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Neurological injury from lightning — Clinical Guidelines

Overview

Lightning strikes can cause severe neurological injuries, including acute cerebral edema and various neurological deficits, often requiring immediate and specialized care to minimize long-term damage 1 3 12.

Diagnosis

Clinical Presentation: Symptoms may include immediate loss of consciousness, seizures, confusion, motor deficits, and sensory disturbances 1 12.

Electrolyte and Metabolic Panels: Assess for electrolyte imbalances and metabolic disturbances 12.

Imaging: CT or MRI scans to evaluate for cerebral edema, hemorrhage, or other structural brain injuries 2 12.

Neurological Assessment: GCS (Glasgow Coma Scale) and focal neurological examination to grade severity 2.

Management

Initial Stabilization: Airway management, ventilation support, and fluid resuscitation as needed 12.

Cerebral Edema Management: Use of hyperosmolar agents like mannitol for acute cerebral edema (dose typically 0.5-1 g/kg IV over 30-60 minutes) 2.

Supportive Care: Monitoring intracranial pressure, maintaining normotension, and managing seizures with anticonvulsants 2.

Early Mobilization: Once stable, consider early mobilization to prevent complications like deep vein thrombosis 6.

Special Populations

Military Personnel: Higher incidence among males, ages 20-29, non-Hispanic whites, and Army members 3.

Pediatrics and Elderly: Specific data limited; general principles apply but require tailored assessment and monitoring 3.

Key Recommendations

Immediate Assessment and Stabilization: Conduct rapid neurological and systemic assessment post-lightning strike, focusing on airway, breathing, and circulation (Evidence: Expert opinion 12).

Monitor and Manage Cerebral Edema: Utilize hyperosmolar therapies like mannitol for managing acute cerebral edema (Evidence: Moderate 2).

Supportive Care and Monitoring: Implement continuous monitoring of intracranial pressure and neurological status, adjusting treatments accordingly (Evidence: Expert opinion 2).

Early Mobilization: Once clinically stable, initiate early mobilization to reduce ICU complications (Evidence: Moderate 6).

Educate and Prevent: Implement lightning safety protocols in outdoor activities to prevent injuries (Evidence: Expert opinion 7).

References

1 Gasser B. Cases of Lightning Strikes during Mountain-Sports Activities: An Analysis of Emergencies from the Swiss Alps. International journal of environmental research and public health 2022. link 2 Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A et al.. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocritical care 2020. link 3 Williams VF, Oetting AA, Stahlman S. Update: Lightning strike injuries, active component, U.S. Armed Forces, 2008-2017. MSMR 2018. link 4 Mazzeo AT, Battaglini I, Brazzi L, Mascia L. The link between anesthesiology and neurology: a mindful cooperation to improve brain protection. Minerva anestesiologica 2017. link 5 Delgadillo D, Chapman S, Fahrenkopf MP, Martin MD. Acute-Onset Quadriplegia With Recovery After High-Voltage Electrical Injury. Annals of plastic surgery 2017. link 6 Witcher R, Stoerger L, Dzierba AL, Silverstein A, Rosengart A, Brodie D et al.. Effect of early mobilization on sedation practices in the neurosciences intensive care unit: a preimplementation and postimplementation evaluation. Journal of critical care 2015. link 7 Walsh KM, Cooper MA, Holle R, Rakov VA, Roeder WP, Ryan M. National Athletic Trainers' Association position statement: lightning safety for athletics and recreation. Journal of athletic training 2013. link 8 Choi HA, Ko SB, Presciutti M, Fernandez L, Carpenter AM, Lesch C et al.. Prevention of shivering during therapeutic temperature modulation: the Columbia anti-shivering protocol. Neurocritical care 2011. link 9 Vir D, Sachin, Gupta D, Modi M, Panda N. Neurological manifestations in speech after snake bite: a rare case. The Pan African medical journal 2010. link 10 Andrews PJ, Citerio G, Longhi L, Polderman K, Sahuquillo J, Vajkoczy P. NICEM consensus on neurological monitoring in acute neurological disease. Intensive care medicine 2008. link 11 Hilbish C. Bispectral Index monitoring in the neurointensive care unit. The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses 2003. link 12 Jepsen DL. How to manage a patient with lightning injury. The American journal of nursing 1992. link 13 Munoz-Garcia D, Ludwin SK. Intermediate glial cells and reactive astrocytes revisited. A study in organotypic tissue culture. Journal of neuroimmunology 1985. link80065-5) 14 Cooper MA. Lightning injuries. Emergency medicine clinics of North America 1983. link 15 Moylan FM, Herrin JT, Krishnamoorthy K, Todres ID, Shannon DC. Inappropriate antidiuretic hormone secretion in premature infants with cerebral injury. American journal of diseases of children (1960) 1978. link

Neurological injury from lightning