open access

Ahead of print
Review article
Published online: 2020-10-07
Submitted: 2020-01-19
Accepted: 2020-08-11
Get Citation

Neurological and neurourological complications of electrical injuries

Konstantina G. Yiannopoulou, Georgios I. Papagiannis, Athanasios I. Triantafyllou, Panayiotis Koulouvaris, Aikaterini I. Anastasiou, Konstantinos Kontoangelos, Ioannis P. Anastasiou
DOI: 10.5603/JNNS.a2020.0076
·
Pubmed: 33026644

open access

Ahead of print
Review article
Published online: 2020-10-07
Submitted: 2020-01-19
Accepted: 2020-08-11

Abstract

Electrical injury can affect any system and organ. Central nervous system (CNS) complications are especially well recognised, causing an increased risk of morbidity, while peripheral nervous system (PNS) complications, neurourological and cognitive and psychological abnormalities are less predictable after electrical injuries.

PubMed was searched for English language clinical observational, retrospective, review and case studies published in the last 30 years using the key words: electrical injury, electrocution, complications, sequelae, neurological, cognitive, psychological, urological, neuropsychological, neurourological, neurogenic, and bladder.

In this review, the broad spectrum of neurological, cognitive, psychological and neurourological consequences of electrical trauma are discussed, and clinical features characteristic of an underlying neurological, psychological or neurourological disorder are identified. The latest information about the most recently discovered forms of nervous system disorders secondary to electrical trauma, such as the presentation of neurological sequelae years after electrocution, in other words long-term sequelae, are presented. Unexpected central nervous system or muscular complications such as hydrocephalus, brain venous thrombosis, and amyotrophic lateral sclerosis are described. Common and uncommon neuropsychological syndromes after electrical trauma are defined. Neurourological sequelae secondary to spinal cord or brain trauma or as independent consequences of electrical shock are also highlighted.

Abstract

Electrical injury can affect any system and organ. Central nervous system (CNS) complications are especially well recognised, causing an increased risk of morbidity, while peripheral nervous system (PNS) complications, neurourological and cognitive and psychological abnormalities are less predictable after electrical injuries.

PubMed was searched for English language clinical observational, retrospective, review and case studies published in the last 30 years using the key words: electrical injury, electrocution, complications, sequelae, neurological, cognitive, psychological, urological, neuropsychological, neurourological, neurogenic, and bladder.

In this review, the broad spectrum of neurological, cognitive, psychological and neurourological consequences of electrical trauma are discussed, and clinical features characteristic of an underlying neurological, psychological or neurourological disorder are identified. The latest information about the most recently discovered forms of nervous system disorders secondary to electrical trauma, such as the presentation of neurological sequelae years after electrocution, in other words long-term sequelae, are presented. Unexpected central nervous system or muscular complications such as hydrocephalus, brain venous thrombosis, and amyotrophic lateral sclerosis are described. Common and uncommon neuropsychological syndromes after electrical trauma are defined. Neurourological sequelae secondary to spinal cord or brain trauma or as independent consequences of electrical shock are also highlighted.

Get Citation

Keywords

electrical injury, neurological sequelae, neurourological complications

About this article
Title

Neurological and neurourological complications of electrical injuries

Journal

Neurologia i Neurochirurgia Polska

Issue

Ahead of print

Published online

2020-10-07

DOI

10.5603/JNNS.a2020.0076

Pubmed

33026644

Keywords

electrical injury
neurological sequelae
neurourological complications

Authors

Konstantina G. Yiannopoulou
Georgios I. Papagiannis
Athanasios I. Triantafyllou
Panayiotis Koulouvaris
Aikaterini I. Anastasiou
Konstantinos Kontoangelos
Ioannis P. Anastasiou

