Lesions along the upper motor neuronal pathway with locked-in features after lightning strike and cardiac arrest: A case-review analysis

Abstract

Objective: This study describes a case of lesions of the upper motor neuronal pathway with locked-in features after lightning strike and cardiac arrest.

Design: A case-review analysis.

Methods: In a 29-year-old male who was hit by a lightning strike during farming activities, cardiopulmonary resuscitation was provided first by co-workers and continued with success by the medical rescue service. After conducting advanced life support under monitoring and therapeutic hypothermia, quadriplegia with facial diplegia was recognized. A review was undertaken detailing the clinical course.

Results: MR imaging presented signs consistent with hypoxia-induced damage and diffusion-weighted MR images revealed pronounced damages along the upper motor neuronal pathway. A reactive electroencephalogram pattern, sustained eye movement and the patient communicating via eye-blinking were interpreted as locked-in features. Two weeks after admission the patient was transferred to a neurological rehabilitation centre for further professional care.

Conclusion: Direct damage of the upper motor neuron pathway due to the current of the lightning should be considered, albeit the relative contribution of hypoxia-induced damage cannot be separated.

• Brain hypoxia
• lightning strike
• locked-in syndrome
• out-of-hospital cardiac arrest
• quadriplegia
• upper motor neuronal pathway