ICU, Ningbo Medical Center Lihuili Eastern Hospital, No 1111, Jiangnan Rd, Ningbo 315100, China.
Nephrology Department, Guangxing Hospital of Zhejiang Chinese Medical University, No 453, Tiyuchang Rd, Hangzhou 310007, China.
Am J Emerg Med. 2018 Dec;36(12):2337.e3-2337.e5. doi: 10.1016/j.ajem.2018.08.064. Epub 2018 Aug 27.
Electrical injury causes direct damage to nerves. It may manifest as peripheral nerve injury, spinal cord damage, cerebellar ataxia, hypoxic encephalopathy, or intracerebral hemorrhage. Various factors determine the severity of electric injury, including type of current, amperage, voltage, tissue resistance, pathway of the current, and duration of contact with the body. However, the severity of the electrical injury is not proportional to the source voltage, visible burns, loss of consciousness, or neuroimaging findings. While most neurologic aftereffects due to electric injuries are immediate and transient, delayed and permanent manifestations are also known. We report a case of a middle-aged man who accidentally sustained cerebellar infarction without burns, which occurred 4 days after a slight electrical injury. Magnetic resonance imaging of the brain showed an acute infarct in the bilateral cerebellar and left occipital regions. The exact mechanism of the delayed cerebellar infarction after a slight electric injury still remains unknown. The initial electrical injury might result in a transient neurapraxia-like situation, but progressive cellular damage and death accounts for the evolution of delayed-onset symptoms. We learned from this case that we should not underestimate any potential risk of electrical injury; continuous observation should be made in case of subsequent neurologic dysfunction.
电击伤可直接导致神经损伤,其表现形式可为周围神经损伤、脊髓损伤、小脑性共济失调、缺氧性脑病或脑出血等。多种因素决定了电击伤的严重程度,包括电流类型、电流强度、电压、组织电阻、电流通路和与身体接触的时间。然而,电击伤的严重程度与电源电压、可见的烧伤、意识丧失或神经影像学发现不成比例。虽然电击伤后大多数神经后遗症是即刻和短暂的,但也有迟发性和永久性表现。我们报告了 1 例中年男性患者,在轻微电击伤 4 天后,无烧伤而出现小脑梗死。头部磁共振成像显示双侧小脑和左侧枕叶急性梗死。轻度电击伤后迟发性小脑梗死的确切机制尚不清楚。初始的电击伤可能导致短暂的神经失用样情况,但进展性细胞损伤和死亡导致迟发性症状的出现。从这个病例中我们了解到,不应低估任何潜在的电击伤风险;如有后续神经功能障碍,应持续观察。