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Published 7 July 2009
Cite this as: BMJ Case Reports 2009 [doi:10.1136/bcr.06.2009.2008]
Copyright © 2009 by the BMJ Publishing Group Ltd.

Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

A lightning strike to the head causing a visual cortex defect with simple and complex visual hallucinations

Ingo Kleiter1, Ralf Luerding1, Gerhard Diendorfer2, Helga Rek1, Ulrich Bogdahn1, Berthold Schalke1

1 Department of Neurology, University of Regensburg, Regensburg, Germany
2 Austrian Lightning Detection and Information System (ALDIS), Vienna, Austria

Correspondence to:
I Kleiter, ingo.kleiter{at}klinik.uni-regensburg.de

SUMMARY

The case of a 23-year-old mountaineer who was hit by a lightning strike to the occiput causing a large central visual field defect and bilateral tympanic membrane ruptures is described. Owing to extreme agitation, the patient was sent into a drug-induced coma for 3 days. After extubation, she experienced simple and complex visual hallucinations for several days, but otherwise largely recovered. Neuropsychological tests revealed deficits in fast visual detection tasks and non-verbal learning and indicated a right temporal lobe dysfunction, consistent with a right temporal focus on electroencephalography. At 4 months after the accident, she developed a psychological reaction consisting of nightmares, with reappearance of the complex visual hallucinations and a depressive syndrome. Using the European Cooperation for Lightning Detection network, a meteorological system for lightning surveillance, the exact geographical location and nature of the lightning strike were retrospectively retraced


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