Lesions along the upper motor neuronal pathway with locked-in features after lightning strike and cardiac arrest: A case-review analysis. (March 2014)

• Record Type: Journal Article
• Authors: Abdulla, Susanne; Conrad, Anton; Schwemm, Karl-Peter; Stienstra, Mark P.; Gorsselink, Edward L.; Dengler, Reinhard; Abdulla, Walied
• Is Part Of: Brain injury. Volume 28:Number 3(2014)
• Page Start: 298
• Page End: 303
• Publication Date: 2014-03
• Subjects: Brain damage -- Periodicals; Brain -- Wounds and injuries -- Periodicals; Brain Injuries -- Periodicals; 617.481
• DOI: 10.3109/02699052.2013.860476
• Languages: English
• ISSNs: 0269-9052

Abstract

<abstract> <title>Abstract</title> <p> <italic>Objective</italic>: This study describes a case of lesions of the upper motor neuronal pathway with locked-in features after lightning strike and cardiac arrest.</p> <p> <italic>Design</italic>: A case-review analysis.</p> <p> <italic>Methods</italic>: In a 29-year-old male who was hit by a lightning strike during farming activities, cardiopulmonary resuscitation was provided first by co-workers and continued with success by the medical rescue service. After conducting advanced life support under monitoring and therapeutic hypothermia, quadriplegia with facial diplegia was recognized. A review was undertaken detailing the clinical course.</p> <p> <italic>Results</italic>: MR imaging presented signs consistent with hypoxia-induced damage and diffusion-weighted MR images revealed pronounced damages along the upper motor neuronal pathway. A reactive electroencephalogram pattern, sustained eye movement and the patient communicating via eye-blinking were interpreted as locked-in features. Two weeks after admission the patient was transferred to a neurological rehabilitation centre for further professional care.</p> <p> <italic>Conclusion</italic>: Direct damage of the upper motor neuron pathway due to the current of the lightning should be considered, albeit the relative contribution of hypoxia-induced damage cannot be separated.</p> </abstract>