Complete pacemaker failure following lightning strike injury: A case report.

INTRODUCTION: Modern cardiovascular implantable electronic devices (CIEDs) have mechanisms that prevent damage from external electric shocks, and malfunction following accidental electrocution is rare. However, the effects of lightning injuries in patients with CIEDs are uncertain. CASE PRESENTATION: A 74-year-old man with a dual-chamber pacemaker due to complete heart block was struck by a lightning while farming. He had no serious injury at the time and sought medical evaluation 1 month later, when he presented with asymptomatic bradycardia. Device interrogation suggested major battery and lead damage, requiring extraction and subsequent placement of a new pacing system. DISCUSSION: While a previous report depicted pacing threshold elevation without extensive device impairment, our patient presented with major damage to the whole pacing system. The factors contributing to these divergent outcomes are unclear. Differences in injury mechanism, pacemaker model, and the pattern of electric current dispersion within the device may each play a part in this discrepancy.

An Autopsy Series: Lightning-related Deaths in Van and Hakkâri Provinces, Turkey

ABSTRACT Objective: To report the largest series of lightning-related deaths in Turkey, to review the literature on this subject, and to identify similarities and differences between the autopsy findings in this study and the information available in literature. Methods: In this study, autopsy reports and crime scene investigation data on 11 lightning-related fatalities that occurred in the Van and Hakkâri Provinces, Turkey, from January 1, 2011 to December 31, 2015 were retrospectively reviewed. Results: Of the 1699 fatalities, 11 (2.53%) evaluated by medico-legal autopsy in the Van and Hakkâri Province in a 5-year period died from lightning strikes. Of these cases, 10 (90.1%) were males and 1 (9.9%) was female (p < 0.05). All cases were in the 11 to 33 years age group. All cases were injured outdoors. Conclusion: We concluded that deaths due to lightning strikes are relatively rare in Turkey, and may be reduced with precautions such as avoiding staying under trees or in the vicinity of high towers, refraining from touching metal objects, avoiding lying on the ground, leaning on walls, and crouching outdoors.

Discusión sobre la necesidad de delimitación de una nueva nosografía psiquiátrica y psicológica. síndrome del accidentado por rayo eléctrico / Discussion on the delimitation of a nosography new psychiatric and psychological need. syndrome of the accident by electric ray

La observación y análisis de las variadas manifestaciones clínicas y secuelas que presentan las víctimas sobrevivientes de accidente por rayo, nos proporciona la posibilidad de cambiar el punto de vista desde el cual consideramos y estudiamos las mismas. Debemos evaluar la conveniencia de considerar tales manifestaciones meramente como un conjunto de signos y síntomas inespecíficos o pertenecientes a múltiples síndromes ya tipificados; o bien, abrir una nueva y profunda discusión en torno a la posibilidad de su agrupación y delimitación de una nueva categoría nosográfica psiquiátrica y psicológica. La metodología de la presente investigación se basa en el análisis de gran parte de la casuística extranjera de estos pacientes y la investigación bibliográfica exhaustiva sobre las escasas publicaciones científicas existentes. Asimismo, se revisan distintos procedimientos habituales en el ingreso de estos pacientes a los centros de salud que dificultan el estudio epidemiológico y sanitario de los mismos.

The observation and analysis of the varied clinical manifestations and sequels surviving accident victims presented by ray, gives us the possibility to change the point of view from which we consider and study them. We must assess the appropriateness of considering such manifestations merely as a set of signs and symptoms nonspecific, or belonging to multiple syndromes already described; Alternatively, open a new and profound discussion about the possibility of their grouping and delimitation of a new category of psychiatric and psychological nosographic. The methodology of this research is based on the analysis of much of the world Casuistry of these patients and the comprehensive bibliographic research on the scarce existing scientific publications. Also reviewed various common procedures in income of these patients to health centers, hindering the health and epidemiological study of them.

