Imaging of spinal cord injuries from high voltage electrical burns – a case study and literature review
Jessica Papali’i-curtin1, Richard Wong She1, Lindsay Damkat-Thomas1, Andrew Houghton1, 1Middlemore Hospital, Auckland Aotearoa
Abstract
Although spinal cord dysfunction is a known consequence in 3-7% of high voltage electrical burns (1, 2); imaging and electromyographic studies do not appear reliable in diagnosing or determining the extent or level of injury. We present a case study of a 28-year-old male who sustained high voltage electrical burns resulting in paraplegia and bilateral upper limb amputations. MRI repeated over a 5 month interval did not demonstrate radiological evidence of a spinal cord injury, yet his clinical exam showed complete loss of power below L2. Nerve conduction studies were not normal but difficult to interpret.
There are limited cases of spinal cord injury post high voltage electrical burns in the English literature. Variable recovery has been reported. Variable patterns of detection on imaging and neurophysiologic studies are described. Our case highlights the limitation of regular MRI to visualise abnormalities in both the acute and late phases despite obvious clinical dysfunction. For our patient, the lack of MRI findings meant that he could not receive certain supports reserved for spinal cord injury patients, as the criteria for access to these supports required radiologic evidence of spinal cord injury. With over 60 cases of spinal cord injury post high voltage electrical injury reported in the literature, this should be a recognised potential sequalae of such injuries.
1. Kingsly, P.; Dhanraj, P.; Cupta, A. Recovery after spinal cord injury due to high tension electrical burns: a 5-year experience. 2008. Burns, vol 34, 6.
2. Koller, J.; Orsagh, J. Delayed neurological sequalae of high-tension electrical burns. 1989. Burns vol 15, 3
Biography
I am a SET 3 plastics trainee in New Zealand and have just completed my 6 months burn rotation at the national burns unit in Auckland.