On Doctoring MEDLINE searches, with reference librarian comments, March 2000

The question was

What are the potential neurological effects that can occur
in a patient that has been struck by lightning?

1     Lightning injuries/co [Complications]    results=53   
2     limit 1 to (human and english language)    results=49   
3     from 2 keep 1-2,8,14,18,21-26,32,43,46    results= 14   

Reference Librarian comments

Good job! You used subject-headings appropriately, selected subheadings, combined sets, "limited" results, etc.

Just for fun, I tried the search also. I didn't have a lot of time, so it's a "quick & dirty" approach, but the subject is interesting.

Here's my strategy, and results (below...)

Medline 1991 to January 2000

#
Search History
Results
1
exp *Lightning injuries/
117
2
exp Neurologic examination/
24603
3
exp Brain/
180033
4
(nerve$ or neurolog$).tw.
103399
5
Neuropsychological Tests/
9844
6
exp personality disorders/
4968
7
exp autonomic nervous system diseases/
3006
8
exp spinal cord injuries/ or exp brain injuries/
12818
9
or/2-8
302114
10
1 and 9
32
11
limit 10 to (human and english language)
27

<1>
AN 99215779
AU Norman ME. Younge BR.
IN Seacoast Ophthalmology, Portsmouth, New Hampshire 03801, USA.
TI Association of high-dose intravenous methylprednisolone with reversal of
blindness from lightning in two patients.
SO Ophthalmology. 106(4):743-5, 1999 Apr.
LM Pre-1993 at Dana,1993-date at MFHSL.
AB OBJECTIVE: To report possibly beneficial effects of treatment with high-dose
corticosteroids given intravenously to two patients with loss of vision after
lightning strikes. DESIGN: Case reports. PARTICIPANTS: Two
patients who suffered the effects of a lightning strike.
INTERVENTION: High-dose intravenous methylprednisolone (NASCIS-2 Protocol).
MAIN OUTCOME MEASURES: Vision recovery, pupil responses, and optic
nerve appearance. RESULTS: One patient had unilateral
ophthalmoscopically visible abnormality with light perception vision and a
relative afferent defect in that eye; vision recovered to 20/25. The other
patient had no light perception, nonreactive pupils, and normal fundus
examinations in both eyes; vision recovered bilaterally to
normal (20/20). CONCLUSIONS: High-dose intravenous corticosteroid treatment
in these patients may have had a role in their visual recovery.

<2>
AN 98309521
AU van Zomeren AH. ten Duis HJ. Minderhoud JM. Sipma M.
IN Department of Neurology, University Hospital, Groningen,
The Netherlands.
TI Lightning stroke and neuropsychological
impairment: cases and questions.
SO Journal of Neurology, Neurosurgery & Psychiatry.
64(6):763-9, 1998 Jun.
LM Pre-1993 Dana; 1993-dateMFHSL;for Web access-check catalog
AB OBJECTIVE: To objectify neuropsychological impairments in
survivors of lightning stroke with lasting complaints about
poor concentration and inability to divide their attention. DESIGN: A series
of six cases of lightning stroke were studied. All patients
had lost consciousness and reported amnesia of varying length. Assessment
took place between one and four years after injury, ensuring that their
neurological state had stabilised. They were tested with a
neuropsychological battery with an emphasis on attention and
memory. Personality and emotional reaction to the accident
were assessed with questionnaires and a lightning fear
scale. Complaints were recorded by means of a trauma
complaints list including 10 questions on symptoms of the post-traumatic
stress disorder. RESULTS: Patients reported fatigue and lack of energy as
their main complaints. In addition, poor concentration, irritability, and
emotional lability were mentioned often. Neuropsychological
tests disclosed mild impairments in memory, attention, and
visual reaction times. Two patients could be classified as depressed, and one
of these also showed convincing signs of the post-traumatic stress disorder.
CONCLUSION: As the lasting complaints and impairments could not be explained,
for all six cases, as resulting from head injury concomitant with
lightning stroke, cerebral hypoxia or a post-traumatic
stress syndrome, it is concluded that lightning stroke can
result in subtle cognitive impairments. It is speculated that most complaints
of these survivors are caused by a vegetative dysregulation, a disorder that
has often been noted in the literature on the effects of electrical injury to
the nervous system. Such a dysregulation
might cause both the main complaint of fatigue and the mild cognitive
impairments identified with the present test battery.