References (100)
  1. Shih JG, Shahrokhi S, Jeschke MG. Review of Adult Electrical Burn Injury Outcomes Worldwide: An Analysis of Low-Voltage vs High-Voltage Electrical Injury. J Burn Care Res. 2017; 38(1): e293–e298.
  2. Ding H, Huang M, Li D, et al. Epidemiology of electrical burns: a 10-year retrospective analysis of 376 cases at a burn centre in South China. J Int Med Res. 2019 [Epub ahead of print]: 300060519891325.
  3. Tashiro J, Burnweit CA. Swimming Pool Electrical Injuries: Steps Toward Prevention. Pediatr Emerg Care. 2019; 35(4): 261–264.
  4. Wesner ML, Hickie J. Long-term sequelae of electrical injury. Can Fam Physician. 2013; 59(9): 935–939.
  5. Hahn-Ketter AE, Whiteside DM, Pliskin N, et al. Long-term consequences of electrical injury: neuropsychological predictors of adjustment. Clin Neuropsychol. 2016; 30(2): 216–227.
  6. Stockly OR, Wolfe AE, Espinoza LF, et al. The impact of electrical injuries on long-term outcomes: A Burn Model System National Database study. Burns. 2020; 46(2): 352–359.
  7. Friedstat J, Brown DA, Levi B. Chemical, Electrical, and Radiation Injuries. Clin Plast Surg. 2017; 44(3): 657–669.
  8. Dechent D, Emonds T, Stunder D, et al. Direct current electrical injuries: A systematic review of case reports and case series. Burns. 2020; 46(2): 267–278.
  9. Huynh W, Lam A, Vucic S, et al. Corticospinal tract dysfunction and development of amyotrophic lateral sclerosis following electrical injury. Muscle Nerve. 2010; 42(2): 288–292.
  10. Andrews CJ, Reisner AD. Neurological and neuropsychological consequences of electrical and lightning shock: review and theories of causation. Neural Regen Res. 2017; 12(5): 677–686.
  11. Reisner AD. Possible mechanisms for delayed neurological damage in lightning and electrical injury. Brain Inj. 2013; 27(5): 565–569.
  12. Reul JM, Nutt DJ. Glutamate and cortisol--a critical confluence in PTSD? J Psychopharmacol. 2008; 22(5): 469–472.
  13. Bailey DM, Bärtsch P, Cooper MA. Electron paramagnetic resonance spectroscopic evidence of increased free radical generation and selective damage to skeletal muscle following lightning injury. High Alt Med Biol. 2003; 4(3): 281–289.
  14. Moher D, Liberati A, Tetzlaff J, et al. PRISMA Group, PRISMA Group, PRISMA Group, PRISMA Group, PRISMA Group, PRISMA Group, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 2009; 3(3): e123–e130.
  15. Cherington M. Central Nervous System Complications of Lightning and Electrical Injuries. Seminars in Neurology. 2008; 15(03): 233–240.
  16. Yiannopoulou KG, Avramidis T, Divari R, et al. Focal dystonia, tremor and myokymic discharges secondary to electrical injury. Neurol Int. 2009; 1(1): e2.
  17. Shih JG, Shahrokhi S, Jeschke MG. Review of Adult Electrical Burn Injury Outcomes Worldwide: An Analysis of Low-Voltage vs High-Voltage Electrical Injury. J Burn Care Res. 2017; 38(1): e293–e298.
  18. Tamam Y, Tamam C, Tamam B, et al. Peripheral neuropathy after burn injury. Eur Rev Med Pharmacol Sci. 2013; 17 Suppl 1: 107–111.
  19. Wong YS, Ong CT, Hsieh YY, et al. Carpal tunnel syndrome after an electrical injury: a case report and review of literature. J Occup Health. 2018; 60(4): 320–323.
  20. Cahill KC, Tiong WHC, Conroy FJ. Trineural injury to the right hand after domestic electrocution. J Burn Care Res. 2014; 35(5): e353–e356.
