Spinal cord injury after electrical trauma treated in a burn unit

Objective. To analyse the incidence, diagnosis and outcome of spinal cord i njury in patients with electrical injuries. Patients and methods. Retrospective analysis of patients with electrical in juries admitted to our Intensive Care Burn Unit over a 5 year period. Among 435 admissions, 57 (13.1% of all admissions) were electrical injuries, due to either electrical flash (n=34) or high voltage (n=23). Two cases (8.6% of high voltage injuries) presented signs of spinal cord injury. Both cases presented an acute transverse myelopathy, involving the pyramidal tract, t he posterior cords and the spinothalamic tract, causing a pyramidal syndrom e with abnormal sensation and involvement of posterior cords, one with para plegia and the other one with quadriplegia. Diagnoses were made 1 and 2 wee ks after admission, respectively, when sedation was discontinued and neurol ogical signs could be appreciated. Computerised axial tomography and nuclea r magnetic resonance were normal in both cases at the moment of diagnosis. Both patients experienced a slow but progressive improvement of their neuro logical condition, and remain presently in a rehabilitation program 15 and 18 months after trauma. Discussion. Our cases illustrate (i) that damage to the spine is not infreq uent after electrical injury, (ii) the difficulty in making the diagnosis o f spinal cord injury after electrical trauma, and (iii) the importance of e arly diagnosis to define neurological prognosis and start available therapi es as soon as possible. (C) 1999 Elsevier Science Ltd and ISBI. All rights reserved.