Cho Chul-Hyun, Lee Dong Gyu
Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.
Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea.
Ann Rehabil Med. 2017 Apr;41(2):318-322. doi: 10.5535/arm.2017.41.2.318. Epub 2017 Apr 27.
We present the case of a 33-year-old man who experienced a 10,000-V electrical shock when working with electrical wiring. He suffered third-degree burns on his scalp at the right occiput (entry wound) and on his left arm (exit would), and a second-degree burn on his left foot (exit wound). He presented with severe spasticity of both lower extremities, motor weakness with a Medical Research Council grade of 3, and sensory impairments below thoracic level 11 that included an inability to sense light touch and defects in proprioception. Initial magnetic resonance imaging (MRI) scans of his spine and brain showed no definite abnormalities. However, tractography obtained by diffusion tensor imaging of the brain showed absence of the right medial lemniscus tract. A cervical MRI scan 1 month later showed spinal cord swelling from cervical 1-5 levels, and signal changes in the lateral and posterior white matter in the axial view. After 6 months of rehabilitation, he recovered almost normal degree of motor function in his lower extremities and disappearance of spasticity. However, since the sensory impairments persisted, especially defects in proprioception, he was unable to walk independently.
我们报告一例33岁男性病例，该患者在进行电气布线工作时遭受了10000伏的电击。他的右枕部头皮（入口伤口）和左臂（出口伤口）出现三度烧伤，左脚（出口伤口）出现二度烧伤。他表现为双下肢严重痉挛，肌力减弱，医学研究委员会（Medical Research Council）肌力评级为3级，胸11水平以下存在感觉障碍，包括无法感知轻触觉和本体感觉缺陷。其脊柱和脑部的初始磁共振成像（MRI）扫描未显示明确异常。然而，通过脑部弥散张量成像获得的纤维束成像显示右侧内侧丘系束缺失。1个月后的颈椎MRI扫描显示颈1至5水平脊髓肿胀，轴位视图中外侧和后侧白质有信号改变。经过6个月的康复治疗，他下肢的运动功能恢复到几乎正常程度，痉挛消失。然而，由于感觉障碍持续存在，尤其是本体感觉缺陷，他无法独立行走。