<3>
AN 97217887
AU Cherington M. Krider EP. Yarnell PR. Breed DW.
IN Lightning Data Center, St. Anthony Hospital, Denver, CO
80204, USA.
TI A bolt from the blue: lightning strike to the head [see
comments].
CM Comment in: Neurology 1998 Mar;50(3):830
SO Neurology. 48(3):683-6, 1997 Mar.
LM Pre-1993 at Dana,1993-date at MFHSL.
AB We report an extraordinary event of a lightning strike to
the head of a helmeted bicyclist that occurred under fair weather conditions
with a cloudless sky. The patient sustained a cardiac arrest and hypoxic
encephalopathy with residual neurologic impairment. With the
availability of highly developed meteorologic equipment, we were able to
determine that the lightning "bolt from the blue" probably
originated in a thunderstorm that was about 16 km away and obscured by the
mountains.

<4>
AN 97044793
AU Janus TJ. Barrash J.
IN Department of Neurology, University of Iowa College of
Medicine, Iowa City 52242-1053, USA.
TI Neurologic and neurobehavioral effects of electric and
lightning injuries.
SO Journal of Burn Care & Rehabilitation. 17(5):409-15, 1996 Sep-Oct.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB There are few studies of the effects of electric and
lightning injuries (ELI) on the
neurologic and neuropsychological status of
injured patients. We reviewed records of fourteen patients
with ELI injuries seen at our hospital (12 with high-voltage
electric and two with lightning injury). Eight had cardiac
arrest after injury, and 10 had neurologic complaints when
first evaluated. Eight had normal neuroimaging results. Six had
electroencephalograms; four showed abnormal results. Thirteen underwent
neuropsychological testing. Twelve (92%) showed cognitive
dysfunction including impairments in memory, attention, and affective
disturbances (anxiety, depression, irritability, and poor frustration
tolerance). Five of 12 (62%) had multiple physically aggressive outbursts,
not present before the injury. Patients with cardiac arrest did not differ in
neurologic psychologic testing from patients not sustaining
cardiac arrest. Patients with ELI who had neurobehavioral symptoms had a
coherent syndrome characterized by disturbances in cognition (attention and
memory), mood (distress with prominent irritability), and behavior
(aggressive outbursts). Serial neurologic and
neuropsychological evaluations will aid in better defining
the sequelae of ELI.

<5>
AN 97091366
AU Shaw PK. Brouwer RE. Spaander PJ. Tjandra YI.
IN Department of Internal Medicine, Rode Kruis Hospital, Gravenhage,
Netherlands.
TI Nature's high-voltage injuries: sometimes a deadly
consequence. [Review] [20 refs]
SO Netherlands Journal of Medicine. 49(4):153-9, 1996 Oct.
LM Dana. Incomplete holdings, check catalog.
AB A patient is described who presented with the clinical picture of
respiratory failure, persistent comatose state and myocardial injury after
being struck by lightning. The discussion reviews the
management of lightning injuries with
emphasis on cardiovascular and neurological complications.
[References: 20]

<6>
AN 96326759
AU Wetli CV.
IN Metro-Dade County Medical Examiner Department, Miami, Florida, USA.
TI Keraunopathology. An analysis of 45 fatalities.
SO American Journal of Forensic Medicine & Pathology. 17(2):89-98, 1996 Jun.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB An analysis of 45 victims of fatal lighting strike revealed the incident
occurred most frequently in the early afternoon during midsummer in a field
of one form or another. The scene of death, damage to clothing, and
alterations of metallic objects on the victim are described. A terminal
cardiac rhythm of ventricular fibrilation was recorded in
half for whom data were available, and asystole was found in 40%. All but
four had cutaneous injuries, and nearly one-third had
pathognomonic patterns of erythematous arborization. When examined, tympanic
membranes were found to be ruptured in > 80%. This study also revealed that
craniocerebral injury and cardiac contusion can be serious direct
consequences of lightning strike. A correlative approach to
the investigation and autopsy of lightning victims is
suggested.

