Immediately after the shock, the patient sustained burn marks and experienced short-term memory loss and fatigue. Three dayslater, the patient saw an internist and reported upper right quadrant pain, headaches, numbness, weakness, fatigue, insomnia, and minimal, first degree burn marks on his right underarm and on the dorsal aspect of both forearms. The surface area was 1.1% for each forearm, and an additional 1.1% for the right underarm, for a total affected area of 3.3%. One week later, the patient received MRIs of the lumbosacral spine, cervical spine and brain which all reported no abnormalities. One month later, the patient visited a psychologist regarding anxiety, insomnia, and depression, and was diagnosed with post-traumatic stress disorder and retrograde amnesia. Three months after the electrical injury, the patient saw an ophthalmologist regarding pain behind his right orbital and ‘‘drooping” of the right side of his face; he was diagnosed with Bell’s palsy. Two years after the incident, the patient had an orthopedic evaluation for right side body pain, loss of right hand motor control, right hand tremors, pain behind the right orbital and headaches with no orthopedic abnormalities found. The following day, the patient visited a neurologist and a different ophthalmologist regarding the same symptoms, with no abnormalities found. Three years after the electrical injury,cannabis grow racks the patient visited a neurologist regarding hypesthesia in the right side of the face and to pinpricks to the right hand, severe pain in the right arm and hand, moderate pain in the left arm and hand, and was diagnosed with electrocution neuropathy.
Five months later, the same neurologist noted improvement of the pain in the right arm and hand area. During the same year, the patient visited a therapist and was diagnosed with PTSD, severe anxiety, and situational depression and was prescribed psychotherapy as treatment. Six years after the injury, additional documentation of the damage sustained from the electrical injury was needed to provide objective evidence as part of a lawsuit against the electric company responsible for the exposed wires. The patient visited our laboratory for an MRI DTI and quantitative volumetric analysis, and a clinical neuropsychologist for an exam. At the time of the neuropsychological exam, the patient was taking Bupropion XL, Clobex, Hydrocodone/Acetaminophen, melatonin, Klonopin , Namenda , Neurontin , and medical marijuana. On the Diller-Weinberg Test, the patient missed 39/47 stimuli, and his visual encoding/processing speed on specific Wechsler Adult Intelligence Scale sub-tests was between the 1st and 5th percentile. On the dominant finger tapping test, the patient scored in the 5th percentile. His performance on a timed task of fine motor dexterity was impaired between 2 – 3 standard deviations below the mean, and his motor and processing speed index was in the 2nd percentile, which is typical residual of electrical injury. The patient scored 20 less points on his Performance intelligent quotient than his Verbal IQ , which is statistically significant and notably unusual. He scored as severely depressed on his Beck, and has had severe chronic pain and PTSD symptoms in the clinical range. The patient’s past medical history was significant for meningitis at age 10, and arthritis and hypertension as an early adolescent. The patient underwent several unrelated orthopedic surgeries from sports related injuries, with the last surgery being sixteen years before the electrical injury. According to his ex-fiancé, the patient was very social and outgoing before the electrical shock, while he became withdrawn and isolated afterwards.
The patient enjoyed activities such as surfing, swimming, hiking, basketball, and skateboarding, all of which he was unable to do, or did differently, after the injury. At the time of the incident, he was in good health and working as a physical trainer.In the presence of an external electric field, cell membrane permeabilization occurs as the lipids in the lipid bilayer undergo reorganization in a process known as electroporation. In turn, cell contents such as ions are able to move freely in and out of cells. Through the phenomenon of electroporation, current is able to travel through and leave the body through the second contact point to a grounding source. Clearly these aspects of EI are quite mechanistic, however, one of its enigmas include the remote neuropsychological deterioration of the patient regardless of the trajectory of the current . EI has been known to cause a spectrum of neuropsychological and psychiatric disorders. Duff compiled a review of twenty eight studies of EI and lightning injury patients, logging 2738 victims reporting a total of 4441 signs or symptoms. These signs/ symptoms were ‘‘categorized into nine different domains of sequelae, which included disturbance of consciousness, attention/concentration deficits, speech/language deficits, sensory deficits, memory deficits, other cognitive deficits, psychiatric complaints, somatic complaints, and neurological complaints”. Another study of the long-term sequelae of low-voltage electrical injury done by Singerman reported numbness, weakness, and memory problems as the most frequent neurological problems and anxiety, nightmares, insomnia, and flashbacks of the event as the most frequent psychological problems. Since the literature suggests EI causes neuropsychological sequelae, it is worth using MRI imaging techniques to examine any structural abnormalities and cerebral lesions. Irregularities observed on MRI scans are generally unique to each EI case, however white matter hyperintensities found on fluid-attenuated inversion recovery image sequences are a common factor.
