The site of neurological damage causing paralysis after electrical trauma remains to be clarified. A patient is described who developed a flaccid tetraplegia after a high voltage electrical injury. The findings on initial examination and neurophysiological investigation showed a very severe generalised sensory-motor polyneuropathy. His subsequent follow up over 60 months showed a remarkable degree of reinnervation and the unmasking of a myelopathy. The degree of reinnervation noted suggests an axonopathy that left the other elements of the peripheral nerves relatively spared. These findings provide the most convincing evidence to date that a generalised polyneuropathy can follow electrical injury and that it results from non-thermal mechanisms such as electroporation. (J Neurol Neurosurg Psychiatry 2001;71:535-537) Keywords: electrical injury; tetraplegia after electrical injury; recovery after electrical injury Various neurological syndromes have been described after electrical injury.1 The brain, spinal cord, or peripheral nerves may be involved and presentation may be immediate or delayed.2 3 Involvement of the peripheral nervous system 4 is well recognised to cause various mononeuropathies, which may be multiple, 5 6 sometimes as a result of plexus involvement. This paper describes a patient rendered tetraplegic after electrical injury, and the remarkable recovery that occurred over a 5 year follow up period. Our clinical and electrophysiological findings provide the most convincing evidence to date that electrical injury can cause a generalised polyneuropathy, outside the area of electrically induced thermal injury, as a result of non-thermal mechanisms including electroporation.
Case reportA 24 year old man with a history of aVective disorder deliberately made contact with a 20 000 voltage AC supply. The current entered via the right arm and exited via the left elbow, resulting in 30% full thickness burns to the right arm, left elbow, and abdomen, and flash burns to the face and neck. On initial assessment in accident and emergency it was noted that he was conscious and talking. He was unable to move his left arm and both legs. Tendon reflexes were not commented on, but both plantars were noted to be flexor. The right arm was non-viable and required amputation at the shoulder. Elsewhere, immediate escharotomies were followed by successive extensive debridement of necrotic tissue, in places down to the bone. Skin and musculocutaneous grafts were required to cover the resulting tissue deficits. He required mechanical ventilation, initially with propofol and subsequently midazolam sedation. At day 18, he required minimal sedation and it was clear that he was completely paralysed below the neck. At day 38 he had made no progress weaning from ventilation and formal neurological assessment was performed.He was cognitively intact. There were cortical cataracts with corrected visual acuities of 6/24 on the right and 6/9 on the left. The cranial nerves were normal and the jaw jerk brisk. There was marke...
Fludarabine is a comparatively new drug for the treatment of low-grade lymphoid malignancy. This report describes five cases of unusual neurological illnesses occurring after treatment with fludarabine. These suggest that caution should be exercised in patients receiving fludarabine who develop neurological abnormalities, with prompt investigation and if necessary cessation of the drug.
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