Muerte por fulguración / Death by lightning

En el Servicio Provincial de Medicina Legal de Villa Clara, se realizó un estudio descriptivo, longitudinal, retrospectivo, de los fallecidos por fulguración entre el 1ro. de enero de 2009 y el 31 de diciembre de 2014, para determinar sexo, edad y ocupación de los afectados, zona y época del año de mayor ocurrencia, así como las lesiones externas más frecuentes. En el libro de registro y las actas de necropsias, se encontraron 16 fallecidos por esta causa. Predominó el sexo masculino, en la edad laboral; septiembre, mayo y junio fueron los meses de mayor incidencia. Todos los hechos ocurrieron en la zona rural, y el 62,5 %, a la intemperie. La zona noroeste de la provincia resultó la más afectada y las lesiones más frecuentes fueron las quemaduras. Aunque el número de fulguraciones no parece alto, es el fenómeno natural que provoca más muertes en Cuba.

A retrospective, longitudinal and descriptive study of deceased people due to lightning was carried out from January 1st, 2009 to December 31st, 2014 in order to determine gender, age and occupation of the affected individuals, location and time of the year of higher occurrence, as well as, the most frequent external lesions. Sixteen deaths due to this cause were registered in the logbook and in the autopsy reports. Working-age men predominated; the months with the highest incidence were September, May and June. All the incidents happened in rural area, and the 62.5 % was in the outdoors. Northwest region of the province turned out to be the most affected one and burns were the most frequent lesions. Although the number of deaths by lightning doesn't seem to be very high, this is the natural phenomenon that causes more deaths in Cuba.

Muerte por fulguración / Death by lightning

En el Servicio Provincial de Medicina Legal de Villa Clara, se realizó un estudio descriptivo, longitudinal, retrospectivo, de los fallecidos por fulguración entre el 1ro. de enero de 2009 y el 31 de diciembre de 2014, para determinar sexo, edad y ocupación de los afectados, zona y época delaño de mayor ocurrencia, así como las lesiones externas más frecuentes. En el libro de registro y las actas de necropsias, se encontraron 16 fallecidos por esta causa. Predominó el sexo masculino, en la edad laboral; septiembre, mayo y junio fueron los meses de mayor incidencia. Todos los hechos ocurrieron en la zona rural, y el 62,5 por ciento, a la intemperie. La zona noroeste de la provincia resultó la más afectada y las lesiones más frecuentes fueron las quemaduras. Aunque el número de fulguraciones no parece alto, es el fenómeno natural que provoca más muertes en Cuba(AU)

Lightning deaths: a retrospective review of New Mexico's cases, 1977-2009.

To better understand lightning deaths, a retrospective review of electronic records from New Mexico's Office of the Medical Investigator database was performed between 1977 and 2009 to update and assess current risk factors. Information on demographics, circumstances, autopsy, and death certificates were collected and analyzed. Fifty-four decedents were identified, ages 2-71 years old (mean 34 years old), 42 males and 12 females. Common racial/ethnic groups were non-Hispanic Whites and American Indians (together comprising 72% of all cases). Physical findings were often related to the heat carried by the electrical current including clothing alterations (29.6%) and burning of skin (53.7%). Most deaths occurred on weekend afternoons in summer months, associated with recreational activities or agricultural work, and rural locations (77.8%). Utilizing the demographic information, clustered events, and associated outdoor activities will assist in creating public awareness and provide a framework to support targeted warnings in an attempt to prevent future deaths.

Struck by lightning: Lichtenberg figures on a 19th-century wax model

Wax models in dermatology were used to a large extent until the 1930s as three-dimensional models to illustrate various pathologic conditions and in particular cutaneous signs of disease. As an example, a young woman who was struck by lightning and developed Lichtenberg figures is presented. Lichtenberg figures are a fernlike pattern on skin, characteristic of lightning. Such a wax model housed in the German Hygiene Museum Dresden, Germany, illustrates the significance of wax models and how, even today, they can play an important role in medical education.

