Acute transient hemiparesis induced by lightning strike

Area of Science:

• Neurology
• Emergency Medicine
• Environmental Health

Background:

• Lightning strikes are a significant cause of injury and death, primarily affecting the nervous system.
• Neurological complications range from transient symptoms to permanent disability, with keraunoparalysis being a notable temporary paralysis.
• Understanding the immediate and long-term effects of lightning strikes is crucial for effective medical intervention.

Observation:

• A 22-year-old male mountaineer presented with left-sided hemiparesis and sensory loss three hours after a lightning strike.
• Initial examination revealed no loss of consciousness, preserved cranial nerves, and normal hemodynamics.
• Neurological deficits included severe weakness (1/5 muscle force) and complete sensory loss on the left, with normal findings on the right.

Findings:

• Despite initial severe hemiparesis and sensory deficits, prompt treatment including hydration, heparin, and physical therapy led to significant motor and sensory recovery.
• Brain MRI, CT scans, and cervical MRI showed no evidence of structural damage or significant vascular impairment.
• The patient's motor and sensory functions normalized within two days, with only mild paresthesia remaining, which resolved within three days.

Implications:

• This case underscores the potential for rapid neurological recovery following lightning-induced hemiparesis with appropriate medical management.
• It highlights the importance of early intervention and multidisciplinary care in managing acute lightning strike injuries.
• Further research into the pathophysiology and optimal treatment strategies for lightning-related neurological deficits is warranted.