2018 Volume 23 Issue 1 Pages 59-64
We report a case of prolonged unconsciousness and progressive brain swelling due to a diffuse brain tissue injury caused by a surface flashover and blast injury.
A 48‒year‒old man was struck by lightning while cycling. At the accident site, he was unconscious, but his breathing and cardiac rhythm were regular. On admission, he had left ear bleeding and belt‒like superficial dermal burns extending from his left ear to the left arm and to the genital area. Imaging examinations of his head revealed diffuse brain swelling with a left‒sided subdural hematoma and subarachnoid hemorrhage, and bilateral intracerebral hemorrhage. His brain swelling was progressive and intractable, and he died 11 days after the injury.
The cause of his brain swelling was considered attributable not only to the rupture of brain vessels due to Joule heating and electric energy caused by the electric current, but also to diffuse brain tissue injury caused by the surface flashover and blast injury since the patient’s skin on the head was wet. Clinicians should note that in patients with a lightning injury whose skin is wet, intracranial injury and progressive brain swelling caused by a surface flashover and blast injury can be fatal.
