- Department of Neurosurgery, PGIMER, Chandigarh, India
Department of Neurosurgery, PGIMER, Chandigarh, India
DOI:10.4103/2152-7806.90033Copyright: © 2011 Aggarwal A. 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: Aggarwal A, Salunke P. Bolt from the blue: Basal ganglion bleed following lightning strike. Surg Neurol Int 19-Nov-2011;2:170
How to cite this URL: Aggarwal A, Salunke P. Bolt from the blue: Basal ganglion bleed following lightning strike. Surg Neurol Int 19-Nov-2011;2:170. Available from: http://sni.wpengine.com/surgicalint_articles/bolt-from-the-blue-basal-ganglion-bleed-following-lightning-strike/
Injuries secondary to lightning strike are fortunately rare. Nervous system is commonly involved.[
A 17-year-old male was struck by lightning while working in the field. He was found unconscious by his co-workers. He was hospitalized within an hour. Examination revealed left corneal ulceration (entry wound) and superficial burn injury over the right side of neck (exit wound). The electrocardiogram was normal. Neurologically, he was not responding to commands and was localizing to painful stimulus with the right upper limb. He had left hemiplegia. Computed tomography (CT) scan of head showed bleed with multiple layers in the right lentiform nucleus with mass effect [
Lightning injuries to central nervous system are second only to acute cardiovascular injuries as the principal cause of death. Neurologic complications after lightning consist of: 1) immediate and transient variety presenting with the symptomatology which includes loss of consciousness, amnesia, confusion, headache, paresthesia, and weakness; 2) immediate and prolonged or permanent variety which includes post-hypoxic-ischemic encephalopathy, intracranial hemorrhages, cerebral infarction and cerebellar syndromes; 3) delayed presentation after weeks to months including motor system disease and movement disorders and 4) destructive injuries secondary to falls.[
The mechanisms of neurological injuries include thermal effects, electrical effects, induced electrical currents, blast effects, and injuries related to falls. Lightning's electrical current is enormous, even though of brief duration, and causes immense thermal injury to tissues. Electric fields can damage the structural integrity of the lipid bilayer present in membrane of nerve and muscle tissues, termed as electroporation. The intense heating of the air surrounding the lightning flash can generate an explosive thunderous blast causing barotraumas.[
Intracranial hemorrhages in lightning-strike patients often appear in basal ganglia.[
Most victims of lightning who have not had a cardiac arrest will survive. Most of these patients are young, and with aggressive management, these patients survive to have a productive life.
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