Neurotrophic keratitis caused by lightning injury: a case report.

BACKGROUND: This study aimed to report a case of neurotrophic keratitis caused by lightning. CASE PRESENTATION: A 38-year-old man was hit by lightning and suffered eye injury. He eventually developed neurotrophic keratitis. RESULTS: The patient's injury history and burn site were analyzed, and it was judged that lightning directly damaged his cornea, eventually resulting in neurotrophic keratitis. Fortunately, the patient's vision improved after treatment. CONCLUSION: Lightning can cause eye damage, and the clinical manifestations are diverse. Lightning currents cause corneal nerve loss, resulting in neurotrophic keratitis. To maintain corneal integrity and prevent disease progression, early assessment and appropriate treatment are necessary.

Lightning Strike Injuries.

Lightning is a common environmental hazard, and is a significant cause of global injury and death. Care and evaluation should follow general trauma guidelines, but several unique aspects of lightning injuries necessitate deviations from standard care that can improve survival and overall outcomes. When evaluating lightning strike patients, some common injury patterns are pathognomonic for lightning strikes and easy to recognize, while others are subtle and require heightened awareness. While most lightning-related injuries resolve spontaneously, some may have significant long-term symptoms. Anticipatory guidance and specialty referral may be needed for appropriate follow-up, evaluation, and treatment.

Lightning deaths in three outdoor dogs: A case study.

This case report presents findings in three German Shepherd placed outdoor, dead after a night of thunderstorm.

Lightning strike­induced cauda equina syndrome: a case report.

Peripheral nerve injuries after being struck by lightning have been documented. Here, we report a case of cauda equina syndrome induced by lightning. A 27-year-old man presented with numbness, a burning sensation in the saddle region, and increased urinary urgency after being struck by lightning. He had absent Achilles reflexes and paresthesia in the saddle region upon neurological examination, and magnetic resonance imaging of the spine was normal. Electrophysiological studies indicated involvement of bilateral L5, S1, and S2 myotomes and revealed cauda equina lesions. 
Peripheral nerve injury induced by lightning is rare, and the evaluation of people with neurological complaints using electromyography will help determine the true incidence.

Seizure, A Shocking Effect of a Lightning Strike on Aerodrome: A Case Report.

Lightning injuries have a high morbidity and mortality because of the electrical effects on the circulatory, respiratory, and central nervous systems. Most lightning-related deaths occur immediately after injury due to fatal arrhythmias or respiratory failure. We describe the case of a patient who experienced a seizure and respiratory distress secondary to a lightning strike and how our team was able to stabilize and transport the patient. Ultimately, in this particular case study, the patient survived with minimal residual neurologic and hemodynamic effects. Based on this clinical vignette, we review the pathophysiology of lightning injuries and the predictive factors of positive outcomes in such unusual accidents.

Rain may improve survival from direct lightning strikes to the human head.

There is evidence that humans can survive a direct lightning strike to the head. Our question is: could water (rain) on the skin contribute to an increase in the survival rate? We measure the influence of rain during high-energy direct lightning strikes on a realistic three-compartment human head phantom. We find a lower number of perforations and eroded areas near the lightning strike impact points on the head phantom when rain was applied compared to no rain. Current amplitudes in the brain were lower with rain compared to no rain before a fully formed flashover. We conclude that rain on the scalp potentially contributes to the survival rate of 70-90% due to: (1) lower current exposition in the brain before a fully formed flashover, and (2) reduced mechanical and thermal damage.

A 15-year review of lightning deaths in Germany-with a focus on pathognomonic findings.

Lethal accidents caused by lightning are divided into observed and unobserved events. Pathognomonic or characteristic findings are often overlooked during external postmortem examination. Classical mistakes may be made which may often lead to an incorrect diagnosis. An analysis of 270 fatalities was performed on a historical collection of the Committee for Lightning Conductor Construction for the United Economic Area e. V. (ABBW) on lethal accidents due to lightning that occurred in Germany for the period 1951-1965. Furthermore, a selective literature research was carried out. The aim of the study was to analyze the death scene, the clothing, and the victim. The authors focused on chief findings which were relevant to the correct diagnosis of "death by lightning." Both Lichtenberg figures and singed body hair were considered pathognomonic for a lightning strike. The question arose as to whether Lichtenberg figures, for example, represented the finding that most often led to the correct diagnosis. Of the 270 lightning-struck victims from the case collection, 129 (47.8%) had singed body hair and 25 (9.3%) had Lichtenberg figures. A comparison of the frequency of the two reported findings, singed body hair versus Lichtenberg figures, has only been performed in the literature for case numbers below 40. This study is the first evaluation of a relatively large number of lethal accidents due to lightning. Singed body hair was reported more frequently in lightning-struck victims than Lichtenberg figures. This study showed that singed body hair is probably more diagnostically important than Lichtenberg figures.

