Ann Rehabil Med.  2017 Apr;41(2):318-322. 10.5535/arm.2017.41.2.318.

Medial Lemniscus Tract Lesion After High Voltage Electrical Injury: A Case Report

• Cho CH
• Lee DG

• KMID: 2389492
• DOI: http://doi.org/10.5535/arm.2017.41.2.318

Abstract

We present the case of a 33-year-old man who experienced a 10,000-V electrical shock when working with electrical wiring. He suffered third-degree burns on his scalp at the right occiput (entry wound) and on his left arm (exit would), and a second-degree burn on his left foot (exit wound). He presented with severe spasticity of both lower extremities, motor weakness with a Medical Research Council grade of 3, and sensory impairments below thoracic level 11 that included an inability to sense light touch and defects in proprioception. Initial magnetic resonance imaging (MRI) scans of his spine and brain showed no definite abnormalities. However, tractography obtained by diffusion tensor imaging of the brain showed absence of the right medial lemniscus tract. A cervical MRI scan 1 month later showed spinal cord swelling from cervical 1-5 levels, and signal changes in the lateral and posterior white matter in the axial view. After 6 months of rehabilitation, he recovered almost normal degree of motor function in his lower extremities and disappearance of spasticity. However, since the sensory impairments persisted, especially defects in proprioception, he was unable to walk independently.

Keyword

Electric injuries; Burns; Medial lemniscus; Diffusion tensor imaging

MeSH Terms

Adult
Arm
Brain
Burns
Diffusion Tensor Imaging
Electric Injuries
Electric Wiring
Foot
Humans
Lower Extremity
Magnetic Resonance Imaging
Muscle Spasticity
Proprioception
Rehabilitation
Scalp
Shock
Spinal Cord
Spine
White Matter

Figure

• 

  Fig. 1 A third-degree burn on the right scalp of the patient, and skull necrosis.

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  Fig. 2 (A, C) A cervical spinal magnetic resonance imaging (MRI) taken 1 week after the injury reveals no specific findings, but a brain MRI shows signal changes in the right temporal lobe. (B) A cervical spine T2-weighted MRI, taken 30 days after the injury, shows swelling and signal changes from C1 to C5. (D) An axial T2-weighted image at the C2-3 level shows damage to the lateral and posterior column.

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  Fig. 3 Tractography of the corticospinal tract (CST) and medial lemniscus tract (ML). (A) The right CST (red) and left CST (blue) are well-connected on each anatomical level from the brain stem to the cortex. (A, B) Although the ML (green) is seen in the right hemisphere, it cannot be viewed in the left hemisphere. Both CST and right ML are properly located on the anatomical locations from cerebral cortex to pons level (C).

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