Traumatic Pneumocephalus in the Absence of Skull Fracture in an Electrical Burn Victim: a case report

Resumo

Paciente do sexo masculino de 38 anos foi transportado de helicóptero para o centro de referência de trauma e queimaduras devido a queimaduras elétricas de alta tensão causadas por fios elétricos num poste. Foi internado com um GCS de 14 pontos e o caminho de tensão elétrica que entra no tórax e sai pela região parieto-occipital direita e vice-versa. Aproximadamente 8% da superfície do corpo foi queimada. A TAC do crânio mostrou um osso craniano intacto e pneumocéfalia laminar na região parietal direita. O tratamento conservador foi escolhido com resolução espontânea 5 dias depois. Durante duas semanas, o paciente permaneceu em coma e decidiu-se não abordar cirurgicamente o paciente. O choque elétrico é uma resposta elevada e aguda resultante da presença de fluxo elétrico no corpo humano. A ocorrência de pneumocefalia está mais frequentemente associada a cenários de lesão traumática, mas os mecanismos que causam alterações ósseas após a condutividade elétrica ainda não são bem compreendidos e tais casos raramente são reportados. Dado o cenário de inúmeras complicações resultantes de acidentes com alta voltagem, deveria ser rotina que os médicos responsáveis pelos serviços de emergência realizem tomografias computorizadas ao crânio em pacientes resultantes destes acidentes, para evitar lesões não notadas.

Palavras-chave

Danos encefálicos; Danos elétricos; Pneumoencefalia

Abstract

A 38-year-old male patient was airlifted to the trauma and burns referral center with high-voltage electrical burns caused by electrical wires on a pole. He was admitted with a 14-point GCS and the electrical voltage path entering the thorax and exiting in the right parietooccipital region and back. Approximately 8% of the body surface was burned. Skull CT showed an intact cranial bone case and laminar pneumocephalus in the right parietal region. Conservative treatment was chosen with spontaneous resolution 5 days later. For two weeks, the patient remained in coma and it was decided not to surgically approach the patient. Electric shock is a high and acute response resulting from the presence of electrical flow in the human body. The occurrence of pneumocephalus is most often associated with traumatic injury scenarios, but the mechanisms that cause bone changes after electrical conductivity are still not well understood and such cases are rarely reported. Given the scenario of numerous complications resulting from accidents with high voltage, it should be routine for doctors responsible for emergency services to perform CT scans of the skull on patients resulting from these accidents in order to avoid unnoticed injuries.

Keywords

Brain injuries; Electric injuries, Pneumocephalus

References

1. Hoffman Z, Cwynar R, Bielesz B, Ceglarz M, KamińskaWinciorek G, Bażowski P. Multidisciplinary approach for a severe head burn caused by high-voltage electrical shock-a case report. J Educ Health Sport. 2022;12(9):754-62. https://doi.org/10.12775/ JEHS.2022.12.09.089.

2. Fish RM, Geddes LA. Conduction of electrical current to and through the human body: a review. Eplasty. 2009;9:e44. PMid:19907637.

3. Brinn LB, Moseley JE. Bone changes following electrical injury: case report and review of literature. Am J Roentgenol Radium Ther Nucl Med. 1966;97(3):682-6. https://doi.org/10.2214/ajr.97.3.682. PMid:5927612.

4. Priestley KL, Scarbrough TJ, Polcari PJ, Whitaker BG. Traumatic pneumocephalus without skull fracture from a high-voltage electrical injury. Cureus. 2021;13(7):e16700. https://doi.org/10.7759/cureus.16700. PMid:34462706.

5. Griffin J, Kaleemi R, Rasheed N, Syed I. Silent intruder: traumatic pneumocephalus without a fractured skull. Eurorad. 2024;1-7. https:// doi.org/10.35100/eurorad/case.18579.

6. Bacci N, Burnett B, Lin S, Pellegrini J, Thompson T. Harnessing Thor’s Hammer: experimentally induced lightning trauma to human bone by high impulse current. Forensic Sci Int Synerg. 2021;3:100206. https://doi.org/10.1016/j.fsisyn.2021.100206. PMid:34988414.

7. Kleinschmidt-DeMasters BK. Neuropathology of lightning-strike injuries. Semin Neurol. 1995;15(4):323-31. https://doi.org/10.1055/s-2008-1041039.

PMid:8848648.