Spinal cord injury after electrical trauma treated in a burn unit.

OBJECTIVE: To analyse the incidence, diagnosis and outcome of spinal cord injury in patients with electrical injuries. PATIENTS AND METHODS: Retrospective analysis of patients with electrical injuries 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, the posterior cords and the spinothalamic tract, causing a pyramidal syndrome with abnormal sensation and involvement of posterior cords, one with paraplegia and the other one with quadriplegia. Diagnoses were made 1 and 2 weeks after admission, respectively, when sedation was discontinued and neurological signs could be appreciated. Computerised axial tomography and nuclear magnetic resonance were normal in both cases at the moment of diagnosis. Both patients experienced a slow but progressive improvement of their neurological 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 infrequent after electrical injury, (ii) the difficulty in making the diagnosis of spinal cord injury after electrical trauma, and (iii) the importance of early diagnosis to define neurological prognosis and start available therapies as soon as possible.