Predictors of mortality following electrical and lightning injuries in Malawi: A decade of experience.

INTRODUCTION: Electrical injuries can be devastating, and data is lacking in low-resource settings. We aimed to identify predictors of mortality following electrical and lightning injuries (ELI) in Malawi. METHODS: We performed a retrospective observational study of patients presenting with ELI and burn injuries at a tertiary hospital in Malawi from 2011 to 2020. Outcomes were compared and predictors of mortality were modeled. RESULTS: A total of 382 ELI and 6371 burn patients were included. The mean ages for ELI and burn groups were 24 ± 14 and 11 ± 14 years, respectively (p < 0.01). Most patients were injured at home (91% in the burn group versus 51% in the ELI group, p < 0.01). The crude mortality rate in the ELI group was 28%, compared to 12% in the burn group (p < 0.01). On multivariate logistic regression, predictors of mortality included ELI (odds ratio [OR] 13.3, 95% confidence interval [CI] 7.2-24.5) and total body surface area burned (OR 1.1, 95% CI 1.1-1.1). Predicted mortality for ELI has increased over time (p = 0.05). CONCLUSIONS: ELI confers more than 13 times higher odds of mortality than burn injuries in Malawi, with mortality risk increasing over time. More efforts are needed to prevent electrical hazards and implement timely interventions for patients with ELI.

[Clinical characteristics and analysis of risk factors for heart injuries in 55 patients with lightning injury on plateau in Tibet Autonomous Region].

Objective: To explore the clinical characteristics and treatment outcomes of patients with lightning injury on plateau in Tibet Autonomous Region, and to analyze the risk factors for heart injuries in these patients. Methods: A retrospective case series study was conducted. From January 2008 to July 2023, 55 patients with lightning injury who met the inclusion criteria were admitted to the General Hospital of PLA Tibet Military Area Command. The gender, age, ethnicity, time of injury, location of injury (average altitude), activity at the time of injury, the occurrence of thermal burns on the body surface, the occurrence of complication, the occurrence of combined injury, underlying disease or physiological process before injury, length of hospital stay, treatment outcome, and effective rate of treatment were recorded. The patients were divided into juvenile group (11 cases), young group (28 cases), middle-aged group (14 cases), and elderly group (2 cases) according to age bracket, then the gender and ethnicity distribution of patients in the 4 groups were compared. According to the occurrence of heart injuries at admission, the patients were divided into heart injury group (44 cases) and non-heart injury group (11 cases), then the gender, age, ethnicity, average altitude of location of injury, length of hospital stay, the occurrence of complication, the occurrence of combined injury, site of thermal burns on the body surface, and area of thermal burns on the body surface in patients were compared between the two groups. Data were statistically analyzed with Mann-Whitney U test, chi-square test, or Fisher's exact probability test. The multivariate logistic regression analysis was conducted to screen the independent risk factors for heart injury in patients with lightning injury. Results: Among the 55 patients aged 10-68 years, 39 were male and 16 were female, including 47 Tibetans and 8 Hans. There were no statistically significant differences in gender or ethnicity distribution of patients among the 4 groups with different age brackets (P>0.05). Lightning injuries occurred from May to September, which mostly occurred in June and July. The incidence of lightning injury was higher in Chengguan District of Lhasa City (average altitude of 3 650 m) and Baqing County of Naqu City (average altitude of 4 500 m), being 20.0% (11/55) and 16.4% (9/55), respectively. A total of 96.4% (53/55) of the patients were engaged in outdoor activities when injured, such as grazing, digging Cordyceps, and harvesting highland barley. Among the 55 patients, 46 (83.6%) cases had thermal burns on the body surface, with burn area mainly being not more than 10% total body surface area and burn depth mainly being deep partial-thickness. Fifty-two (94.5%) patients had complications, with heart injury being the most common complication (44 cases, 80.0%). Twenty-two (40.0%) patients had 11 combined injuries, and traumatic brain injury was the most common combined injury. Seventeen (30.9%) patients had 11 underlying diseases or physiological processes before injury. The length of hospital stay of patients was 9 (5, 17) d. Among the 55 patients, 14 cases were cured and discharged, 40 cases were improved, and 1 case died, with effective rate of treatment of 98.2%. Compared with those in non-heart injury group, the proportion of complication occurrence (χ2=12.28), the proportion of trunk burns (χ2=5.15), and the average altitude of location of injury (Z=-2.38) of patients in heart injury group were increased significantly (P<0.05), while there were no significant changes in the other indicators (P>0.05). Multivariate logistic regression analysis showed that the average altitude at the location of injury was the independent risk factor for heart injury in patients with lightning injury (with odds ratio of 3.28, 95% confidence interval of 1.35-7.99, P<0.05). Conclusions: Lightning injuries on plateau in Tibet Autonomous Region mainly occur from May to September, with an average altitude of 4 500 m at the location of injury. Patients with lightning injury are injured when participating outdoor activities, and the affected patients are mainly mainly young male Tibetans. Most of the injuries are mild burns. Lightning injuries are complex and have many complications, with heart injury being the most common one. The average altitude at the location of injury is the independent risk factor for heart injury in patients with lightning injury.

