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7 - Acute and delayed neurological sequelae of electrical injury
- from Part II - Clinical manifestations and management
- Edited by R. C. Lee, University of Chicago, E. G. Cravalho, Massachusetts General Hospital, Boston, J. F. Burke, Professor of Surgery, Chief of Trauma Services, Massachusetts General Hospital, Boston
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- Book:
- Electrical Trauma
- Published online:
- 08 April 2010
- Print publication:
- 22 October 1992, pp 133-152
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- Chapter
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Summary
Introduction
Modern society has experienced a tremendous proliferation in the use of electricity. Like a bird perched on a high-tension wire, the human body is immune to shock so long as it is not part of the electric circuit, but current out of the constraints of its wire poses a dramatic hazard to life and limb. Despite safeguards, electrical injuries still account for 3% of all burn centre admissions and cause approximately 1000 deaths per year.
Electricity is a particularly temperamental and unpredictable maimer of young, working males injured on the job or while participating in recreational activities. In the United States, about one-third of the injuries occur in construction workers and another third in electricians.
Electrical injury can be likened to the ‘Grand Masquerader’ of thermal injuries, manifesting a variety of unpredictable immediate and delayed sequelae that even the most astute physician cannot anticipate always, yet ever must be prepared to recognize and treat. Any organ system may be involved, and damage may only become evident at some time distant from the injury.
Permanent neurological damage following major electrical burns has long been feared as a dreaded complication. Immediate as well as subsequent complications can develop. Neurological complications involving either cerebral complaints (loss of consciousness, seizures, decreased memory, emotional lability, learning impairment or headaches) or peripheral complaints (sensorimotor loss, paraesthesias, paralysis, paresis, dysaesthesias, causalgia, or reflex sympathetic dystrophy) have been described.
Review of literature
Neurological disorders from electric shock can be classified as cerebral syndromes, spinal syndromes and peripheral nerve syndromes. In addition, the effects can be manifested immediately or can present after a long time delay.