Lightning stroke and neuropsychological impairment: cases and questions

OBJECTIVE To objectify neuropsychological impairments in survivors of lightning stroke with lasting complaints about poor concentration and inability to divide their attention. DESIGN A series of six cases of lightning stroke were studied. All patients had lost consciousness and reported amnesia of...

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Veröffentlicht in:Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 1998-06, Vol.64 (6), p.763-770
Hauptverfasser: van Zomeren, Adriaan H, ten Duis, Henk-Jan, Minderhoud, Jan M, Sipma, Mirjam
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creator van Zomeren, Adriaan H
ten Duis, Henk-Jan
Minderhoud, Jan M
Sipma, Mirjam
description OBJECTIVE To objectify neuropsychological impairments in survivors of lightning stroke with lasting complaints about poor concentration and inability to divide their attention. DESIGN A series of six cases of lightning stroke were studied. All patients had lost consciousness and reported amnesia of varying length. Assessment took place between one and four years after injury, ensuring that their neurological state had stabilised. They were tested with a neuropsychological battery with an emphasis on attention and memory. Personality and emotional reaction to the accident were assessed with questionnaires and a lightning fear scale. Complaints were recorded by means of a trauma complaints list including 10 questions on symptoms of the post-traumatic stress disorder. RESULTS Patients reported fatigue and lack of energy as their main complaints. In addition, poor concentration, irritability, and emotional lability were mentioned often. Neuropsychological tests disclosed mild impairments in memory, attention, and visual reaction times. Two patients could be classified as depressed, and one of these also showed convincing signs of the post-traumatic stress disorder. CONCLUSION As the lasting complaints and impairments could not be explained, for all six cases, as resulting from head injury concomitant with lightning stroke, cerebral hypoxia or a post-traumatic stress syndrome, it is concluded that lightning stroke can result in subtle cognitive impairments. It is speculated that most complaints of these survivors are caused by a vegetative dysregulation, a disorder that has often been noted in the literature on the effects of electrical injury to the nervous system. Such a dysregulation might cause both the main complaint of fatigue and the mild cognitive impairments identified with the present test battery.
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DESIGN A series of six cases of lightning stroke were studied. All patients had lost consciousness and reported amnesia of varying length. Assessment took place between one and four years after injury, ensuring that their neurological state had stabilised. They were tested with a neuropsychological battery with an emphasis on attention and memory. Personality and emotional reaction to the accident were assessed with questionnaires and a lightning fear scale. Complaints were recorded by means of a trauma complaints list including 10 questions on symptoms of the post-traumatic stress disorder. RESULTS Patients reported fatigue and lack of energy as their main complaints. In addition, poor concentration, irritability, and emotional lability were mentioned often. Neuropsychological tests disclosed mild impairments in memory, attention, and visual reaction times. Two patients could be classified as depressed, and one of these also showed convincing signs of the post-traumatic stress disorder. CONCLUSION As the lasting complaints and impairments could not be explained, for all six cases, as resulting from head injury concomitant with lightning stroke, cerebral hypoxia or a post-traumatic stress syndrome, it is concluded that lightning stroke can result in subtle cognitive impairments. It is speculated that most complaints of these survivors are caused by a vegetative dysregulation, a disorder that has often been noted in the literature on the effects of electrical injury to the nervous system. Such a dysregulation might cause both the main complaint of fatigue and the mild cognitive impairments identified with the present test battery.</description><identifier>ISSN: 0022-3050</identifier><identifier>EISSN: 1468-330X</identifier><identifier>DOI: 10.1136/jnnp.64.6.763</identifier><identifier>PMID: 9647306</identifier><identifier>CODEN: JNNPAU</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd</publisher><subject>Adolescent ; Adult ; Amnesia - diagnosis ; Amnesia - etiology ; Biological and medical sciences ; Brain Injuries - complications ; Brain Injuries - diagnosis ; Brain Injuries - etiology ; Cardiac arrest ; Cognition Disorders - diagnosis ; Cognition Disorders - etiology ; Consciousness ; Female ; Humans ; Injuries ; Injuries of the nervous system and the skull. Diseases due to physical agents ; Lightning ; Lightning Injuries - complications ; lightning stroke ; Male ; Medical sciences ; Memory ; Neuropsychological Tests ; Neuropsychology ; Paralysis ; Personality Assessment ; Personality Disorders - diagnosis ; Personality Disorders - etiology ; post-traumatic stress disorder ; Psychiatric Status Rating Scales ; Severity of Illness Index ; Stress Disorders, Post-Traumatic - diagnosis ; Stress Disorders, Post-Traumatic - psychology ; Surveys and Questionnaires ; Traumas. 