- Department of Trauma and Emergency, All India Institute of Medical Science, Bhubaneswar, Odisha, India
- Department of Neurosurgery, All India Institute of Medical Science, Bhubaneswar, Odisha, India
- Department of Neurology, All India Institute of Medical Science, Bhubaneswar, Odisha, India
Correspondence Address:
Ashis Patnaik
Department of Neurology, All India Institute of Medical Science, Bhubaneswar, Odisha, India
DOI:10.4103/2152-7806.153650
Copyright: © 2015 Patnaik 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: Patnaik A, Mahapatra AK, Jha M. Pan-brachial plexus neuropraxia following lightning: A rare case report. Surg Neurol Int 19-Mar-2015;6:
How to cite this URL: Patnaik A, Mahapatra AK, Jha M. Pan-brachial plexus neuropraxia following lightning: A rare case report. Surg Neurol Int 19-Mar-2015;6:. Available from: http://sni.wpengine.com/surgicalint_articles/pan-brachial-plexus-neuropraxia-following-lightning-rare-case-report/
Abstract
Background:Neurological complications following lightning are rare and occur in form of temporary neurological deficits of central origin. Involvement of peripheral nervous system is extremely rare and only a few cases have been described in the literature. Isolated unilateral pan-brachial plexus neuropraxia has never been reported in the literature. Steroids have long been used for treatment of neuropraxia. However, their use in lightning neural injury is unique and requires special mention.
Case Description:We report a rare case of lightning-induced unilateral complete flaccid paralysis along with sensory loss in a young patient. Lightning typically causes central nervous involvement in various types of motor and sensory deficit. Surprisingly, the nerve conduction study showed the involvement of peripheral nervous system involvement. Steroids were administered and there was significant improvement in neurological functions within a short span of days. Patients’ functions in the affected limb were normal in one month.
Conclusion:Our case was interesting since it is the first such case in the literature where lightning has caused such a rare instance of unilateral pan-brachial plexus lesion. Such cases when seen, raises the possibility of more common central nervous system pathology rather than peripheral involvement. However, such lesions can be purely benign forms of peripheral nerve neuropraxia, which can be managed by steroid treatment without leaving any long-term neurological deficits.
INTRODUCTION
Brachial plexus injury is usually of traumatic origin due to road traffic accidents, fall from height, etc. The neurological deficits arising out of this injury can involve all the trunks and cords resulting in pan-brachial palsy or may involve selective trunks with characteristic motor and sensory deficit pattern. Depending upon the severity of neural involvement, it can be simple, reversible functional dysfunction of neuropraxia to severe complete loss of structural integrity in form of neurotmesis. However, practically complete or pan-brachial plexus neuropraxia of traumatic origin is not possible. But sudden, reversible loss of all modalities of sensation or motor power can occur following exposure to a very high electric current or voltage such as lightning. This is due to the electroporatic effect of high electric current, which de-stabilises the membrane potential across any biological cell membranes such as that of neurons.[
CASE REPORT
A 25-year-old male patient presented with complete flaccid paralysis and numbness of right upper limb. One day earlier, he had been electrocuted while holding a telephone pole with his right hand during the lightning. Immediately, following this he developed complete paralysis of right side upper limb with loss of sensation. There was no loss of consciousness, disturbance of speech, or seizure. The right side upper limb was normal on general examination with no entry burn points, bluish coloration, and all the peripheral pulses were normal. On neurologic examination, there was complete loss of all movements with power around all joints being grade 0 in right upper limb [
DISCUSSION
Brachial palsy including neuropraxia is commonly caused by traumatic events, and that caused by lightning injury have been rarely described in the literature.[
Electroporation, or electro-permeabilization, is a gross increase in the electrical conductivity and permeability of the plasma membrane caused by an externally applied electrical field. Neuropraxia can be caused by the effect of electroporation, which results in disturbed threshold of membrane excitability due to the electric current. Electric injury either direct or in form of lightning can cause temporary suspension of nerve conduction due to their membrane destabilizing effect. Steroids can speed up the recovery by their membrane stabilizing effect. This is mediated through prevention of lipid peroxidation of cell membranes and restoration of membrane sodium pumps. Steroids also reduce the peri-neuronal edema, which may have a role in the pathogenesis of brachial plexus neuropraxia caused by lightning or other electrical energy.
Our case was exclusive in that the brachial plexus involvement was caused by lightning injury and there was pan-brachial involvement. Although, the literature mentions that peripheral nerve damage caused by lightning injury has poor outcome,[
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