<7>
AN 97077286
AU Milton WJ. Hal O'Dell R. Warner EG.
IN Department of Radiology, Baptist Medical Center of Oklahoma, Oklahoma City
73112, USA.
TI MRI of lightning injury: early white matter changes
associated with cerebral dysfunction [see comments]. [Review] [9 refs]
CM Comment in: J Okla State Med Assoc 1997 Feb;90(2):74
SO Journal - Oklahoma State Medical Association. 89(3):93-4, 1996 Mar.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB A previously healthy male was struck by lightning. He
developed neurologic deficits, including mild cerebral
brain dysfunction. Magnetic resonance imaging (MRI) showed
numerous foci of hyperintensity on long TR images, scattered throughout the
supratentorial white matter. To our knowledge, the early MRI findings of
lightning injury have not been previously reported.
[References: 9]

<8>
AN 96274884
AU Yarnell PR. Lammertse DP.
IN Lightning Data Center, Provenant St. Anthony Hospital,
Denver, Colorado, USA.
TI Neurorehabilitation of lightning and electrical
injuries. [Review] [51 refs]
SO Seminars in Neurology. 15(4):391-6, 1995 Dec.
LM Dana. Incomplete holdings, check catalog.
AB Lightning and electrical (L/E) injuries
can be among the most dramatic of all events that damage the
nervous system. The three major classes of
neurologic sequelae that require the expertise of the
neurorehabilitationist are: (1) cerebral disorders, either
global or focal; (2) neuropsychologic sequelae; and (3)
spinal cord injury. Neurorehabilitation
management necessary for each of these three areas will be discussed. From
the viewpoint of the neurorehabilitationist, therapy principles are the same
for L/E trauma as for other more common forms of injury. The goal is to
maximize the functional return given the specific impairment. [References:
51]

<9>
AN 96274883
AU Cohen JA.
IN Department of Neurology, University of Colorado Health
Sciences Center, Denver 80205, USA.
TI Autonomic nervous system
disorders and reflex sympathetic dystrophy in
lightning and electrical injuries. [Review]
[23 refs]
SO Seminars in Neurology. 15(4):387-90, 1995 Dec.
LM Dana. Incomplete holdings, check catalog.
AB Both lightning and electrical injuries can
cause autonomic nervous
system (ANS) symptoms and signs (Table 1). Published
descriptions of ANS involvement occurring with lightning and
electrical injuries are rare. The most often reported
neurologic complications of lightning
injuries involve the central nervous
system. ANS abnormalities have been documented with
lightning, although the descriptions are scant. There is a
lack of complete clinical information or ANS testing data in these cases.
This is usually a result of the transient nature of ANS complications. In
electrical injuries, ANS involvement is less well described
than for lightning. Electrical injuries can
be associated with peripheral nerve damage. As a result of
peripheral nerve damage, reflex sympathetic dystrophy (RSD)
may occur in patients with electrical injuries. Various
treatment strategies for RSD associated with electrical
injuries are found in single case reports. This article
summarizes ANS involvement, predominantly in lightning
injuries, and describes RSD and its treatment, predominantly
in electrical injuries. [References: 23]

