Introduction Lightning is one of the most powerful and spectacular natural phenomena. A flash of lightning can heat the air around it to 27 000 degrees Celsius, 6 times hotter than the surface of the sun. Lightning strikes the earth more than 8 million times per day. It was responsible for more than 2 40 000 injuries per year worldwide. Neurologic complications after lightning strikes are not uncommon. They vary from transient benign symptoms to permanent neurological deficits. We present a case of keraunoparalysis and a literature review of neurologic manifestations of lightning strikes.

Case A 23 year old man presented with acute paraplegia with complete sensory loss in the lower limbs after being struck by lightning. He also suffered from other significant injuries including mild sensorineural hearing loss in the left ear, right upper lobe pulmonary contusion, rhabdomyolysis (creatine kinase level peaked at 17 867units/L) and bilateral lower limb compartment syndrome requiring emergency fasciotomy. MRI full spine was normal with no evidence of cord lesion. His lower limb neurology improved significantly over 48 hours.

Conclusion Keraunoparalysis is characterised by transient lower limb weakness that usually improves within hours to days. In patients presenting with paraparesis post lightning strike, it is important to consider the diagnosis of keraunoparalysis to avoid unnecessary surgical procedures. Neuroimaging is crucial to exclude other etiologies such as traumatic cord injuries or bleeding.

References

1. . Cherington M. Neurologic manifestations of lightning strikes. Neurology2003;60:182–5.

2. . Ritenour AE, Morton MJ, McManus JG, Barillo DJ, Cancio LC. Lightning injury: A review. Burns2008;34:585–94.

3. . Kumar A, Srinivas V, Sahu BP. Keraunoparalysis: What a neurosurgeon should know about it?J Craniovertebr Junction Spine2012Jan;3(1):3–6.