The latter three of the case studies cited all report WMH specifically in the cerebral corticospinal tract. EI has also been known to cause hypoxia, which is characterized by cytotoxic edema in the cortex of the central region and the basal ganglia.The average lamppost in a densely populated city, such as New York City, works on a single-phase 120 V/240 V 60 Hz, AC received from a nearby three-phase generator. The patient received an electrical shock after submerging his hands in a puddle on a sidewalk charged with stray voltage from a nearby lamppost. Workers from the electrical company in the area testified that exposed ends of an electrical cable of a lamppost were causing 8 V of stray voltage. Using the information we know about wet skin resistance, we can also assume that the patient’s hand had a resistance of 1000 X, while the patient’s internal body had a resistance of 300 X. Rearranging Eq. , we calculate the current passing through the patient’s hand to be approximately 8 mA, while the current passing through the internal body is approximately 26 mA. However since salt water is more conductive than pure water, this would have potentially lowered the resistivity of the patient’s hand, causing the current passing through his hands to be comparatively higher and thus accounting for the no-let-go phenomenon he experienced. To examine the validity of this approximation, we consider the patient’s dog that went into seizure upon stepping in the charged puddle. A study done by Woodbury investigated the stimulus parameters needed to induce electroshock seizures on rats, and found that at 60 Hz AC, the current needed to promote seizures was 17.7 mA. This is extremely similar to the current needed, 16 mA, to induce the no-let-go phenomenon in the average male. Thus we can assume with substantial confidence that the current passing through the patient’s hand was roughly around 16 mA AC.At the time of the neuropsychological exam,commercial grow racks the patient was taking multiple medications that could have potentially affected cognitive performance. An investigation of these potential effects was conducted. Depressed patients treated with Bupropion scored similarly to normal, healthy controls on neuropsychiatric tests that assessed verbal memory, visual memory, finger tapping, and symbol digital coding. On the dominant finger-tapping test, our patient scored in 5th percentile, while on the coding sub-test, he scored in the 10th percentile. The patient’s visual and verbal memory scores were average. In a study that assessed the neuropsychiatric effects of Hydrocodone, subjects that had taken hydrocodone performed 10% worse than the mean on the motor performance test, while no variance was found on simple and complex reaction time tests. Our patient scored in the 2nd percentile on the motor and processing speed index. In a study done on 38 patients taking Clonazepam, 8 patients experienced behavioral side effects while 30 patients did not . The mean absolute discrepancy between VIQ and PIQ of the 8 patients was 17.5 points, while the discrepancy between VIQ and PIQ of the 30 patients who did not experience behavioral side effects was 6.5 points. Our patient’s VIQ and PIQdifference was 20 points. No study has been done on the effects of memantine on cognitive behavior for patients without Alzheimer’s disease , but for patients with AD, memantine improved language and memory scores in comparison to a placebo group.
Gonzalez measured the effects of cannabis on cognitive performance by determining overall indexes of neuropsychological performance and running individual neuropsychological tests . Habitual cannabis users performed 1/5th a standard deviation worse than controls in overall index scores, and had performed significantly worse on memory tests. The patient’s performance on memory tests and his full scale IQ were rated average. No effects of melatonin on neurocognitive performance were found . No effects of gabapentin on neurocognitive performance were found.Methamphetamine is a highly addictive, psychomotor stimulant. It is estimated that approximately 1.1 million Americans 12 years or older meet criteria for methamphetamine use disorder and 205,000 individuals initiated methamphetamine use in 2018 . Methamphetamine is associated with hyper sexuality, and its use is predictive of riskier sexual behaviors such as higher frequencies of unprotected sexual intercourse , as well as needle sharing , which can lead to increased risk of HIV-transmission , among other infections. While engagement in substance use treatment may decrease sexual risk behaviors and subsequent adverse health outcomes, less focus has been placed on precipitating and perpetuating factors of methamphetamine use and sexual risk behaviors. For example, loneliness is linked to increased sexual risk behaviors in the general population . Loneliness is a common human experience with nearly half of Americans reporting feeling lonely “sometimes” to “always” . Loneliness is defined as a feeling that accompanies the perception that one’s social needs are not being met by the quantity, or especially the quality of one’s social relationships . Thus, loneliness is the perception of being alone, rather than objective social isolation. It has been linked to a myriad of adverse mental and physical health outcomes including depression , anxiety , anger , suicide , cognitive decline , Alzheimer’s disease , poor cardiovascular health , and type II diabetes . These negative health outcomes are a consequence of, and/or exacerbated by, poor health behaviors that may arise from loneliness. Mechanistically, feeling alone is instinctually related to feelings of being unsafe, which in turn increases sympathetic activation, according to one loneliness model . Chronic hypervigilance, coupled with cognitive biases that the world is a threatening place and other negative social expectations, may lead to behaviors that further isolate and exacerbate loneliness . Being engrossed in this self-fulfilling prophecy has significant impacts on health-related behaviors. Furthermore, emotion regulation as well as other types of self-control behaviors become compromised when someone feels lonely . Inadequate self-regulation may contribute to the relationship between loneliness and substance abuse. This relationship is likely bidirectional: some individuals may self-medicate with methamphetamine use in response to distressing feelings of loneliness , whereas others may first engage in methamphetamine use and subsequently find themselves unable to participate in activities that maintain positive social relationships, leading to feelings of social isolation . Intuitively, this feedback loop between methamphetamine use and loneliness could have direct or indirect effects on increased sexual risk behaviors and successive adverse health outcomes. Previous work has shown that loneliness and methamphetamine use are independently associated with riskier sexual behaviors. Loneliness, together with methamphetamine use, may confer additive risk for engaging in riskier sexual behaviors. That is, a lonely individual who turns to methamphetamine to cope with feelings of loneliness may be more likely to engage in riskier sexual behaviors, given the hyper sexuality and impulsivity that accompany methamphetamine use. Moreover, a methamphetamine user whose social network has eroded to a point of experiencing loneliness may lack the opportunities to engage in safer alternatives to risky sex. Generally, attitudes and norms about health behaviors are linked to concurrent and future intentions, and engagement in those health behaviors including sexual risk behaviors . Individuals who use methamphetamine, and perhaps particularly those who are lonely, may have different assessments of risk and consequences in relation to safe sex than those who do not use methamphetamine. If true, addressing beliefs and intentions to practice safer sex in this particularly vulnerable population may be an important treatment focus with critical public health implications.