24-05-2025
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[24-05-2025 11.58] PPM 1: OPD now:
56M with a history 20 years back of electric current injury when a live wire fell on his left shoulder and he fell and started hanging upside down on that wire for some time before he was rescued.
On examination:
Tell tale skin changes of the current injury
Assymetric muscle power with 4- left upper and lower limb and 4+ in right upper and lower limb along with wasting in left lower limb and hyper reflexia in all four limbs with bilateral planter extensors. Jaw jerks absent.
Impression: Chronic high cervical cord myelopathy due to past lightning injury
Complains of increased left lower limb pain necessitating tying of his limbs at night particularly since 4 years when he switched his job from electrician to farmer.
[24-05-2025 12.04] PPM 1: His cervical x-ray for his current neck pains. He has history of bore water consumption since 40 years.
[24-05-2025 13.28] PPM 3: This image shows the back of a 56-year-old male. Prominently visible is a large, elongated, hyperpigmented scar running vertically on his left upper back, extending from the shoulder region downwards. This scar appears to be a healed burn, consistent with the patient's history of an electric current injury where a live wire fell on his left shoulder. There are also smaller, healed scars visible on his lower back near the waistline, which could represent exit wounds or other contact points from the electrical injury.
The clinical information provided paints a picture of the long-term consequences of this severe electrical injury sustained 20 years ago:
Key Clinical Findings and Interpretation:
History of Injury: A live wire falling on the left shoulder and the patient subsequently hanging upside down on it indicates a probable entry point at the left shoulder and a complex path for the electrical current through the body, potentially involving the spinal cord.
Skin Changes: The prominent scar on the left shoulder is a "tell-tale sign" of the electrical burn, likely the primary contact point.
Neurological Deficits:
Asymmetric Muscle Power: Weakness is more pronounced on the left side (power 4-/5 in left upper and lower limbs) compared to the right (4+/5). This asymmetry could be related to the current entering on the left.
Wasting in Left Lower Limb: Suggests chronic denervation or severe disuse atrophy.
Hyperreflexia in all four limbs & Bilateral Plantar Extensors (Babinski sign): These are definitive signs of an Upper Motor Neuron (UMN) lesion, indicating damage to the corticospinal tracts within the spinal cord or brain. Since all four limbs are affected, the lesion is likely in the cervical spinal cord (above the C5 level to affect arms, and above the lumbar segments to affect legs).
Jaw jerk absent: This is generally a normal finding.
Impression: Chronic high cervical cord myelopathy due to past electric current injury.
This diagnosis is strongly supported by the neurological findings. An electrical injury can cause direct thermal damage, vascular compromise (leading to infarction), or delayed neurological deterioration in the spinal cord. A high cervical lesion would explain the UMN signs in all four limbs.
The "chronic" nature reflects the 20-year duration since the injury.
Current Complaints:
Increased left lower limb pain: This could be neuropathic pain or pain secondary to spasticity, both common sequelae of spinal cord injuries.
Necessitating tying of limbs at night: This strongly suggests severe spasticity or painful spasms, which can be disruptive to sleep and are characteristic of UMN lesions.
Worsening since switching job to farmer: Increased physical activity associated with farming could exacerbate spasticity, pain, and fatigue in a neurologically compromised individual.
Summary:
The image shows clear cutaneous evidence of a past severe electrical injury on the left shoulder and lower back. The clinical examination reveals significant neurological deficits consistent with a chronic cervical myelopathy (damage to the spinal cord in the neck region). This myelopathy is characterized by upper motor neuron signs (weakness, hyperreflexia, Babinski sign) affecting all four limbs, more so on the left. The patient's current debilitating pain and spasticity in the left lower limb, worsened by increased physical demands, are direct consequences of this long-standing spinal cord injury.
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