Acute and Evolving MRI of High-Altitude Cerebral Edema: Microbleeds, Edema, and Pathophysiology.

MR imaging of high-altitude cerebral edema shows reversible WM edema, especially in the corpus callosum and subcortical WM. Recent studies have revealed hemosiderin deposition in WM long after high-altitude cerebral edema has resolved, providing a high-altitude cerebral edema "footprint." We wished to determine whether these microbleeds are present acutely and also describe the evolution of all MR imaging findings.

Lichtenberg figures and lightning: case reports and review of the literature.

The Lichtenberg figure (LF) is a recognizable skin pattern that is only seen in individuals struck by lightning. LF, also known as a ferning pattern, is a transient finding. It is not a burn, and biopsies of the skin reveal no pathologic changes.

Neurorehabilitation of cerebral disorders following lightning and electrical trauma.

The most devastating casualties in lightning and electrical trauma patients are the result of lesions of the nervous system, and especially lesions of the brain. The brain injuries can be divided into three categories: global dysfunction; focal brain injuries; and behavioral-cognitive sequelae without gross physical signs. Lightning injuries are usually the result of outdoor sports and leisure activities.

Mountain medical mystery. Unwitnessed death of a healthy young man, caused by lightning.

A healthy 20-year-old man failed to return home after a jog in the Colorado mountains. His lifeless body was found the next day on an exposed mountain slope. The differential diagnosis in such mysterious, unwitnessed mountain deaths includes cardiac arrhythmia, cerebral hemorrhage, pulmonary embolism, seizures, trauma, high-altitude sickness, and hypothermia.

High-altitude cerebral edema (HACE): the Denver/Front Range experience.

High-altitude cerebral edema (HACE) is a potentially fatal metabolic encephalopathy associated with a time-dependent exposure to the hypobaric hypoxia of altitude. Symptoms commonly are headache, ataxia, and confusion progressing to stupor and coma. HACE is often preceded by symptoms of acute mountain sickness and coupled, in its severe form, with high-altitude pulmonary edema.

Lightning injuries during snowy conditions.

Skiers and other snow sports enthusiasts can become lightning casualties. Two such accidents are reported, one being fatal. There are fewer warning signals of impending lightning strikes in winter-like conditions.

High-altitude cerebral edema evaluated with magnetic resonance imaging: clinical correlation and pathophysiology.

Context: Because of its onset in generally remote environments, high-altitude cerebral edema (HACE) has received little scientific attention. Understanding the pathophysiology might have implications for prevention and treatment of both this disorder and the much more common acute mountain sickness.

Objectives: To identify a clinical imaging correlate for HACE and determine whether the edema is primarily vasogenic or cytotoxic.

A bolt from the blue: lightning strike to the head.

We report an extraordinary event of a lightning strike to the head of a helmeted bicyclist that occurred under fair weather conditions with a cloudless sky. The patient sustained a cardiac arrest and hypoxic encephalopathy with residual neurologic impairment. With the availability of highly developed meteorologic equipment, we were able to determine that the lightning "bolt from the blue" probably originated in a thunderstorm that was about 16 km away and obscured by the mountains.

Neurorehabilitation of lightning and electrical injuries.

Lightning and electrical (L/E) injuries can be among the most dramatic of all events that damage the nervous system. The three major classes of neurologic sequelae that require the expertise of the neurorehabilitationist are: (1) cerebral disorders, either global or focal; (2) neuropsychologic sequelae; and (3) spinal cord injury. Neurorehabilitation management necessary for each of these three areas will be discussed.

Neurologic complications of lightning injuries.

Over the past ten years, we have cared for 13 patients who suffered serious neurologic complications after being struck by lightning. The spectrum of neurologic lesions includes the entire neuraxis from the cerebral hemispheres to the peripheral nerves. We describe these various neurologic disorders with regard to the site of the lesion, severity of the deficit, and the outcome.

Childhood lightning injuries on the playing field.

Two young boys were struck by lightning during summer outdoor activities. One of them died. A literature review reveals that the most commonly reported locations of childhood lightning injuries are on the playing field, at the swimming pool, and in tents.

Lightning strikes: nature of neurological damage in patients evaluated in hospital emergency departments.

Emergency physicians and staff are usually the first to evaluate and manage victims of lightning strikes. Damage to the nervous system is often the most devastating consequence of lightning strikes. Contrary to most articles in the literature in which neurological disorders are said to be either transient or delayed, we report the cases of six patients with severe, immediate, and in at least three, permanent clinical problems.

Minor whiplash head injury with major debilitation.

A group of patients suffering major debility after minor whiplash head trauma, seen in one office practice, has been retrospectively studied. Typically, acute neck and upper back aches and headache evolved into a multiple somatic, affective and cognitive dysfunction syndrome. Neuropsychological evaluations noted impairments on tests of cognitive flexibility, non-verbal reasoning, new learning/memory, psychomotor agility, and attention.

Poor outcome after lateral medullary infarcts.

In two patients, lateral medullary infarcts were followed by repeated brainstem ischemia. One patient had posturally sensitive vertebrobasilar TIAs, and the other had TIAs followed by quadriparesis. Both had angiographic evidence of intracranial vertebral artery occlusion on one side and severe stenosis of the contralateral vertebral artery.

Basilar artery narrowing and hyperparathyroidism: illustrative case.

A patient presenting with a pontine infarction caused by mid-basilar artery narrowing associated with hyperparathyroidism is described. The narrowing reversed with surgical removal of his parathyroid adenoma and normalization of his serum calcium. This patient's illness lends evidence to the role of calcium in cerebral vasoconstriction.

Long-term survival and neurologic status after resuscitation from out-of-hospital cardiac arrest.

Thirty-eight survivors from among 117 patients hospitalized after out-of-hospital cardiac arrest were evaluated approximately 3 1/2 years later. Twenty patients were living; 18 had died. Fifty-three percent had resumed independent social activities, but only 32% had returned to work.