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DESIGN A series of six cases of lightning stroke were studied. All patients had lost consciousness and reported amnesia of varying length. Assessment took place between one and four years after injury, ensuring that their neurological state had stabilised. They were tested with a neuropsychological battery with an emphasis on attention and memory. Personality and emotional reaction to the accident were assessed with questionnaires and a lightning fear scale. Complaints were recorded by means of a trauma complaints list including 10 questions on symptoms of the post-traumatic stress disorder. RESULTS Patients reported fatigue and lack of energy as their main complaints. In addition, poor concentration, irritability, and emotional lability were mentioned often. Neuropsychological tests disclosed mild impairments in memory, attention, and visual reaction times. Two patients could be classified as depressed, and one of these also showed convincing signs of the post-traumatic stress disorder. CONCLUSION As the lasting complaints and impairments could not be explained, for all six cases, as resulting from head injury concomitant with lightning stroke, cerebral hypoxia or a post-traumatic stress syndrome, it is concluded that lightning stroke can result in subtle cognitive impairments. It is speculated that most complaints of these survivors are caused by a vegetative dysregulation, a disorder that has often been noted in the literature on the effects of electrical injury to the nervous system. Such a dysregulation might cause both the main complaint of fatigue and the mild cognitive impairments identified with the present test battery.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Amnesia - diagnosis</subject><subject>Amnesia - etiology</subject><subject>Biological and medical sciences</subject><subject>Brain Injuries - complications</subject><subject>Brain Injuries - diagnosis</subject><subject>Brain Injuries - etiology</subject><subject>Cardiac arrest</subject><subject>Cognition Disorders - diagnosis</subject><subject>Cognition Disorders - etiology</subject><subject>Consciousness</subject><subject>Female</subject><subject>Humans</subject><subject>Injuries</subject><subject>Injuries of the nervous system and the skull. Diseases due to physical agents</subject><subject>Lightning</subject><subject>Lightning Injuries - complications</subject><subject>lightning stroke</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Memory</subject><subject>Neuropsychological Tests</subject><subject>Neuropsychology</subject><subject>Paralysis</subject><subject>Personality Assessment</subject><subject>Personality Disorders - diagnosis</subject><subject>Personality Disorders - etiology</subject><subject>post-traumatic stress disorder</subject><subject>Psychiatric Status Rating Scales</subject><subject>Severity of Illness Index</subject><subject>Stress Disorders, Post-Traumatic - diagnosis</subject><subject>Stress Disorders, Post-Traumatic - psychology</subject><subject>Surveys and Questionnaires</subject><subject>Traumas. 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DESIGN A series of six cases of lightning stroke were studied. All patients had lost consciousness and reported amnesia of varying length. Assessment took place between one and four years after injury, ensuring that their neurological state had stabilised. They were tested with a neuropsychological battery with an emphasis on attention and memory. Personality and emotional reaction to the accident were assessed with questionnaires and a lightning fear scale. Complaints were recorded by means of a trauma complaints list including 10 questions on symptoms of the post-traumatic stress disorder. RESULTS Patients reported fatigue and lack of energy as their main complaints. In addition, poor concentration, irritability, and emotional lability were mentioned often. Neuropsychological tests disclosed mild impairments in memory, attention, and visual reaction times. Two patients could be classified as depressed, and one of these also showed convincing signs of the post-traumatic stress disorder. CONCLUSION As the lasting complaints and impairments could not be explained, for all six cases, as resulting from head injury concomitant with lightning stroke, cerebral hypoxia or a post-traumatic stress syndrome, it is concluded that lightning stroke can result in subtle cognitive impairments. It is speculated that most complaints of these survivors are caused by a vegetative dysregulation, a disorder that has often been noted in the literature on the effects of electrical injury to the nervous system. Such a dysregulation might cause both the main complaint of fatigue and the mild cognitive impairments identified with the present test battery.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd</pub><pmid>9647306</pmid><doi>10.1136/jnnp.64.6.763</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Adolescent
Adult
Amnesia - diagnosis
Amnesia - etiology
Biological and medical sciences
Brain Injuries - complications
Brain Injuries - diagnosis
Brain Injuries - etiology
Cardiac arrest
Cognition Disorders - diagnosis
Cognition Disorders - etiology
Consciousness
Female
Humans
Injuries
Injuries of the nervous system and the skull. Diseases due to physical agents
Lightning
Lightning Injuries - complications
lightning stroke
Male
Medical sciences
Memory
Neuropsychological Tests
Neuropsychology
Paralysis
Personality Assessment
Personality Disorders - diagnosis
Personality Disorders - etiology
post-traumatic stress disorder
Psychiatric Status Rating Scales
Severity of Illness Index
Stress Disorders, Post-Traumatic - diagnosis
Stress Disorders, Post-Traumatic - psychology
Surveys and Questionnaires
Traumas. Diseases due to physical agents
title Lightning stroke and neuropsychological impairment: cases and questions
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