Neurological and neuropsychological consequences of electrical and lightning shock: review and theories of causation

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Abstract

Injuries from lightning and electrical injuries involve multiple systems of the body, however neurological symptoms are very widely reported. A disabling neuropsychological syndrome is also noted. This paper presents a comprehensive review of neurological and neuropsychological symptoms. Partial theories of causation for these injuries have been advanced, however, there is no convincing explanation for both delay in onset of symptoms and also the genesis of the neuropsychological syndrome. A theory of causation is proposed which satisfies both these constraints. This theory suggests circulating hormones such as cortisol, together with nitric oxide and oxidant free radicals from glutamatergic hyper-stimulation, act on tissues remote from the injury path including the hippocampus. This theory opens a research path to explore treatment options.

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Most cited references 148

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Hippocampal atrophy in recurrent major depression.

Y I Sheline, P. W. Wang, M H Gado … (1996)

Hippocampal volumes of subjects with a history of major depressive episodes but currently in remission and with no known medical comorbidity were compared to matched normal controls by using volumetric magnetic resonance images. Subjects with a history of major depression had significantly smaller left and right hippocampal volumes with no differences in total cerebral volumes. The degree of hippocampal volume reduction correlated with total duration of major depression. In addition, large (diameter > or = 4.5 mm)-hippocampal low signal foci (LSF) were found within the hippocampus, and their number also correlated with the total number of days depressed. These results suggest that depression is associated with hippocampal atrophy, perhaps due to a progressive process mediated by glucocorticoid neurotoxicity.

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Depression duration but not age predicts hippocampal volume loss in medically healthy women with recurrent major depression.

Yvette Sheline, Milan Sanghavi, Mark Mintun … (1999)

This study takes advantage of continuing advances in the precision of magnetic resonance imaging (MRI) to quantify hippocampal volumes in a series of human subjects with a history of depression compared with controls. We sought to test the hypothesis that both age and duration of past depression would be inversely and independently correlated with hippocampal volume. A sample of 24 women ranging in age from 23 to 86 years with a history of recurrent major depression, but no medical comorbidity, and 24 case-matched controls underwent MRI scanning. Subjects with a history of depression (post-depressed) had smaller hippocampal volumes bilaterally than controls. Post-depressives also had smaller amygdala core nuclei volumes, and these volumes correlated with hippocampal volumes. In addition, post-depressives scored lower in verbal memory, a neuropsychological measure of hippocampal function, suggesting that the volume loss was related to an aspect of cognitive functioning. In contrast, there was no difference in overall brain size or general intellectual performance. Contrary to our initial hypothesis, there was no significant correlation between hippocampal volume and age in either post-depressive or control subjects, whereas there was a significant correlation with total lifetime duration of depression. This suggests that repeated stress during recurrent depressive episodes may result in cumulative hippocampal injury as reflected in volume loss.

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Depression, antidepressants, and the shrinking hippocampus.

R Sapolsky (2001)

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Author and article information

Journal

Journal ID (nlm-ta): Neural Regen Res

Journal ID (iso-abbrev): Neural Regen Res

Journal ID (publisher-id): NRR

Title: Neural Regeneration Research

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 1673-5374

ISSN (Electronic): 1876-7958

Publication date (Print): May 2017

Volume: 12

Issue: 5

Pages: 677-686

Affiliations

[1 ]Faculty of Medicine - The University of Queensland, Herston, Australia; Lightning and Electrical Injuries, Mt Ommaney Family Practice, Mt Ommaney, Brisbane, Australia

[2 ]Forensic Diagnostic Center of District Nine, Cambridge, OH, USA

Author notes

[* ] Correspondence to: Christopher J. Andrews, chris.a@ 123456pobox.com .

Author contributions: CJA wrote the initial draft of the physical neurological section. ADR wrote the initial draft of the psychological section. Both authors then collaborated to refine these sections. The section on causation was written by both authors collaboratively, incorporating and unifying their own (similar) theories.

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Christopher J. Andrews http://orcid.org/0000-0001-7216-9866

Article

Publisher ID: NRR-12-677

DOI: 10.4103/1673-5374.206636

PMC ID: 5461597

PubMed ID: 28616016

SO-VID: 3badc21d-d81e-4b7d-9875-c5141b2da7c8

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Neurological and neuropsychological consequences of electrical and lightning shock: review and theories of causation

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Most cited references 148

Hippocampal atrophy in recurrent major depression.

Depression duration but not age predicts hippocampal volume loss in medically healthy women with recurrent major depression.

Depression, antidepressants, and the shrinking hippocampus.

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