<10>
AN 96274879
AU Cherington M.
IN Lightning Data Center, Provenant St. Anthony Hospital,
Denver, Colorado 80204-1374.
TI Lightning and transportation. [Review] [47 refs]
SO Seminars in Neurology. 15(4):362-6, 1995 Dec.
LM Dana. Incomplete holdings, check catalog.
AB It is a little-known fact that lightning casualties often
involve travel or transportation. Lopez and colleagues, in their studies on
the epidemiology of lightning injuries,
have reported that 10% of lightning
injuries are categorized under transportation. In the
majority of their cases, victims were struck while standing outside or near
their vehicles during a thunderstorm. During my review of the
neurologic complications of lightning
injuries, I was impressed by the number of case reports in
which the victim was struck while either in or near a vehicle, airplane or
vessel. In this article, I shall put forth information on four aspects of
lightning that relate to the danger to people traveling in
vehicles, boats, and airplanes. First, I shall deal with
lightning safety on ships and boats. People who enjoy
recreational sailing, including the "weekend sailor" and those who enjoy
fishing from a boat, should be fortified with knowledge about
lightning protection. Second, I shall consider the matter of
lightning strikes to aircraft. In the third section, I shall
discuss the question of lightning safety in automobiles.
Fourth, I shall review those cases found in my literature review in which the
victim was struck while in or near a vehicle, boat, or airplane. [References:
47]

<11>
AN 96274873
AU Kleinschmidt-DeMasters BK.
IN Department of Pathology, University of Colorado Health Science Center,
Denver 80262, USA.
TI Neuropathology of lightning-strike
injuries. [Review] [34 refs]
SO Seminars in Neurology. 15(4):323-8, 1995 Dec.
LM Dana. Incomplete holdings, check catalog.
AB When a person is struck by lightning a spectrum of
neurologic damage can result. Approximately one third of the
strikes prove to be fatal. The possibility of damage to the CNS relates to
the type of lightning injury (direct strike, stride
potential, or side flash), the intensity and duration of the current, the
pathway of the current within the body, and secondary
injuries to brain either from cardiac
arrest and hypoxia or from physical trauma. Direct strikes to the head have a
high degree of fatality and often result in petechiae or larger
brain hemorrhages. Although there may be some predilection
for the petechiae to occur in the brainstem, the larger
hemorrhages may be particularly located near the pathway of the electrical
current and result from direct damage to brain vasculature.
Enlarged perivascular spaces seen histologically are relatively subtle; they
have been attributed to the effects of gas bubbles from electrolysis, heat
formation, or both. Small vessel thrombi and neuronal changes may be present
nearby. Some brain tissue softening and edema may be direct
effects of passage of current. Often, however, hypoxic encephalopathy and
cerebral edema occur following cardiopulmonary arrest when the passage of the
current through the body presumably generates cardiac arrhythmias.
Considerably less is known about the spinal
cord injuries in lightning
strike, although one detailed recent study suggests that demyelination may be
an underlying mechanism. Similarly, myelin damage appears to be a feature of
electrical and possibly lightning injury to the peripheral
nervous system. [References: 34]

<12>
AN 96118005
AU Cooper MA.
IN Department of Emergency Medicine, University of Illinois at Chicago
60612-7354, USA.
TI Emergent care of lightning and electrical
injuries. [Review] [114 refs]
SO Seminars in Neurology. 15(3):268-78, 1995 Sep.
LM Dana. Incomplete holdings, check catalog.
AB High-voltage electrical injuries may be devastating, with
extensive burns, cardiac arrest, amputations, and long, complicated
hospitalizations. Low-voltage injuries, after other
pathologic and high-voltage sources are ruled out, tend to be rather benign
acutely although they may have significant long-term morbidity, including
chronic pain syndromes. Lightning injuries
affect 800 to 1000 persons per year. In lightning injury,
cardiac arrest is the main cause of death, burns tend to be superficial, ad
injuries often are what one would expect of short-circuiting
or overloading the body's electrical systems (tinnitus,
blindness, confusion, amnesia, cardiac arrhythmias, and vascular
instability). Although high-voltage injuries may require the
services of trauma surgeons, in general, therapy for low-voltage and
lightning injury is supportive and involves cardiac
resuscitation for the more seriously injured and supportive care for the less
severely injured. Long-term problems from sleep disturbances, anxiety
attacks, pain syndromes, peripheral nerve damage, fear of
storms (for lightning patients), and diffuse
neurologic and neuropsychologic damage may occur in both
electrical and lightning patients. Other sequelae--such as
seizures or severe brain damage from hypoxia during cardiac
arrest and spinal artery syndrome from vascular spasm--are
indirect results of electrical and lightning injury.
[References: 114]