  21. Piotrowski A, Fillet AM, Perez P, et al. Outcome of occupational electrical injuries among French electric company workers: a retrospective report of 311 cases, 1996-2005. Burns. 2014; 40(3): 480–488.
  22. Patnaik A, Mahapatra AK, Jha M. Pan-brachial plexus neuropraxia following lightning: A rare case report. Surg Neurol Int. 2015; 6(Suppl 2): S110–S112.
  23. Anderson ML, O'Riordan J. Guillain-Barre syndrome-like illness in association with electrical shock injury. BMJ Case Rep. 2013; 2013.
  24. Anketell J, Wilson FC, McCann J. 'Thunder bolts and lightning': survival and neurorehabilitation following out of hospital cardiac arrest secondary to lightning strike. Brain Inj. 2018; 32(12): 1585–1587.
  25. Rådman L, Gunnarsson LG, Nilsagård Y, et al. Neurosensory findings among electricians with self-reported remaining symptoms after an electrical injury: A case series. Burns. 2016; 42(8): 1712–1720.
  26. Reddy D, Earan S, Kuppusamy K. Electrical Injury Causing Facial Nerve Palsy in a Toddler. Indian Pediatrics. 2020; 57(1): 76–77.
  27. Vasquez JC, Shusterman EM, Hansbrough JF. Bilateral facial nerve paralysis after high voltage electrical injury. J Burn Care Rehabil. 1999; 20(4): 307–308.
  28. Bozan N, Kiroglu AF, Ari M, et al. Tympanic Membrane Perforation Caused by Thunderbolt Strike. J Craniofac Surg. 2016; 27(8): e723–e724.
  29. Choi DJ, Kim BG, Park IS, et al. Three cases of inner ear damage after electrical burns. Burns. 2010; 36(6): e83–e86.
  30. Liew L, Morrison GAJ. Bilateral hearing loss following electrocution. J Laryngol Otol. 2006; 120(1): 65–66.
  31. Norman ME, Younge BR. Association of high-dose intravenous methylprednisolone with reversal of blindness from lightning in two patients. Ophthalmology. 1999; 106(4): 743–745.
  32. Baqain E, Haertsch P, Kennedy P. Complete recovery following a high voltage electrical injury associated with delayed onset of quadriplegia and multiple cranial nerves dysfunction. Burns. 2004; 30(6): 603–605.
  33. Parvathy G, Shaji CV, Kabeer KA, et al. High-voltage electrocution causing bulbar dysfunction. J Neurosci Rural Pract. 2016; 7(3): 453–455.
  34. Desai BK, Fairclough R. A case of a speech impediment following a near lightning strike. Int J Emerg Med. 2011; 4: 60.
  35. López Chiriboga AS, Cheshire WP. Trigeminal Neuralgia Following Lightning Injury. J Oral Facial Pain Headache. 2017; 31(4): e7–e9.
  36. Ohn SH, Kim DY, Shin JiC, et al. Analysis of high-voltage electrical spinal cord injury using diffusion tensor imaging. J Neurol. 2013; 260(11): 2876–2883.
  37. Sharma SR, Hussain M, Hibong H. Cervical Myelopathy after High-voltage Electrical Burn of the Head: Report of an Unusual Case. Ann Indian Acad Neurol. 2018; 21(1): 76–79.
  38. Freeman CB, Goyal M, Bourque PR. MR imaging findings in delayed reversible myelopathy from lightning strike. AJNR Am J Neuroradiol. 2004; 25(5): 851–853.
  39. Thompson C, Mutch J, Parent S, et al. The changing demographics of traumatic spinal cord injury: An 11-year study of 831 patients. J Spinal Cord Med. 2015; 38(2): 214–223.
  40. Tyagi AC, Gill A, Felton B. Thoracic Compression Fracture as a Result of Taser Discharge. Clin Pract Cases Emerg Med. 2017; 1(4): 319–322.
  41. Peeters W, van den Brande R, Polinder S, et al. Epidemiology of traumatic brain injury in Europe. Acta Neurochir (Wien). 2015; 157(10): 1683–1696.
