Lightning strike: a first case of unilateral diaphragmatic paralysis

Abstract

Lightning injury is the second most common cause of weather-related deaths in the United States. Despite the several neurological complications such as polyneuropathy, myelopathy, spinal cord injury, motor neuron disease due to the lightning-induced injury, there is no documented case of unilateral diaphragmatic paralysis. We describe the case of a patient with a history of lightning strike at childhood period, prior the onset of isolated, diaphragmatic paralysis, unilaterally. Clinical and electrophysiological findings suggest an injury restricted to the phrenic nerve, unilaterally.

Keywords: diaphragmatic paralysis.; lightning injury; phrenic nerve.

Figure 1

Chest X-ray: Right diaphragm elevation.

Figure 2

Thorax computed tomography (CT). A) Axial section showing elevation at the right diaphragma. B) Sagittal section showing elevation at the right diaphragma.

Figure 3

A) Right phrenic nerve motor conduction study revealing no electrophysiological response. B) Left phrenic nerve motor conduction study revealing normal electrophysiological response.