<13>
AN 96118001
AU Cherington M.
IN Lightning Data Center, Provenant St. Anthony Hospital,
Denver, Colorado 80204-1374, USA.
TI Central nervous system complications of
lightning and electrical injuries. [Review]
[107 refs]
SO Seminars in Neurology. 15(3):233-40, 1995 Sep.
LM Dana. Incomplete holdings, check catalog.

<14>
AN 96118002
AU Wilbourn AJ.
IN Neurology Department, Cleveland Clinic Foundation, OH
44106, USA.
TI Peripheral nerve disorders in electrical
and lightning injuries. [Review] [95 refs]
SO Seminars in Neurology. 15(3):241-55, 1995 Sep.
LM Dana. Incomplete holdings, check catalog.

<15>
AN 96118003
AU Ogren FP. Edmunds AL.
IN Department of Otolaryngology-Head and Neck Surgery, University of Nebraska
Medical Center, Omaha 68198-1225, USA.
TI Neuro-otologic findings in the lightning-injured patient.
SO Seminars in Neurology. 15(3):256-62, 1995 Sep.
LM Dana. Incomplete holdings, check catalog.
AB Although lightning injuries are common,
neuro-otologic sequelae are infrequently reported. The most common otologic
injury encountered in the lightning strike victim is
tympanic membrane rupture; the most common vestibular disturbance documented
is transient vertigo. A variety of other clinical findings have been
described in this population of patients. They include sensorineural hearing
loss, conductive deafness, tinnitus, basilar skull fracture, avulsion of the
mastoid bone, burns to the external auditory canal, and peripheral facial
nerve palsy. The initial treatment of the
lightning strike victim consists of basic life support
measures. Once stabilized, the patient should undergo a complete otologic and
vestibular evaluation. The majority of otolaryngologic problems encountered
can be managed expectantly, with periodic re-evaluation. Tympanoplasty should
be delayed for 6 to 12 months because of the frequent delay in spontaneous
healing.

<16>
AN 96118006
AU Primeau M. Engelstatter GH. Bares KK.
IN Department of Psychology, Finch University of Health Sciences/Chicago
Medical School, Illinois, USA.
TI Behavioral consequences of lightning and electrical injury.
[Review] [31 refs]
SO Seminars in Neurology. 15(3):279-85, 1995 Sep.
LM Dana. Incomplete holdings, check catalog.

<17>
AN 95407522
AU Ozgun B. Castillo M.
IN Department of Radiology, University of North Carolina School of Medicine,
Chapel Hill 27599-7510, USA.
TI Basal ganglia hemorrhage related to lightning strike.
[Review] [10 refs]
SO Ajnr: American Journal of Neuroradiology. 16(6):1370-1, 1995 Jun-Jul.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB We describe a case of bilateral basal ganglia hemorrhage after a
lightning strike to the head documented by a CT scan. Review
of the literature shows this to be the most common brain
imaging finding that can be attributed to a lightning
strike. Several mechanistic theories are discussed, with the most plausible
one being related to preferential conduction pathways through the
brain. [References: 10]

<18>
AN 95304764
AU Cherington M. Yarnell PR. London SF.
IN Lightning Data Center, St Anthony Hospital Central, Denver,
CO 80204-1374, USA.
TI Neurologic complications of lightning
injuries. [Review] [49 refs]
SO Western Journal of Medicine. 162(5):413-7, 1995 May.
LM Pre-1993 at Dana,1993-date at MFHSL.
AB Over the past ten years, we have cared for 13 patients who suffered serious
neurologic complications after being struck by
lightning. The spectrum of neurologic
lesions includes the entire neuraxis from the cerebral hemispheres to the
peripheral nerves. We describe these various
neurologic disorders with regard to the
site of the lesion, severity of the deficit, and the outcome. Damage to the
nervous system can be a serious problem for
patients struck by lightning. Fatalities are associated with
hypoxic encephalopathy in patients who suffered cardiac arrests. Patients
with spinal cord lesions are likely to have
permanent sequelae and paralysis. New technology for detecting
lightning with wideband magnetic direction finders is useful
in establishing lightning-flash densities in each state.
Florida and the Gulf Coast states have the highest densities. Colorado and
the Rocky Mountain states have the next highest. [References: 49]