  42. Menon DK, Schwab K, Wright DW, et al. Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010; 91(11): 1637–1640.
  43. Heydari F, Golban M, Majidinejad S. Traumatic Brain Injury in Older Adults Presenting to the Emergency Department: Epidemiology, Outcomes and Risk Factors Predicting the Prognosis. Adv J Emerg Med. 2020; 4(2): e19.
  44. Ng SiY, Lee AY. Traumatic Brain Injuries: Pathophysiology and Potential Therapeutic Targets. Front Cell Neurosci. 2019; 13: 528.
  45. Grassner L, Bierschneider M, Strowitzki M, et al. Different sequelae of electrical brain injury - MRI patterns. Burns. 2017; 43(4): e7–ee10.
  46. Isao T, Masaki F, Riko N, et al. Delayed brain atrophy after electrical injury. J Burn Care Rehabil. 2005; 26(5): 456–458.
  47. Lewis MC, Lewis DE. Frontal Sinus TASER Dart Injury. J Emerg Med. 2016; 50(3): 490–492.
  48. Steward L, Wagner AL, Neumann R, et al. Delayed Presentation of a Vertex Epidural Hematoma Following High-Voltage Electrical Injury to the Head. J Burn Care Res. 2019; 40(4): 517–519.
  49. Krisht KM, Chamoun R, Couldwell WT. Supraclinoid internal carotid artery-inferior petrosal sinus arteriovenous fistula after high-voltage electrical burn injury. J Clin Neurosci. 2013; 20(7): 1036–1038.
  50. Caksen H, Yuca SA, Demirtas I, et al. Right thalamic hemorrhage resulting from high-voltage electrical injury: a case report. Brain Dev. 2004; 26(2): 134–136.
  51. Axayacalt GA, Alejandro CE, Marcos RA, et al. Brain hemorrhage after electrical burn injury: Case report and probable mechanism. Surg Neurol Int. 2016; 7(Suppl 28): S759–S762.
  52. Sprecher W, Wenz W, Haffner HT. Rupture of an intracranial aneurysm--unusual complication of an electric shock. Forensic Sci Int. 2001; 122(2-3): 85–88.
  53. Kokatnur L, Rudrappa M. Acute Stroke due to Electrocution: Uncommon or Unrecognized? Case Rep Neurol Med. 2016; 2016: 9510863.
  54. Singh Jain R, Kumar S, Suresh DT, et al. Acute vertebrobasilar ischemic stroke due to electric injury. Am J Emerg Med. 2015; 33(7): 992.e3–992.e6.
  55. R SK, G SK, L M. Electrocution Causing Acute Ischemic Stroke - A Rare Presentation. J Assoc Physicians India. 2020; 68(1): 60.
  56. Verma GC, Jain G, Wahid A, et al. Acute ischaemic stroke and acute myocardial infarction occurring together in domestic low-voltage (220-240V) electrical injury: a rare complication. J Assoc Physicians India. 2014; 62(7): 620–623.
  57. Aslan S, Yilmaz S, Karcioglu O. Lightning: an unusual cause of cerebellar infarction. Emerg Med J. 2004; 21(6): 750–751.
  58. Yang L, Cui C, Ding H, et al. Delayed cerebellar infarction after a slight electric injury. Am J Emerg Med. 2018; 36(12): 2337.e3–2337.e5.
  59. Fleury V, Kleinig TJ, Thompson PD, et al. Cardio-embolic cerebellar stroke secondary to mitral valve chordae rupture as a delayed complication of a high-voltage electrical injury. J Clin Neurosci. 2008; 15(2): 210–212.
  60. Nizhu LN, Hasan MdJ, Rabbani R. High-voltage electrocution-induced pulmonary injury and cerebellar hemorrhage with fractures in atlas. Trauma Case Rep. 2020; 25: 100267.
  61. Chandrasekhar DP, Noone ML, Babu SP, et al. Magnetic resonance imaging findings in brain resulting from high-voltage electrical shock injury of the scalp. Indian J Radiol Imaging. 2018; 28(3): 312–314.
