Pathogenesis and recovery of tetraplegia after electrical injury

J Neurol Neurosurg Psychiatry, 2001 · DOI: · Published: October 1, 2001

Simple Explanation

This paper describes a case of a patient who developed paralysis in all four limbs (tetraplegia) after experiencing a high-voltage electrical injury. Initial examinations and tests showed a severe sensory-motor polyneuropathy, indicating widespread nerve damage. Over a five-year period, the patient showed significant recovery, suggesting the nerves were able to regenerate. The findings suggest that electrical injuries can cause a polyneuropathy, even outside areas directly burned by the electricity, and that this damage can be due to non-thermal mechanisms, possibly involving the formation of pores in cell membranes.

Study Duration

60 Months

Participants

1 patient: 24 year old male

Evidence Level

Level 4: Case Report

Key Findings

1
The patient developed a severe generalized sensory-motor polyneuropathy after high voltage electrical injury, leading to flaccid tetraplegia.
2
Significant reinnervation occurred over 5 years, suggesting an axonopathy where nerve fibers were damaged but surrounding cells were spared, allowing regeneration.
3
A myelopathy was unmasked during recovery, indicating spinal cord involvement that contributed to the patient's ongoing disability.

Research Summary

This case documents convincingly, for the ﬁrst time, a severe generalised sensory-motor polyneuropathy after electrical injury and records a remarkable degree of clinical and electrophysiological recovery over a 5 year period. With time, a remarkable degree of reinnervation occurred and a myelopathy not seen on MRI but previously reported at postmortem,10 was unmasked; this now causes most of the disability including the double incontinence. The subsequent remarkable degree of regeneration and recovery of the peripheral nerves in both legs as well as the left arm is entirely consistent with a generalised axonopathy, relative sparing of anterior horn cells, and regeneration after acute wallerian degeneration.

Practical Implications

Diagnostic awareness

Increased awareness of generalized polyneuropathy as a potential consequence of electrical injury, even without obvious thermal damage.

Rehabilitation potential

Highlights the potential for significant neurological recovery and reinnervation following severe electrical injuries, informing rehabilitation strategies.

Pathophysiology understanding

Supports the role of non-thermal mechanisms, such as electroporation, in causing nerve damage from electrical injuries, guiding future research.

Study Limitations

1
Single case study limits generalizability.
2
MRI may not have been sensitive enough to detect early spinal cord damage.
3
Lack of early electrophysiological investigation in similar cases limits comparative data.

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