of Medicine in Tirana, Albania. http://orcid.org/0000-0001-5286-1265

DOI:

https://doi.org/10.3889/oamjms.2016.141

Keywords:

lightning injuries, electrical discharge, leukoencephalopathy, neurologic sequelae

Abstract

BACKGROUND: Lightning injuries may produce a variety of medical conditions, and specific neurological complications have been identified, with the character of immediate aftershock effects or even long-term consequences.

AIM: The authors describe the incidental finding following a routine unenhanced brain MRI performed to a young female patient, suffering from a headache.

CASE REPORT: Diffuse white matter changes with the character of a leukoencephalopathy were seen, which strictly interested only the right cerebral hemisphere. The parents referred that she suffered from an indoor lightning strike at age of seven months, although she survived with almost no external burns or signs, and recovered uneventfully at that time. A discussion over the effects of electrocution and lightning strike on the human body in general, and over the nervous system, is made. Particular attention must be shown when making the differential diagnosis of leukoencephalopathies with a strictly one-hemisphere extension since several other conditions might resemble each other under the radiological aspect, here including brain viral infections, genetic disorders, and so on.

CONCLUSION: The particularity of the long-term aftershock effects of the lightning strike on the central nervous system raise again the necessity of collecting data and duly reporting every electrical accident, lightning events included.

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References

Smith M, Smith M, American Academy of Orthopaedic Surgeons. ACLS for EMT-Basics. Jones & Bartlett Learning, 2006: 79-80. PMCid:PMC1868698

Cherington M, Yarnell PR, London SF. Neurologic complications of lightning injuries. West J Med. 1995; 162(5): 413-7. PMid:7785254 PMCid:PMC1022790

Cherington M. Neurologic manifestations of lightning strikes. Neurology. 2003; 60(2):182-5. https://doi.org/10.1212/01.WNL.0000033801.15204.B5 PMid:12557851 DOI: https://doi.org/10.1212/01.WNL.0000033801.15204.B5

Backhaus R, Kirzinger L, Platen S, Kreuzer PM, Kleiter I, LÃ¼rding R, Zack F, Schulte-Mattler W, Schalke B. Blitzschlagverletzungen. Klinische Neurophysiologie. 2015 Oct 19. DOI: https://doi.org/10.1055/s-0035-1559794

Reisner AD. Possible mechanisms for delayed neurological damage in lightning and electrical injury. Brain Inj. 2013; 27(5):565-9. https://doi.org/10.3109/02699052.2013.766928 PMid:23473007 DOI: https://doi.org/10.3109/02699052.2013.766928

Christensen JA, Sherman RT, Balis GA, Wuamett JD. Delayed neurologic injury secondary to high-voltage current, with recovery. J Trauma. 1980; 20(2):166-8. https://doi.org/10.1097/00005373-198002000-00012 PMid:7354498 DOI: https://doi.org/10.1097/00005373-198002000-00012

Kleinschmidt-DeMasters BK. Neuropathology of lightning-strike injuries. Semin Neurol. 1995; 15(4):323-8. https://doi.org/10.1055/s-2008-1041039 PMid:8848648 DOI: https://doi.org/10.1055/s-2008-1041039

Freeman CB, Goyal M, Bourque PR. MR imaging findings in delayed reversible myelopathy from lightning strike. AJNR Am J Neuroradiol. 2004; 25(5):851-3. PMid:15140734

Herrero F, Garcia-Morato V, Salinas V, Alonso S. An unusual case of lightning injury: a melted silver necklace causing a full thickness linear burn. Burns. 1995; 21:308â€“309. https://doi.org/10.1016/0305-4179(94)00016-Q DOI: https://doi.org/10.1016/0305-4179(94)00016-Q

Lane JR. Clinical Lecture on Injuries from Lightning. Br Med J. 1872; 2(605):114-6. https://doi.org/10.1136/bmj.2.605.114 PMid:20746717 PMCid:PMC2296982 DOI: https://doi.org/10.1136/bmj.2.605.114

ten Duis HJ, Klasen HJ, Reenalda PE. Keraunoparalysis, a 'specific' lightning injury. Burns Incl Therm Inj. 1985; 12(1):54-7. https://doi.org/10.1016/0305-4179(85)90183-4 DOI: https://doi.org/10.1016/0305-4179(85)90183-4

Milton WJ, Hal O'Dell R, Warner EG. MRI of lightning injury: early white matter changes associated with cerebral dysfunction. J Okla State Med Assoc. 1996; 89(3):93-4. PMid:8919853

Brew BJ, Davies NW, Cinque P, Clifford DB, Nath A. Progressive multifocal leukoencephalopathy and other forms of JC virus disease. Nat Rev Neurol. 2010; 6(12):667-79. https://doi.org/10.1038/nrneurol.2010.164 PMid:21131916 DOI: https://doi.org/10.1038/nrneurol.2010.164

van der Knaap MS, Barth PG, GabreÃ«ls FJ, Franzoni E, Begeer JH, Stroink H, Rotteveel JJ, Valk J. A new leukoencephalopathy with vanishing white matter. Neurology. 1997; 48(4):845-55. https://doi.org/10.1212/WNL.48.4.845 PMid:9109866 DOI: https://doi.org/10.1212/WNL.48.4.845

Singh S, Alexander M, Sase N, Korah IP. Solitary hemispheric demyelination in acute disseminated encephalomyelitis: clinicoradiological correlation. Australas Radiol. 2003; 47(1):29-36. https://doi.org/10.1046/j.1440-1673.2003.t01-2-01126.x PMid:12581051 DOI: https://doi.org/10.1046/j.1440-1673.2003.t01-2-01126.x

Kreci A, Vyshka G, Sinamati A. Lightning injuries in an in-door setting: a case report and review of the literature. Journal of Environment Pollution and Human Health. 2013; 1(2): 16-20.