  62. Shetty BS, Kanchan T, Shetty M, et al. Fatal electrocution by a support metal wire. J Forensic Sci. 2010; 55(3): 830–831.
  63. Ackerman LL, Ryken TC, Kealey GP, et al. Onset of symptomatic hydrocephalus requiring emergency cerebrospinal fluid diversion following high-voltage electrical burn injury. J Neurosurg. 2010; 112(2): 394–398.
  64. Sure U, Kleihues P. Intracerebral venous thrombosis and hematoma secondary to high-voltage brain injury. J Trauma. 1997; 42(6): 1161–1164.
  65. Singh G, Kaif M, Deep A, et al. High-voltage electrical burn of the skull causing thrombosis of the superior sagittal sinus. J Clin Neurosci. 2011; 18(11): 1552–1554.
  66. Grell K, Meersohn A, Schüz J, et al. Risk of neurological diseases among survivors of electric shocks: a nationwide cohort study, Denmark, 1968-2008. Bioelectromagnetics. 2012; 33(6): 459–465.
  67. Neugroschl C, Berrada S, Elosegi JA, et al. Imaging of epilepsy following electrical injury. JBR-BTR. 2013; 96(2): 81–83.
  68. Navinan MR, Kandeepan T, Kulatunga A. A case of paroxysmal atrial fibrillation following low voltage electrocution. BMC Res Notes. 2013; 6: 384.
  69. Grzesiek M, Ellmann C, Ditting T. Put Your Lights On: Electrocution As a Cause of an Unexplained Fall and Loss of Consciousness. Eur J Case Rep Intern Med. 2019; 6(5): 001084.
  70. Glatstein M, Scolnik D, Mari E, et al. Levodopa treatment of late onset extrapyramidal movements in a child after high voltage electrocution. Am J Ther. 2013; 20(5): 554–557.
  71. Parashar A, Chittoria R, Nanda V. Extrapyramidal symptoms following electrical burns--a case report. Burns. 2004; 30(4): 402–404.
  72. Lin K, Lin J, Piovesan EJ, et al. Tongue tremor in a patient with coma after electrical injury. Mov Disord. 2003; 18(7): 834–836.
  73. Baskerville JR, McAninch SA. Focal lingual dystonia, urinary incontinence, and sensory deficits secondary to low voltage electrocution: case report and literature review. Emerg Med J. 2002; 19(4): 368–371.
  74. Lim ECH, Seet RCS. Segmental dystonia following electrocution in childhood. Neurol Sci. 2007; 28(1): 38–41.
  75. Boonkongchuen P, Lees A. Case of torticollis occurring following electrical injury. Mov Disord. 1996; 11(1): 109–110.
  76. Peters S, Visser AE, D'Ovidio F, et al. Euro-MOTOR Consortium. Associations of Electric Shock and Extremely Low-Frequency Magnetic Field Exposure With the Risk of Amyotrophic Lateral Sclerosis. Am J Epidemiol. 2019; 188(4): 796–805.
  77. Vergara X, Mezei G, Kheifets L. Case-control study of occupational exposure to electric shocks and magnetic fields and mortality from amyotrophic lateral sclerosis in the US, 1991-1999. J Expo Sci Environ Epidemiol. 2015; 25(1): 65–71.
  78. Jafari H, Couratier P, Camu W. Motor neuron disease after electric injury. J Neurol Neurosurg Psychiatry. 2001; 71(2): 265–267.
  79. Huynh W, Lam A, Vucic S, et al. Corticospinal tract dysfunction and development of amyotrophic lateral sclerosis following electrical injury. Muscle Nerve. 2010; 42(2): 288–292.
  80. Gunnarsson LG, Bodin L. Amyotrophic Lateral Sclerosis and Occupational Exposures: A Systematic Literature Review and Meta-Analyses. Int J Environ Res Public Health. 2018; 15(11).
  81. Wang MD, Little J, Gomes J, et al. Identification of risk factors associated with onset and progression of amyotrophic lateral sclerosis using systematic review and meta-analysis. Neurotoxicology. 2017; 61: 101–130.
