From burn to paralysis: delayed spinal cord injury in high-voltage electrical burns
DOI:
https://doi.org/10.66166/cjaim.2.1.5Keywords:
electrical injury, spinal cord injury, quadriplegiaAbstract
Electrical burn injuries, though uncommon, can cause severe neurological complications, with sequelae observed in up to 67% of high-voltage cases. This report presents two cases of spinal cord injuries following high-voltage electrical burns in male patients aged 29 and 53. The first patient, a 29-year-old male, sustained 9% total body surface area (TBSA) burns. His initial neurological assessment was unremarkable, but post-injury he developed quadriplegia with preserved sensation. Imaging was inconclusive, and he required prolonged intensive care unit care, showing only modest neurological improvement over time. The second patient, a 53-year-old male, suffered 25% TBSA burns, initially presenting unconscious and requiring resuscitation. He developed delayed paraplegia, with electromyoneurography confirming severe bilateral lumbosacral plexus injury despite normal spinal imaging. Both patients underwent supportive treatment, surgical interventions, and rehabilitation, showing varying degrees of motor recovery. Neurological sequelae in electrical injuries may result from direct electrical damage, vascular injury, or ischemic changes. Despite no clear spinal abnormalities on imaging, significant neurological deficits were present. No specific treatment exists, and corticosteroid use remains controversial. These cases underscore the need for early neurological evaluation, awareness of long-term consequences, and further research to develop standardized treatment protocols.
References
1. Hunt JL, Sato RM, Baxter CR. Acute electric burns. Current diagnostic and therapeutic approaches to management. Arch Surg. 1980 Apr;115[4]:434–8. DOI: 10.1001/archsurg.1980.01380040062011
2. Aggarwal S, Maitz P, Kennedy P. Electrical flash burns due to switchboard explosions in New South Wales--a 9-year experi-ence. Burns. 2011 Sep;37[6]:1038–43. DOI: 10.1016/j.burns.2011.01.017
3. Koumbourlis AC. Electrical injuries. Crit Care Med. 2002 Nov;30[11 Suppl]:S424-430. DOI: 10.1097/00003246-200211001-00007
4. Bernal E and Arnoldo BD. 38 – Electrical Injuries. In: Herndon DN, editor. Total Burn Care [Fifth Edition]. Elsevier; 2018. 396-402.
5. Characteristics and risk factors for electrical burn injuries: a study based on World Health Organization Global Burn Registry. Burns. 2024 Jun 1;50[5]:1116–21. DOI: 10.1016/j.burns.2024.01.014
6. Saracoglu A, Kuzucuoglu T, Yakupoglu S, Kilavuz O, Tuncay E, Ersoy B, et al. Prognostic factors in electrical burns: a review of 101 patients. Burns. 2014 Jun;40[4]:702–7. DOI: 10.1016/j.burns.2013.08.023
7. Duff K, McCaffrey RJ. Electrical injury and lightning injury: a review of their mechanisms and neuropsychological, psychiatric, and neurological sequelae. Neuropsychol Rev. 2001 Jun;11[2]:101–16. DOI: 10.1023/a:1016623318049
8. Bounds EJ, Khan M, Kok SJ. Electrical Burns [Archived].
9. Yiannopoulou KG, Papagiannis GI, Triantafyllou AI, Koulouvaris P, Anastasiou AI, Kontoangelos K, et al. Neurological and neurourological complications of electrical injuries. Neurol Neurochir Pol. 2021;55[1]:12–23. DOI: 10.5603/JNNS.a2020.0076.
10. Zemaitis MR, Lopez RA, Huecker MR. Electrical Injuries
11. Ko SH, Chun W, Kim HC. Delayed spinal cord injury following electrical burns: a 7-year experience. Burns. 2004 Nov;30[7]:691–5. DOI: 10.1016/j.burns.2004.03.007.
12. Fariduddin MM, Haq N, Bansal N. Hypothyroid myopathy. InStatPearls [internet] 2024 Jun 7. StatPearls Publishing.
13. Phuyal P, Bhutta BS, Nagalli S. Hypokalemic periodic paralysis. InStatPearls [Internet] 2024 Mar 19. StatPearls Publishing.
14. Neal JM, Barrington MJ, Brull R, Hadzic A, Hebl JR, Horlocker TT, et al. The Second ASRA Practice Advisory on Neurologic Complications Associated with Regional Anesthesia and Pain Medicine: Executive Summary 2015. Reg Anesth Pain Med. 2015;40[5]:401–30. DOI: 10.1097/AAP.0000000000000286.
15. Galeiras Vázquez R, Ferreiro Velasco ME, Mourelo Fariña M, Montoto Marqués A, Salvador de la Barrera S. Update on traumatic acute spinal cord injury. Part 1. Med Intensiva. 2017 May;41[4]:237–47. DOI: 10.1016/j.medin.2016.11.002.
16. Abebe MW, Alem SE. Late onset quadriparesis in high voltage electrical burn–A case report. Burns Open. 2022 Oct 1;6[4]:169-72. https://doi.org/10.1016/j.burnso.2022.09.001
17. Baltrusch S. The Role of Neurotropic B Vitamins in Nerve Regeneration. Biomed Res Int. 2021 Jul 13;2021:9968228. DOI: 10.1155/2021/9968228.
18. Sathienluckana T, Palapinyo S, Yotsombut K, Wanothayaroj E, Sithinamsuwan P, Suksomboon N. Expert consensus guidelines for community pharmacists in the management of diabetic peripheral neuropathy with a combination of neurotropic B vitamins. J Pharm Policy Pract. 2024;17[1]:2306866. DOI: 10.1080/20523211.2024.2306866.
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The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Copyright (c) 2026 Goran Sabo, MD, Agata Skunca, MD, Morana Banic, MD, Tihana Magdic Turkovic, Associate Professor, Primarius, PhD, Marinko Vucic, Associate Professor, Primarius, PhD (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
