Acute Stroke due to Electrocution: Uncommon or Unrecognized?

Area of Science:

• Neurology
• Emergency Medicine
• Radiology

Background:

• Electrocution injuries are increasing due to greater reliance on electricity.
• Neurological complications from electrocution are known, but acute stroke is uncommon.

Purpose of the Study:

• To report a rare case of acute stroke secondary to high-voltage electrocution.
• To discuss the potential mechanism of stroke in electrocution injuries.

Main Methods:

• A case report of a previously healthy male patient who sustained a high-voltage electrical injury.
• Brain Magnetic Resonance Imaging (MRI) and MR angiography were performed.
• Neurological examination and assessment of hemodynamic stability were conducted.

Main Results:

• The patient presented with confusion and language deficits despite hemodynamic stability post-electrocution.
• MRI revealed acute stroke in the bilateral anterior cerebral artery (ACA) territory and watershed regions of the left middle cerebral artery (MCA) territory.
• MR angiography showed incidental A1 segment aplasia of the right ACA, indicating sole perfusion to the frontal lobes via the left ACA.

Conclusions:

• Electrocution can precipitate vasospasm, leading to end-organ damage consistent with stroke.
• The patient's watershed infarcts were likely caused by vasospasm in the left anterior circulation.
• Pre-existing A1 segment aplasia may have exacerbated the stroke risk in this electrocution case.