  82. Fischer H, Kheifets L, Huss A, et al. Occupational Exposure to Electric Shocks and Magnetic Fields and Amyotrophic Lateral Sclerosis in Sweden. Epidemiology. 2015; 26(6): 824–830.
  83. Kara M, Yalcin S, Malas FU, et al. Ultrasound imaging for the upper limb nerves in CRPS: a patient with electrical injury. Pain Physician. 2014; 17(4): E556–E557.
  84. Roshanzamir S, Keshavarzi E. Sympathetic skin response impairment: A good predictor of bone loss in electrical burn victims. Burns. 2020; 46(2): 394–399.
  85. Kanjwal K, Karabin B, Kanjwal Y, et al. Postural orthostatic tachycardia syndrome: a rare complication following electrical injury. Pacing Clin Electrophysiol. 2010; 33(7): e59–e61.
  86. Naik SB, Murali Krishna RV. A Case of Keraunoparalysis: A Bolt from the Blue. Indian J Crit Care Med. 2018; 22(11): 804–805.
  87. Rahmani SH, Faridaalaee G, Jahangard S. Acute transient hemiparesis induced by lightning strike. Am J Emerg Med. 2015; 33(7): 984.e1–984.e3.
  88. Delgadillo D, Chapman S, Fahrenkopf M, et al. Acute-Onset Quadriplegia With Recovery After High-Voltage Electrical Injury. Annals of Plastic Surgery. 2017; 79(5): e33–e36.
  89. Rotariu EL, Manole MD. Cardiac Arrest Secondary to Lightning Strike: Case Report and Review of the Literature. Pediatr Emerg Care. 2020; 36(1): e18–e20.
  90. Schaefer NR, Yaxley JP, O'Donohue P, et al. Electrical burn causing a unique pattern of neurological injury. Plast Reconstr Surg Glob Open. 2015; 3(4): e378.
  91. Welk B, Schneider MP, Thavaseelan J, et al. Early urological care of patients with spinal cord injury. World J Urol. 2018; 36(10): 1537–1544.
  92. Djordjevic ML, Bizic M, Stojanovic B, et al. Outcomes and special techniques for treatment of penile amputation injury. Injury. 2019; 50 Suppl 5: S131–S136.
  93. Welk B, Schneider MP, Thavaseelan J, et al. Early urological care of patients with spinal cord injury. World J Urol. 2018; 36(10): 1537–1544.
  94. Rivas JG, Dorrego JM, Hernández MM, et al. Traumatic rupture of the corpus cavernosum: surgical management and clinical outcomes. A 30 years review. Cent European J Urol. 2014; 67(1): 88–92.
  95. Djordjevic ML, Bumbasirevic MZ, Krstic Z, et al. Severe penile injuries in children and adolescents: reconstruction modalities and outcomes. Urology. 2014; 83(2): 465–470.
  96. Srivastava S, Kumari H, Singh A, et al. Electrical burn injury: a comparison of outcomes of high voltage versus low voltage injury in an Indian scenario. Ann Burns Fire Disasters 2018;30. ; 31(3): 174–177.
  97. Culnan DM, Farner K, Bitz GH, et al. Volume Resuscitation in Patients With High-Voltage Electrical Injuries. Ann Plast Surg. 2018; 80(3 Suppl 2): S113–S118.
  98. Boyd AN, Hartman BC, Sood R, et al. A voltage-based analysis of fluid delivery and outcomes in burn patients with electrical injuries over a 6-year period. Burns. 2019; 45(4): 869–875.
  99. Gille J, Schmidt T, Dragu A, et al. Electrical injury - a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors. Scand J Trauma Resusc Emerg Med. 2018; 26(1): 43.
  100. Saracoglu A, Kuzucuoglu T, Yakupoglu S, et al. Prognostic factors in electrical burns: a review of 101 patients. Burns. 2014; 40(4): 702–707.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl