Disclosures: Brandon J. Smith, MD: No financial relationships or conflicts of interest

Case Diagnosis: Delayed cervical myelopathy

Case Description or Program Description: A 30-year-old man suffered a prolonged electrocution event from a downed power line, resulting in 3rd and 4th degree burns to his face, trunk, and left upper limb. He was able to ambulate to EMS. Due to the severity of his facial injuries, he was intubated and sedated. He required multiple irrigation/debridement procedures and skin grafts for his burns. After two weeks, sedation was weaned, and he was found to have diffuse neurologic deficits consistent with delayed onset cervical myelopathy. Spine magnetic resonance imaging (MRI) revealed T2 cord signal changes from C2-C5. He benefited from burn and spinal cord injury (SCI) rehabilitation programs to address upper limb peripheral nerve injury, facial injury, spasticity, and neurogenic bladder and bowel dysfunction. His rehabilitation course was complicated by cataract development secondary to electrocution injury which required surgical removal.

Setting: Acute inpatient rehabilitation

Assessment/Results: During inpatient rehabilitation, he progressed to stand pivot transfers with moderate assistance, full oral diet, and independence with power mobility. He discharged with his family’s assistance after 51 days of inpatient rehabilitation.

Discussion (relevance): Severe electrical injuries are often associated with multi-organ system clinical sequelae that can result in disabling impairments. The incidence of SCI associated with high voltage electrocution injury is up to 5%. The onset of neurologic deficits are typically immediate, but this case describes a rare phenomenon of delayed onset myelopathy. Other comorbidities that impacted his rehabilitation included cataract development, facial trauma, spasticity, peripheral neuropathy, and wound contractures. Despite these comorbidities, the patient was able to discharge home with family.

Conclusions: SCIs after electrical accidents are difficult to manage given the medical complexity, rarity of the condition, and variable patient presentations. Understanding clinical sequalae of electrocution-associated SCI can enable providers to better predict barriers to rehabilitation and set realistic functional goals for this patient population.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/delayed-cervical-myelopathy-after-high-voltage-electrical-injury-a-case-report/