Delayed cerebellar infarction after a slight electric injury

Electrical injury causes direct damage to nerves. It may manifest as peripheral nerve injury, spinal cord damage, cerebellar ataxia, hypoxic encephalopathy, or intracerebral hemorrhage. Various factors determine the severity of electric injury, including type of current, amperage, voltage, tissue resistance, pathway of the current, and duration of contact with the body. However, the severity of the electrical injury is not proportional to the source voltage, visible burns, loss of consciousness, or neuroimaging findings. While most neurologic aftereffects due to electric injuries are immediate and transient, delayed and permanent manifestations are also known. We report a case of a middle-aged man who accidentally sustained cerebellar infarction without burns, which occurred 4 days after a slight electrical injury. Magnetic resonance imaging of the brain showed an acute infarct in the bilateral cerebellar and left occipital regions. The exact mechanism of the delayed cerebellar infarction after a slight electric injury still remains unknown. The initial electrical injury might result in a transient neurapraxia-like situation, but progressive cellular damage and death accounts for the evolution of delayed-onset symptoms. We learned from this case that we should not underestimate any potential risk of electrical injury; continuous observation should be made in case of subsequent neurologic dysfunction.

as reported in: Am J Emerg Med. 2018 Dec; 36(12): 2337.e3-2337.e5