- Department of Physical Medicine and Rehabilitation, Taoyuan General Hospital Department of Health, Taoyuan, Taiwan
- Department of Neurology, Buddhist Tzu Chi General Hospital, Taipei, Taiwan
- Department of Neurology, Taipei Medical University-Shung Ho Hospital, Taipei, Taiwan
Department of Neurology, Taipei Medical University-Shung Ho Hospital, Taipei, Taiwan
DOI:10.4103/2152-7806.74093© 2010 Huan-Jui Y This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Huan-Jui Y, Chih-Yang L, Huei-Yu L, Po-Chih C. Acute ischemic stroke in low-voltage electrical injury: A case report. Surg Neurol Int 17-Dec-2010;1:83
How to cite this URL: Huan-Jui Y, Chih-Yang L, Huei-Yu L, Po-Chih C. Acute ischemic stroke in low-voltage electrical injury: A case report. Surg Neurol Int 17-Dec-2010;1:83. Available from: http://sni.wpengine.com/surgicalint_articles/acute-ischemic-stroke-in-low-voltage-electrical-injury-a-case-report/
Background:Acute stroke is not a common complication of electrical injury, and only a few cases of acute stroke have been reported for lightning or high-voltage injuries.
Case Report:We present the case of a man who suffered from a low-voltage electrical injury followed by ischemic stroke. Magnetic resonance angiography showed segmental narrowing of the right internal carotid artery and right middle cerebral artery. The patient underwent thrombolytic therapy and catheter-assisted angioplasty. The low-voltage current-induced vasospasm rather than direct vascular injury, and this may explain why the intracranial defect occurred away from the electrical current pathway.
Conclusion:Electric shock injury with low-voltage alternating currents and prolonged contact period may cause ischemic stroke.
Keywords: electrical injury, stroke, vessel spasm
Electrical injuries are relatively common in daily life, and they are accidentally incurred. The severity of electrical injury varies depending on the magnitude of energy delivered, type of current, current pathway and duration of contact. Many organs or tissues, including the heart, muscles, kidneys, skin, and vascular and nervous systems are especially vulnerable to such injury. Acute stroke is a rare complication, though cases of acute stroke due to electrical injury have been reported when the voltage has been high, e.g., with lightning,[
Here, we describe the case of a man who suffered from an ischemic stroke after an accidental electrical injury resulting from a low-voltage alternating current. Such a case has not been reported before, to the best of our knowledge.
A 50-year-old man without any systemic disease or drug history was sent to a hospital after he incurred an electric shock injury while using a handicraft grinder by his two hands. This machine was adapted to a 60-Hz, 110-V alternating current supply. Upon receiving the shock, the man could not sever contact with the machine until 5 minutes later. He fell from a height of 1 meter on his buttocks. He remained conscious but experienced weakness and numbness in the left extremities, and his speech was slurred. He denied any head contusion happened during fall down. On arriving at the hospital, he was alert and his eyes were oriented to the right. Muscle strength on the left side was decreased, with a grade of 2 on the Medical Research Council Scale. The results of laboratory investigations, including complete blood count, coagulation function, and levels of electrolytes, serum glucose, liver enzymes and creatine kinase were all within the normal limits. The findings on chest X-ray scan, electrocardiogram and electrocardiogram were normal. A computed tomography (CT) scan of the brain showed no obvious abnormalities. With the impression of ischemic stroke with left hemiplegia, the patient was administered thrombolytic therapy with recombinant tissue plasminogen activator (r-tPA) within 3 hours after stroke onset, but no clinical improvement was noted. A magnetic resonance imaging scan of the brain showed an acute infarction in the right frontotemporal area involving the right basal ganglia and corona radiata. Magnetic resonance angiography showed segmental narrowing of the siphon of the right internal carotid artery (ICA) and the M1 segment of right middle cerebral artery (MCA) [
The weakness in the extremities experienced after electrical injury may be attributed to rhabdomyolysis, electrolyte imbalance, dehydration, keraunoparalysis, thermal injury, hypoxic encephalopathy, cerebral hypoperfusion, and mostly, vascular injury causing electrical coagulation, vasospasm, dissection, aneurysm formation and rupture. In this case, rhabdomyolysis, electrolyte imbalance and dehydration could be ruled out based on the clinical evaluation and laboratory results. Keraunoparalysis, which is transient paralysis of one or more extremities after lightning injury,[
Janus et al, reported cases of 10 individuals who suffered from lightning injury with neurological complications, and only two of them had abnormal findings on cranial CT scans.[
Thermal injury may be one of the mechanisms underlying cerebral damage.[
Acute stroke may result from vascular structural changes after electrical injury,[
A case of an 800-1500 V electrical injury followed by cerebral venous thrombosis.[
Both vasospasm and endothelial injury may contribute to vascular narrowing. Animal studies of electrical convulsive therapy showed segmental spastic constriction of the pial arteries and arterioles in the brain parenchyma, and the pial arteries were found to directly constrict with electrical stimulation.[
Although acute ischemic stroke has not been observed in low-voltage electrical injuries, a long duration of contact may increase the probability of this occurrence. Stevenson reported that an alternating current with frequencies of 40-150 Hz would induce tetanic muscle contraction.[
Post-lightning stroke patients may combine other neurological problems that should be close observation or management. Smith M.A.[
Electric shock injury with low-voltage alternating currents and a prolonged contact period may cause ischemic stroke. Vasospasms caused by the electrical injury may be the etiology of the stroke. MRI provides a better chance of early diagnosis and more clues for further investigation compared to a CT.
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