Quemadura por rayo / Lightning burn

Fundamento: las quemaduras eléctricas producidas por fenómenos atmosféricos probablemente fueron las primeras y tiene una alta mortalidad.Objetivo: describir el cuadro clínico de un paciente que presentó una descarga eléctrica natural y sobrevivió al evento.Caso clínico: paciente de 37 años de edad, masculino, sin antecedentes patológicos, fue alcanzado por un rayo que conllevó a la pérdida de conciencia por varios minutos, así como quemaduras en cara, zonas del tronco anterior y posterior y miembro superior derecho que se diagnosticaron como lesiones dérmicas A de un 22 por ciento de superficie corporal quemada, con pérdida de conciencia momentánea y complicación renal y oftalmológica posteriormente, sobrevivió al evento inicial.Conclusiones: las quemaduras por electricidad natural o fulguraciones constituyen un evento dramático con graves complicaciones y alta mortalidad(AU)

Background: electric burns produced by atmospheric phenomena were probably the first type of burn and have a high mortality.Objective: to describe the clinical manifestations of a patient who got a natural discharge and survived.Clinical case: a thirty-seven-year-old male patient without pathological records was struck by a lightning that caused the loss of consciousness for some minutes, as well as burns of the face, the torso, the back, and the right fore limb that were diagnosed as A dermic lesions of a 22 percent of the body burned. Subsequently, the patient presented momentary loss of consciousness, and ophthalmic and kidney complications. He survived the initial event.Conclusions: burns by natural electricity and fulgurations constitute a dramatic event with severe complications and a high mortality(AU)

Propuesta metodológica para la prevención y tratamiento de las lesiones por rayos / A methodological proposal for preventing and treating those lesions caused by lightning

Las lesiones causadas por los rayos constituyen la primera causa de muerte en Cuba por los llamados fenómenos meteorológicos. Aproximadamente 65 cubanos mueren anualmente por esta causa. En la provincia de Pinar del Río en el año 2008 las lesiones por los rayos representaron la segunda causa de muerte por accidentes en la edad de 0 - 18 años y la primera de 5 - 14 años. En la economía los daños son cuantiosos, (afectaciones en la infraestructura de las comunicaciones y redes eléctricas en los sistemas informáticos y equipos electrodomésticos, entre otros). Así como se encuentran entre las causas principales de incendios forestales. En Cuba, por esta causa la mayor pérdida de vidas humanas se produce entre los 16 - 30 años de edad, fundamentalmente en zonas rurales. Un tercio de los casos son mortales y de los que sobreviven el 70 por ciento desarrollan secuelas frecuentes. Por no existir en la provincia de Pinar del Río una Metodología diseñada para la prevención y tratamiento de este tipo de accidente a nivel de la Atención Primaria y Secundaria de Salud, así como con la finalidad de impartir este tema en la Docencia Médica de pregrado y postgrado se decide presentar esta investigación...(AU)

Lesions caused by lightning are the main cause of death in Cuba produced by the so-called meteorological phenomena estimating 65 victims yearly. In Pinar del Rio province (year 2008), this kind of lesion represented the second cause of death by accidents in the 0 18 year old group and the first cause in the 5 14 year old group. In the economy the damages are serious (damages in the infrastructure of communications and electricity plants , informatic systems and electrodomestic equipments and so on ). They are also involved in the forest fires. The higher number of human deaths is observed in the 16 30 year old group in the rural areas mainly. A third of the cases is fatal and among those survivors 70 per cent develop frequent sequela. In this province there is not a design of methodology for preventing and treating this kind of accident at primary and secundary health care and it is intended to teach this subject in the pregraduate and postgraduate medical teaching...(AU)

Cluster headache attacks in a woman previously struck by lightning: pathophysiology of the latent period.

BACKGROUND: Cases of patients who developed cluster headache-like symptoms after different putative causes have been reported, indicating a direct relationship between brain lesion and this particular type of headache. Long term, delayed, neurological sequelae after lightning have also been described. CASE REPORT: We describe the case of a woman who, at the age of 10, was struck by lightning. Six years later she developed cluster headache-like attacks. CONCLUSION: We hypothesize that a relationship between the lightning and the cluster headache-like episodes observed in our patient. This case study may have helped throw some light into the still unknown pathophysiology of this particular type of primary headache.