Cutaneous Manifestations of Lightning Injury: A Review of the Literature.

Lightning is a rare but potentially devastating cause of injury and mortality. The cutaneous burns associated with lightning strikes demonstrate peculiar pathognomonic signs and patterns. In this review of the literature, we discuss the epidemiology and etiology of lightning injuries, lightning compared to other forms of high voltage electrical injury, the clinical features of lightning injuries, the most common cutaneous manifestations associated with lightning strikes, and the treatment and prevention of lightning injuries. Some of the cutaneous manifestations include feathering lesions, linear burns, punctate burns, and thermal injuries. While not considered true burns, Lichtenburg figures display a unique ferning pattern. Although lightning injuries are typically superficial, transient, and resolve relatively quickly compared to other electrical burns, the ability to recognize their cutaneous manifestations may improve emergent care and life-saving measures for these victims. Additionally, superficial surface burns secondary to lightning injury do not preclude systemic injury and significant pathology may be underlying.

Emergency Cricothyrotomy in a Harsh Environment: A Case Report of Complete Airway Obstruction Following a Lightning Strike.

A lightning strike is an extreme event with the highest mortality rate among electrical injuries. Death from a lightning strike is caused by either cardiac arrest or respiratory arrest. It is rare for upper airway damage to occur, but in these cases, airway control is recommended. If transoral intubation is unsuccessful, an emergency cricothyrotomy should be considered. Our case report describes an emergency cricothyroidotomy performed in a harsh environment on a mountain 2300 m above sea level on a patient with extensive burns of his supraglottic structures, after being directly hit by a lightning strike.

Delayed Death Due to Lightning: An Autopsy Case Report Highlighting Diagnostic and Medicolegal Issues.

The incidences of lightning strikes are not infrequent. The electric discharge of the lightning strike produces extreme heat and high amperage current, but fatality is reported in only about 10% to 30% of lightning cases. The spectrum of injuries due to lightning strikes can vary from no external injuries to typical external injuries. Merely the presence of superficial injuries due to lightning should not be considered sufficient to dismiss the case as non-serious. Rather clinicians should be wary of internal damage due to the effect of the lightning current as well as delayed complications of the lightning which can be fatal. Similarly, during an autopsy, the forensic pathologist should also investigate for the changes/damage in the internal organs due to the effect of lightning current. The present case reports the incidence of death due to delayed complications of a lightning strike which primary doctors initially overlooked. This case also discusses the histopathological changes in the internal organs due to lightning which can be helpful in the autopsy diagnosis of lightning, particularly in cases with no external or nonspecific injuries.

Lichtenberg figures-morphological findings.

Following a witnessed lethal lightning strike of an adult male who was standing outside in a storm, numerous Lichtenberg figures were identified upon external examination of the body. Sectioning across multiple areas of linear erythema in the figures showed no subcutaneous hemorrhage. This was later confirmed on histology which showed only subtle dermal capillary dilatation with no interstitial hemorrhage or inflammation in these areas. The only areas of interstitial hemorrhage were present in adjacent scattered punctate burns from arcing. The documented resolution of Lichtenberg figures within hours would be more in keeping with temporary functional capillary dilatation, shown in this case, rather than with tissue alteration by interstitial hemorrhage or inflammation.

When Lightning Strikes: Sports and Recreational Activities Safety.

ABSTRACT: Lightning strikes and their sequela are well-known sources of injury associated with sports and outdoor activities. While mortality is relatively rare and has steadily decreased over the years, the potentially catastrophic effects make knowledge about lightning strike injuries continually relevant. The primary focus of lightning-related safety is prevention and newer literature over the last 2 years has been largely case reports. Attempts to reduce lightning-related injuries in outdoor sports have been made with easily recalled guidelines by the National Athletic Trainers' Association, as well as the National Collegiate Athletic Association. Newer technology related to lightning safety uses digital and app-based monitoring systems to aid in injury prevention strategies. Occupational lightning exposure continues to be a hazard, especially for those who work outdoors, including certain military personnel. Service members, athletes, and outdoor enthusiasts should remain vigilant, especially during times with higher likelihood of lightning strikes.