Clinical Features

Lightning deaths are caused by cardiac arrest, usually asystole. As with electrical injuries, the occurrence of respiratory arrest can give rise to hypoxia and subsequent cardiac arrest.

Involvement of the CNS may produce cerebral haemorrhages, oedema and neuronal injury. Hypoxic encephalopathy can follow respiratory arrest. Peripheral nervous system involvement gives rise to sensory disturbance, weakness and chronic pain. A transient limb weakness may occur known as keraunoparalysis or lightning paralysis. This rarely lasts more than a few hours. The lower limbs are more involved than the upper limbs. Autonomic dysfunction can result in wide fluctuations in blood pressure and heart rate.

A variety of delayed neurological conditions may follow lightning strike and superficial linear burns are characteristic.

Delayed neurological conditions

Amyotrophic lateral sclerosis, Parkinsonism and focal dystonias have all been reported within days to months following injury. Behavioural disturbance is also common. Many lightning survivors report depression, chronic fatigue and memory disturbance.

Superficial linear burns

Superficial linear burns tend to involve skin creases where sweat accumulates. Metal jewellery, coins, belt buckles etc. may melt, burning the adjacent skin.

Lichtenberg’s flowers is a characteristic dermatological skin phenomenon caused by lightning strike. A transient fernlike erythematous floral pattern develops on the skin. It doesn’t represent a true thermal burn and fades within 24-36 hours.

Lightning injuries are difficult to diagnose. Victims are often amnesic and the actual moment of lightning strike is usually unwitnessed. The table highlights the more common features.



Cardiac Asystolic arrest, VF / VT arrest, ST and T wave abnormalities, labile blood pressure and heart rate
Respiratory Respiratory arrest from involvement of respiratory centre
Neurological Coma, seizures, confusion, sensory disturbance, keraunoparalysis, chronic pain, neurocognitive deficits, psychiatric disturbance
Skin Linear burns, Lichtenberg’s flowers
Ocular Mydriasis, Horner’s syndrome, cataracts
Auditory Perforated tympanic membranes, tinnitus
Musculoskeletal Secondary trauma with fractures / dislocations