Hazards of bicycling: from handlebars to lightning.

The bicycle, an invention that provides joy and transportation to millions of people, can also be a source of disabling injuries and death. The victims of bicycle accidents are usually in good health and often young. Most of the fatal head injury cases are teenagers. In this article, I have chosen four areas of bicycle trauma that frequently brings the bicycle patient to the attention of a neurologist. These areas are (1) head trauma as a consequence of road collisions; (2) compressive ulnar neuropathy; (3) impotence, probably due to compression of the pudendal nerve or its branches; and (4) lightning-related bicycle injuries. The one thing that all four categories have in common is that they are often preventable. Helmet usage and common sense would lower the number of serious head trauma cases by 50%. Compressive ulnar and pudendal neuropathies can be prevented or reduced if the cyclist would frequently change his or her position in relation to the handlebar and saddle. In the majority of cases of compressive neuropathies, the symptoms improve if the patient takes a holiday from bike riding. Lightning injuries can be avoided or lessened if the cyclist takes proactive measures to limit his or her exposure during thunderstorms. These proactive measures include knowing the climate patterns of the area and knowing where the nearest safe shelter is located.