P29. Transversal spinal cord lesion after electrical injury

Abstract

Case A 37 year old electrician presented with pain and paresthesia after electrical injury. The patient reported that he was removing a heating system at work. Because of an incorrect electrical installation a short circuit was built up by the patient holding the heater in both hands. The 230 voltage flowed through both arms. Because of a defect fuse the electric flow was not interrupted. During and a short time after the accident the patient reported strong pain in both arms and between the scapulae. Initially the symptoms were regressive. With a delay of 1 week the pain restarted and paresthesia in both arms surfaced. The patient presented himself to an emergency department of a local clinic. He was admitted and within one more day a motoric syndrome with a tetraparesis and passive incontinence developed. The patient was sent to a local neurological clinic for further diagnostic investigation. MRI of the spinal cord showed a correlating lesion C 4/5–C5/6. Functional deficits resulted in a sensomotorical transverse section down from C6 with focus on both arms. Although specific diagnostic, including ultrasound and vasculitis screening, was negative the lesion was suspected to be a spinal ischemia. Following treatment was done at the Department of Neurological Rehabilitation. The patient’s history was reevaluated and the diagnosis was revealed as a symptomatic lesion after electrical injury. Clinical and electrophysiological investigations were performed at the Department of Neurology. Quantitative sensoric testing (QST) showed pathological results for temperature and pain reception. Additional, a reduction of the density of intraepidermal nerve fiber could be seen in biopsy of affected skin area. After a year of intensive neurorehabilitation most symptoms recovered, except mild paresthesia, erectile dysfunction and reduced fine motor skills. Conclusion Electrical injury is a rare cause of spinal cord lesion. While diagnostic and therapy is focused mostly on acute symptoms, also delayed complications have to be considered.