<19>
AN 94122595
AU Tseng YL. Tsai MC. Wu MH.
IN Department of Emergency Medicine, National Cheng Kung University Hospital,
Tainan, Taiwan, R.O.C.
TI Lightning injury: report of a case.
SO Journal of the Formosan Medical Association. 92(8):759-61, 1993 Aug.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB Lightning injury can cause severe damage to many
systems and often results in a high mortality. We report a
case of sustained lightning injury in which a 54-year-old
woman presented with heart failure, pulmonary edema and consciousness
disturbance. The patient was found unconscious, lying face down on the ground
of a trash dump on the day of a thunderstorm. No deformities were seen in the
extremities, but scattered third degree burns (less than 1%) were found on
her neck where her necklace had been. Ventilator and inotropic agents with an
adequate fluid supply were used. A Swan-Ganz catheter was inserted for
monitoring. The patient was discharged two weeks later with an uneventful
clinical course, except for mild neurologic sequelae
(amnesia, disorientation).

<20>
AN 93317214
AU Cherington M. Yarnell P. Hallmark D.
IN Department of Neurology, University of Colorado, Denver.
TI MRI in lightning encephalopathy [see comments].
CM Comment in: Neurology 1994 May;44(5):991-2
SO Neurology. 43(7):1437-8, 1993 Jul.
LM Pre-1993 at Dana,1993-date at MFHSL.

<21>
AN 93167592
AU Fontanarosa PB.
IN Northeastern Ohio Universities College of Medicine, Akron.
TI Electrical shock and lightning strike. [Review] [101 refs]
SO Annals of Emergency Medicine. 22(2 Pt 2):378-87, 1993 Feb.
LM Pre-1993 at Dana,1993-date at MFHSL.
AB Cardiac arrest from electrical shock or lightning strike is
associated with significant mortality and requires modification and extension
of standard advanced life support measures to achieve successful
resuscitation. Patients who experience electrical shock or
lightning strike may sustain cardiac and respiratory arrest
secondary to the direct effects of current. However, the majority of victims
have associated multisystem involvement, including
neurologic complications, cutaneous burns, and associated
blunt trauma. As a result, a combination of advanced cardiac life support
measures and advanced trauma life support techniques is indicated. Victims
with cardiac arrest from electrical shock or lightning
strike require prompt, aggressive resuscitation using standard methods for
airway control, ventilation, and chest compressions, as well as usual
measures for defibrillation and cardiac pharmacotherapy. Unique
considerations include vigorous fluid resuscitation and
spinal immobilization for victims of electrical shock and
reversal of normal multiple casualty triage priorities when managing several
lightning strike victims. Because the majority of victims
are relatively young and seldom have significant underlying cardiac disease,
the chance for successful resuscitation may be greater for patients who
experience sudden death from electrical shock or lightning
strike than for those with other causes of cardiac arrest, even among
patients with initial rhythms traditionally unresponsive to therapy. Although
numerous specialized aspects are required for the successful management of
victims of electrical shock and lightning strike, the
following article focuses on the unique considerations necessary for
immediate care of cardiac arrest victims, with emphasis on the underlying
mechanisms of sudden death and currently recommended guidelines for
resuscitation. [References: 101]