Cluster headache attacks in a woman previously struck by lightning: pathophysiology of the latent period

BACKGROUND: Cases of patients who developed cluster headache-like symptoms after different putative causes have been reported, indicating a direct relationship between brain lesion and this particular type of headache. Long term, delayed, neurological sequelae after lightning have also been described. CASE REPORT: We describe the case of a woman who, at the age of 10, was struck by lightning. Six years later she developed cluster headache-like attacks. CONCLUSION: We hypothesize that a relationship between the lightning and the cluster headache-like episodes observed in our patient. This case study may have helped throw some light into the still unknown pathophysiology of this particular type of primary headache.

INTRODUÇÃO: Foram descritos casos de pacientes que desenvolveram cefaléia em salvas como manifestação secundária à diferentes causas, indicando uma relação direta entre uma lesão cerebral e este tipo particular de cefaléia. Seqüelas neurológicas tardias após injúria elétrica por raio também têm sido descritas. RELATO DO CASO: Nós descrevemos o caso de uma mulher que aos 10 anos de idade foi atingida por um raio. Seis anos mais tarde desenvolveu sintomatologia de cefaléia em salvas. CONCLUSÃO: Acreditamos que pode haver relação entre a injúria elétrica causada pelo raio e o aparecimento dos episódios semelhantes à cefaléia em salvas observados na nossa paciente. A provável fisiopatologia envolvida na gênese da cefaléia em salvas de origem secundária é discutida, particularmente em relação ao intervalo latente entre a injúria precipitante inicial e a fase álgica da cefaléia.

Severe stunned myocardium after lightning strike.

OBJECTIVE: To report the development of myocardial stunning and severe heart failure after lightning strike with total recovery of function. DESIGN: Case report. SETTING: Coronary care unit at Medica Sur Clinic, Mexico. PATIENT: A 42-yr-old woman who was hit by lightning developed rapid and progressive hemodynamic deterioration manifested by cardiogenic shock that required invasive monitoring. Twenty-four hours after the strike, intravenous levosimendan and intra-aortic balloon pump were initiated because the patient demonstrated no significant response to management with conventional inotropic agents. Two days later, echocardiographic signs of systolic and diastolic dysfunction improved markedly. Dual-isotope-imaging myocardial perfusion testing with technetium-99m-sestamibi and thallium-201, performed 9 days after admission, showed normal perfusion and normal left ventricular systolic function. The patient exhibited complete recovery of function. The exact mechanism of abnormal contractility in the absence of direct electrofulguration is unknown but may be explained by release of oxygen free radicals, proteolysis of the contractile apparatus, and cytosolic overload of intracellular calcium, followed by reduced myofilament sensitivity to calcium. These abnormalities are consistent with stunned myocardium. CONCLUSIONS: Lightning strike may cause serious contractile dysfunction in the absence of irreversible myocardial injury, but the exact mechanism of this phenomenon remains unknown. We propose that lighting strike can cause myocardial stunning resulting in severe but reversible left ventricular dysfunction. The patient's recovery was facilitated by support treatment including administration of levosimendan, which increases the intracellular sensitivity to calcium, a mechanism disturbed in patients with myocardial stunning.

Cataracts, bilateral macular holes, and rhegmatogenous retinal detachment induced by lightning.

PURPOSE: To report ocular injuries, including a unilateral rhegmatogenous retinal detachment, induced by lightning. METHOD: Case report. A 30-year-old man was injured by lightning. RESULTS: The patient developed a severe decrease in visual acuity in both eyes, an afferent pupillary defect in his left eye, bilateral cataracts, posterior vitreous detachments, macular holes, and an inferotemporal retinal detachment with an associated flap retinal tear in his left eye. CONCLUSIONS: This is a case of bilateral cataracts, posterior vitreous detachments, macular holes, and a unilateral retinal detachment associated with lightning. We postulate that the heating of the retinal surface, the concussive forces on the eye, and a sudden lateral contraction of the attached vitreous resulted in bilateral posterior vitreous detachments and a unilateral peripheral retinal break.

Trauma ocular por raio: relato de 2 casos / Ocular trauma by lighting; report of two cases

Os autores descrevem 2 casos de trauma ocular por descarga elétrica atmosférica, com estudo clínico, angiofluoresceinográfico, eletrofisiológico e campimétrico. A patogênese das múltiplas lesöes na regiäo corneana e coriorretiniana é discutida e a escassa literatura sobre este tipo de trauma, revista