Delayed Demyelinating Disease of the Central Nervous System Following Low-Voltage Alternating Current Electrical Injury: A Case Report and Review of the Literature

Abstract

Electrical injuries are relatively common types of mechanical trauma associated with significant morbidity and mortality. These injuries occur most commonly in adult men and account for approximately 3-7% of admissions to burn units. The type and amount of current, voltage, tissue resistance, and duration of current flow all influence the extent of injury and the patient outcome. A broad spectrum of central nervous system (CNS) and peripheral nervous systems (PNS) disorders caused by electrocution have been described in the literature. Here, we present a rare case of a 45-year-old man, electrocuted with a 240 V low-voltage alternating current (AC), four years prior to presentation, who has been admitted to our neurology clinic with a positive Lhermitte sign, paraparesis, proximal muscle pain, and distal paresthesia of the lower limbs, symptoms that had appeared one year after the electrocution. Magnetic resonance imaging (MRI) of the brain and spinal cord revealed multiple demyelinating lesions involving pons, juxtacortical and periventricular regions of the brain, and cervical and upper thoracic spinal cord. Given that other etiologies of demyelinating diseases of the CNS were excluded, we have interpreted this case and all accompanying pathologic findings as a consequence of electrical injury. Although the general epidemiologic reports regarding age, sex, type of current, circumstances, and site of electrocution correspond to the data of our reported case, this patient presents a delayed, rare neurologic complication with a nonspecific MRI pattern that we did not find in the literature. These patients should be carefully monitored not only during the acute phase but also over a longer period, because, as reported in this case, neurological complications may occur later after electrocution.

Keywords: alternating current; demyelination; electrocution; neurological complications; neuropathology.

Figure 1. Sagittal T1 MRI of the spine showing multiple round hyperintensities in the cervical and upper thoracic spinal cord

MRI: magnetic resonance imaging

Figure 2. Sagittal T2 MRI of the brain showing multiple hyperintense lesions in the pons and subcortical white matter

MRI: magnetic resonance imaging

Figure 3. Axial FLAIR MRI of the brain showing multiple hyperintense lesions in the periventricular and juxtacortical white matter

FLAIR MRI: fluid-attenuated inversion recovery magnetic resonance imaging