Mountain medical mystery. Unwitnessed death of a healthy young man, caused by lightning

Pneumocephalus in lightning injury with additional neurologic sequelae

Lightning strike injury may present with a variety of injuries including burns and the sequelae of falls following the strike, and any pneumocephalus is usually as a result of a basal skull fracture following a fall. We present a case of pneumocephalus without skull fracture following lightning strike in a 58-year-old male. He suffered bilateral tympanic membrane rupture and the air entered his skull via a congenital defect in petrous tegmen tympani. The patient suffered a range of neurologic symptoms that were not fully resolved six months following injury.

Forensic examination after exhumation: Contribution and difficulties after more than thirty years of burial

We report a case of a Tunisian footballer who was found dead abroad under suspicious circumstances. The cause of death was, originally, attributed to a lightning strike. The corpse was buried without/autopsy. Over thirty years later, the family requested the exhumation to verify the identity and the cause of death. The exhumation was performed in 2011. DNA profiling from teeth and femur bone samples confirmed the identity of the deceased. The dry bone study revealed defects in the skull and the pelvis evoking firearm injuries. Post-mortem CT with three-dimensional (3-D) reconstruction allowed to confirm the characteristics of firearms injuries and to speculate about the number and the trajectories of potential shots. Nevertheless, the vitality of these injuries as well as the eventual fatal shot and the shooting distance could not be determined. Likewise, the type of the eventual weapon could not be clarified as there were no bullets or any metallic projectile fragments. Despite all doubts, the forensic explorations have allowed to verify the identity of the deceased, to evoke firearms injuries and, mainly, to deny the proposed cause of death after more than thirty years of burial. Moreover, the loss of soft tissues and bone fragility were the major obstacles.

Lightning injury: a review

Lightning is an uncommon but potentially devastating cause of injury in patients presenting to burn centers. These injuries feature unusual symptoms, high mortality, and significant long-term morbidity. This paper will review the epidemiology, physics, clinical presentation, management principles, and prevention of lightning injuries.

Deaths, Injuries, and Damages from Lightning in the United States in the 1890s in Comparison with the 1990s

A reduction by a factor of 10 in the population-weighted rate of lightning-caused deaths over the last century has been determined in several previous studies. The reasons have been attributed to a number of factors, but none have been quantified in detail with a large dataset. Several thousand lightning-caused deaths, injuries, and reports of property damage in the United States from 1891 to 1894 were analyzed manually from descriptions provided by an 1895 data source. A similar manual analysis was made of information in the NOAA publication Storm Data 100 yr later, from 1991 to 1994. Comparisons show that the decrease in lightning risk to people coincides with a shift in population from rural to urban regions. Major changes in the types of property damaged by lightning between the two periods 100 yr apart are also shown. In addition, the results identify significant shifts in the kinds of incidents in which people and objects are impacted by lightning. This information can help in the development of better guidelines for lightning safety and education.

Lightning injuries: prevention and on-site treatment in mountains and remote areas

Lightning is a hazard during outdoor activities, especially for hikers and mountaineers. Specific preventive measures include staying off ridges and summits, and away from single trees. If possible, stay close to a wall but keeping a distance of at least 1m away from the wall. All metal objects (carabiners, crampons, ice-axe, ski poles, etc.) should be removed and stored away safely. Lightning currents can follow wet ropes. To prevent blunt trauma the helmet should not be removed. Move as quickly as possible away from wire ropes and iron ladders. The crouch position should be adopted immediately if there is a sensation of hair "standing on end". Crackling noises or a visible glow indicate an imminent lightning strike. Rescue of lightning victims may be hazardous. Airborne helicopters can be struck by lightning with disastrous effects. It is prudent to wait until the danger of further strikes has passed. Treatment of lightning victims is based upon the ABCs - (Assessment) airway, breathing and circulation. Victims who are not breathing can often be resuscitated and should be helped first. Respiratory arrest may be prolonged, but the prognosis can be excellent if breathing is supported. Standard Advanced Life Support (ALS), if necessary, should be given at the scene.

Lightning fatalities on the South African Highveld: a retrospective descriptive study for the period 1997 to 2000

A review of the Southern Africa medical literature shows a paucity of published data regarding lightning fatalities. The South African Highveld has a lightning ground flash density of 6 to 9 flashes/km/year, with a high incidence of thunderstorm days per year (some 40-70). The Highveld has a largely urban population, many of whom have low socioeconomic status and poor education, housing, and other infrastructures and hence (possibly) are at greater exposure risk. Thirty-eight victims of lightning-related death were identified from the records of the 6 large medicolegal mortuaries on the South African Highveld, serving a population of approximately 7 million, for the period 1997 to 2000. Analysis of the records revealed that 95% of all victims were black, 79% were male, and the average age was 36 years. Lightning strikes occurred from September through to April (normal summer rainfall period), and the most strikes took place in the late afternoon (3:00 pm to 6:00 pm). All except 1 case occurred outdoors. In the autopsy reports, mention was made of singeing of hair in 68% of cases, and mention of damage to clothing was made in 26% of cases. Cutaneous thermal injuries were noted in 34 of the 38 cases, with apparent electrothermal injuries of the feet noted in 4 cases. Fifty-two percent of victims sustained some form of associated blunt-force injury (including abrasions, contusions, etc). Specific keraunopathologic injuries were described in only 2 of the cases. Twenty-one cases had some form of internal organ injury. This study serves to illustrate the relatively high incidence of lightning strikes in the region and calls for a more systematic and detailed investigative protocol in lightning-related deaths.