<22>
AN 93062583
AU Patten BM.
IN Department of Neurology, Baylor College of Medicine,
Houston, Texas.
TI Lightning and electrical injuries.
[Review] [46 refs]
SO Neurologic Clinics. 10(4):1047-58, 1992 Nov.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB Lightning and electrical injuries are
similar in that both produce immediate tissue injury from burn and trauma
induced by fall and both can arrest the heart and respiratory center.
Immediate support of circulation and respiration is life-saving. Subsequently
the nervous system may show signs of
injury, and seizures, cerebral edema, and muscle and nerve
lesions should be handled as the indications arise. Prevention of the injury
is more effective than any postinjury treatment. Outdoors hikers and campers
must take shelter to minimize their exposure; indoors properly installed
equipment and attention to the relation of the equipment user to the
electrical ground are the key elements in avoiding electrocution.
[References: 46]

<23>
AN 92291737
AU Hawkes CH. Thorpe JW.
IN Neurological Centre, Ipswich Hospital, Suffolk, UK.
TI Acute polyneuropathy due to lightning injury.
SO Journal of Neurology, Neurosurgery & Psychiatry.
55(5):388-90, 1992 May.
LM Pre-1993 Dana; 1993-dateMFHSL;for Web access-check catalog
AB The case of a 19 year old man struck by lightning is
described. He sustained quadriplegia for several months and fully recovered.
It is suggested that his weakness was due to extensive peripheral
nerve damage. In addition, he displayed many well recognised
medical complications of lightning injury including acute
renal failure, rhabdomyolysis, respiratory distress syndrome,
autonomic dysfunction, perforated ear drum, uveitis and
cataract. The literature relating to the neurology of
lightning strike is briefly reviewed.

<24>
AN 92238615
AU Cherington M. Yarnell P. Lammereste D.
IN Neurosciences Department, St Anthony Hospital, University of Colorado School
of Medicine, Denver.
TI Lightning strikes: nature of neurological
damage in patients evaluated in hospital emergency departments.
SO Annals of Emergency Medicine. 21(5):575-8, 1992 May.
LM Pre-1993 at Dana,1993-date at MFHSL.
AB Emergency physicians and staff are usually the first to evaluate and manage
victims of lightning strikes. Damage to the
nervous system is often the most
devastating consequence of lightning strikes. Contrary to
most articles in the literature in which neurological
disorders are said to be either transient or delayed, we
report the cases of six patients with severe, immediate, and in at least
three, permanent clinical problems. Patients with signs of
spinal cord lesions are most likely to have
permanent disabilities.

<25>
AN 92071294
AU Thomas M. Pillai M. Krishna Das KV.
IN Medical College, Trivandrum.
TI Intracranial haematoma resulting from lightning stroke.
SO Journal of the Association of Physicians of India. 39(5):421-2, 1991 May.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB Intra-cerebral haemorrhage due to lightning stroke is
extremely rare. We report a 45 year old woman who developed intracranial
haemorrhage due to a direct lightning stroke. This was
proved by CT scan. The haematoma was evacuated surgically, resulting in full
neurological recovery of the patient.

<26>
AN 92079253
AU Weeramanthri TS. Puddey IB. Beilin LJ.
IN University Department of Medicine, Royal Perth Hospital, Western Australia.
TI Lightning strike and autonomic
failure--coincidence or causally related?.
SO Journal of the Royal Society of Medicine. 84(11):687-8, 1991 Nov.
LM Dana. Incomplete holdings, check catalog.

<27>
AN 91296094
AU Lehman LB.
IN Division of Neurosurgery, Maimonides Medical Center/Coney Island Hospital,
Brooklyn, New York.
TI Successful management of an adult lightning victim using
intracranial pressure monitoring.
SO Neurosurgery. 28(6):907-10, 1991 Jun.
LM Pre-1993 Dana; 1993-date MFHSL (Incomplete, check catalog)
AB Serious central nervous system
injuries after lightning strikes are
fortunately rare. Optimal neurological and neurosurgical
management has not been firmly established. We describe the successful
neurological resuscitation and critical care management
using intracranial pressure monitoring of an adult who sustained a
lightning strike. The role of intracranial pressure
monitoring in this setting is discussed.