Timothy C. Hain, MD
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Content last updated: 2/2003
About 300 to 600 persons die each year from lightning strikes in the United States. There are three distinct ways that lightning may strike. In a direct strike, the most serious form, lightning strikes the person and is conducted to the ground. There is a high rate of serious morbidity. In a side-flash, lightning jumps from the primary strike to a nearby object. This is probably the most common type. A ground strike occurs when lightning strikes the ground near a person. An associated phenomenon is the "flashover" phenomenon. Most of the energy is theorized to flow outside the body of the victim, in part, protecting the victim. In lightning strike there is often a serpiginous pattern (snake or serpent-like) of skin discoloration along the extremities, that disappears within 24 hours. This is called the "Lichtenberg figure", said to be pathognomonic of lightning (Cherington, 2003)
According to Cherington, about 75% of patients with lightning strike have a brief loss of consciousness and 80% have brief limb weakness or paresthesias (2003). Many experience a temporary paralysis called 'keraunoparalysis' a term introduced by the French neurologist, Charcot. It is as brief paralysis with loss of sensation that affects lower limbs more than the upper. Strength returns to normal within one or a few hours. When the heart stops, patients may develop a post-arrest ischemic encephalopathy, resembling the state of those who have undergone cardiac resuscitation after a prolonged cardiopulmonary arrest. Intracranial hemorrhages can occur, particularly in the basal ganglia and brainstem. It has been suggested that current may enter the body through the eyes, nose and ears, and travel from the neocortex (cerebral hemispheres) towards the basal ganglia and brainstem. Cerebral infarctions are unusual, and only a few have been reported. Similarly, cerebellar syndromes are unusual, with only about 4 reported in the literature as far as 2003 (Cherington, 2003).
Dizziness or disorders of hearing are infrequently reported after lightning strike. Epperly and Stewart reported an incident when 10 soldiers were struck simultaneously during training maneuvers. 20 percent had transient tinnitus or hearing complaints. Rupture of the ear drum is the most commonly reported complication. This is attributed to blast effects related to thunder or vaporization of water on body surfaces. Other complications include:
The frequency of this lightning injury causing auditory or vestibular symptoms is unclear, but presumably it is small. The most serious injuries from lightning strikes involve cardiac and neurologic systems. In the author's otoneurologic practice, only three patients have been seen in the last 8 years, out of a total of approximately 5000 patients with dizziness or hearing complaints. According to Jones (1991), the mechanism of injury to the auditory system is conjectural and may vary from case to case. Possible mechanisms may include rupture of the ear, acoustic trauma, flow of electric current through the cochlea, changes in vasculature, and hemorrhage. Cataracts develop in about 6 percent of high voltage injuries and should be suspected whenever electrical injury has occurred around the head.
Case example: A 30 year old woman presented complaining of tinnitus and dizziness attributed to a lightning bolt. While working at a switchboard six years prior to the clinic visit, lightning struck the building where she was working, causing an electric shock transmitted from her headset. The dizziness gradually worsened over years. Her right ear was explored surgically, but nothing abnormal was found. Symptoms at the time she was seen consisted of dizziness, headaches, tinnitus, fullness, difficulty with hearing, and otalgia. ABR was normal. ENG was abnormal with a nonlocalizing pattern. Audiometry showed mild sensorineural hearing reduction on the right side. A rotatory chair test was normal at high frequencies only. A similar case was reported by Qureshi in 1995.