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Case Reports
. 2022 Oct 21;16(1):391.
doi: 10.1186/s13256-022-03500-w.

Neuronal desertification after a direct lightning strike: a case report

Erik Roman-Pognuz  1   2 , Edoardo Moro  3 , Elisabetta Macchini  4 , Edoardo Di Paolo  4 , Kenneth Pesenti  4 , Umberto Lucangelo  4   3 , Rossana Bussani  4   5 , Elisa Baratella  4   6 , Tommaso Pellis  7 , Giuseppe Ristagno  8
Affiliations
Case Reports

Neuronal desertification after a direct lightning strike: a case report

Erik Roman-Pognuz et al. J Med Case Rep. .

Abstract

Background: Lightning strike is a rare but dramatic cause of injury. Patients admitted to intensive care units (ICUs) with lightning strike frequently have a high mortality and significant long-term morbidity related to a direct brain injury or induced cardiac arrest (CA).

Case presentation: A 50-year-old Caucasian man was admitted to our hospital after being struck by lightning resulting in immediate CA. Spontaneous circulation was initially restored, and the man was admitted to the ICU, but ultimately died while in hospital due to neurological injury. The computer tomography scan revealed a massive loss of grey-white matter differentiation at the fronto-temporal lobes bilaterally. Somatosensory-evoked potentials demonstrated bilateral absence of the cortical somatosensory N20-potential, and the electroencephalogram recorded minimal cerebral electrical activity. The patient died on day 10 and a post-mortem study revealed a widespread loss of neurons.

Conclusion: This case study illustrates severe brain injury caused by a direct lighting strike, with the patient presenting an extraordinary microscopic pattern of neuronal desertification.

Keywords: Brain injury; Cardiac arrest; Hypoxic ischaemic brain injury; Lightning strike; Neuronal desertification.

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Conflict of interest statement

The authors declare they have no competing interest

Figures

Fig. 1
Fig. 1
a, b Round black eschar, presumably where the lightning entered the body. b Eschar from a different view
Fig. 2
Fig. 2
Erythematous cutaneous lesions with singed hair at the suprapubic level likely due to the output area
Fig. 3
Fig. 3
Axial non-enhanced brain computed tomography scan demonstrates a loss of grey-white matter differentiation at the fronto-temporal lobes bilaterally with gyral effacement. Subtle subarachnoid hemorrhage (white arrows) is also noted
Fig. 4
Fig. 4
Computed tomography scan performed 4 days after the first scan shows diffuse cortical hypodensity of both cerebral hemispheres, with a more evident loss of grey-white matter differentiation with gyral effacement and compression of lateral ventricles
Fig. 5
Fig. 5
Cerebral parenchymal sections with an abundant, non-selective loss of neuronal elements
See this image and copyright information in PMC

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