If seen in an unaccompanied, comatose patient, lightning injury may be presumed. Vascular Intense vasomotor instability, possibly due to autonomic dysfunction, has been repeatedly documented in these patients. Arterial spasm leads to cold, mottled, pulseless extremities. This is usually a temporary finding, resolving spontaneously within hours. Ophthalmic More than half of all lightning victims suffer some form of ophthalmic injury, most commonly involving the cornea.
Damage is the result of a combination of electrical energy and intense brightness.
They can occur months or even years after the initial insult. Therapy is delayed since a percentage resolve spontaneously over time. It is extremely important to remember that autonomic dysfunction is common after lightning strikes, possibly resulting in mydriasis, loss of pupillary reflex, anisocoria, and Homer's syndrome. Otologic Tympanic membrane rupture is the most common otologic abnormality, occurring in more than half of patients secondary to barotrauma. Ossicular disruption, vertigo and sensori-neural hearing loss can also be evident.