lightning injuries are known to cause neurological diseases , as also death due either to arrhythmias or other associated injuries . greater number of cases may be noted in certain geographical areas with greater average rainfall and thunderstorms , though no place is immune . the actual number of fatalities and injuries associated with lightning strikes is not known due to gross underreporting , especially so in developing countries . a 53-year - old man , a field worker in a government establishment , presented to us with a history of lightning strike while working outdoors during a thunderstorm . he was the only person injured as his colleagues were working at a distance . immediately following the strike , the patient dropped to the ground unconscious , but did not have any direct blow to his arms or other parts of his body . there was no history of any blast effects or of anything falling on the patient 's body during the incident . there was no history of any injuries due to his body rolling on the ground or falling into trenches . there , the patient became conscious within 3 hours and noticed severe pain , weakness , and swelling in his right upper limb , withsevere burns on the upper back . the patient was treated symptomatically and his pain and swelling resolved , but the weakness persisted , for which he was referred to our hospital after 6 weeks of the incident . on examination , his vital parameters were normal . examining his back revealed a large healing scar of the burns sustained due to the lightning strike , as also right suprascapular hollowing . further testing revealed weakness of his right supraspinatus , infraspinatus , biceps brachii , deltoid , teres major , and pectoralis major ( power 2/5 in all muscles ) . biceps and wrist flexors were weaker compared to triceps and wrist extensors , while small muscles of the hand were spared . routine blood investigations and magnetic resonance imaging [ mri ] of cervical spine and brain were normal . nerve conduction study showed reduced amplitude and normal latency and conduction velocity of the sensory component of right median nerve and lateral antebrachial cutaneous nerve . motor nerve study showed decreased amplitude and normal latency and conduction velocity in right median nerve , musculocutaneous nerve , radial nerve , and axillary nerve . emg showed profuse fibrillations in right deltoid , biceps brachii and supraspinatus , and some fibrillations in left abductor pollicis brevis and triceps . a diagnosis of a brachial plexopathy was made , and localized to the upper and middle trunk ( c5,6,7 ) . lightning injuries tend to occur in men in their mid - thirties in the months of july - august while doing outdoor recreational activities during thunderstorms . lightning causes damage either by thermal effects , electrical effects , magnetic field changes , blast effects , and injuries due to falls . direct damage to the cell membrane lipid bilayer leads to electroporation followed by cell damage . lightning - induced neurological disorders may be either immediate and transient , or immediate and permanent . the third category is of delayed syndromes , which includes motor neuron diseases and movement disorders , which has been well described by jafari et al . our patient 's symptoms fell in the second category , that is , immediate and permanent . intracerebral hemorrhage , hypoxic encephalopathy , cerebral infarction , and cerebellar syndromes are more common . critchley assumed that blood vessels constitute the main routes for the passage of currents through the brain as nerve tissue is a poor conductor of electric current , which causes damage in lightning and electric injuries . for the cervical area , this might imply that the sympathetic plexus around the carotid and vertebro - basilar arteries sustains electrical damage leading to autonomic dysfunction . spinal cord syndromes are also well documented . however , lightning injuries rarely cause neuropathy , myopathy , or neuromuscular junction disorders , as against electric injuries . unlike lightning strikes , the longer exposure time in high - voltage electric current causes severe third and fourth degree burns , which leads to neuropathy . as noted above , involvement of the peripheral nervous system due to lightning strikes itself is very rare , a plexopathy even more . this is against the current hypothesis that the short duration of the lightning strike precludes damage to the nerves . it could be likely that the symptoms of neuropathy may have been missed secondary to the more serious complications like cardiac arrhythmia , hypoxic ischemic encephalopathy , and stroke . thus , we would suggest performing routine electrophysiological testing for all patients suffering from lightning strikes in order to find out the true incidence of lightning - induced neuropathy , and not simply rule out the possibility of a lightning strike - induced neuropathy .
we describe a patient who presented with a history of lightning strike injury . following the injury , he sustained acute right upper limb weakness with pain . 
 clinically , the lesion was located to the upper and middle trunk of the right brachial plexus , and the same confirmed with electrophysiological studies . 
 nerve damage due to lightning injuries is considered very rare , and a plexus damage has been described infrequently , if ever . 
 thus , the proposed hypothesis that lightning rarely causes neuropathy , as against high - voltage electric current , due to its shorter duration of exposure not causing severe burns which lead to nerve damage , needs to be reconsidered .