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Struck by Lightning - Pathology of Lightning Induced Injuries.

Dr Sampurna Roy MD       

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"Struck by lightning! Struck by lightning!" -  John Ronald Reuel Tolkien

In the ancient days men probably thought that the bright lightning flash and the roaring of the thunder that followed it were the anger of God.

This was strongly believed when they saw men struck and killed by lightning.

Lightening is a sudden high voltage discharge of electricity in the sky from the positively charged upper part of a cloud to the negatively charged lower part.

Lightning may be upto 8 kilometers, long and to jump such distances they need voltage or electrical pressure, several hundred thousand times as great as that of the electricity supplied to our house.

Scientists believe that the surface of the earth is positively charged during a thunderstorm and that lightning travels from the negatively charged areas of the cloud to Earth.

In addition, they believe that lightning travels from positive parts of clouds to negative parts. - See diagram

When a bolt of lightning approaches the earth or a grounded conductor, it usually breaks up into many paths of varying intensity.

In such circumstances a person struck by lightning may become may become the conductor of a current so small that his injury is superficial and inconsequential or so large as to be fatal with or without extensive burning.

Along with superficial injury there is simultaneous passage of a fatal current through the body with severe burning at the sites of entrance, exit or both.

Pathological changes in various organs of the body:

The enormous energy of a lightning bolt may cause injury by direct effect of the current or by the expanded air resulting in blast-like injuries.



Arborescent cutaneous hyperemia that resembles a fern.

Lightning strikes may be associated with full thickness burns, linear charring and in some cases the current produces an arborescent cutaneous hyperemia that resembles a fern.

This branching or ferning mark is known as Lichtenberg figures.

Lichtenberg figures histologically, show subcutaneous hemorrhage.

 Like in electrical burns there may be homogenization of the collagen in the upper dermis.

In severe cases there is usually infarction of the entire dermis and subcutis, necrosis of vessel walls in the deeper tissue and hemorrhage.

Bone, blood vessel abdominal viscera, tongue and other organs:

In addition to skin burns of varying degrees of severity, victims of lightning may suffer fractures and ruptures of blood vessels and abdominal viscera.

Autopsy findings revealed damage to the tongue, pharynx, larynx, and oesophagus for the first time.



Gravid uterus with fetus:

Instances of fetal electrocution with maternal survival have been reported in which the path of electrical current passed through a gravid uterus after a lightning strike.


Cardiac and lung injuries :

Current passing through the body may cause either ventricular fibrillation or respiratory paralysis.

The patient may have cardiac arrhythmias and myocardial infarction.


Ocular injuries:

A broad variety of ocular injuries can develop in survivors of lightning strikes.

These include cataracts, corneal ulcers (occasionally going on to perforation), iridocyclitis, hyphema ( blood in the anterior chamber) and vitreous hemorrhage.

 In rare cases choroidal ruptures, chorioretinitis, macular tears, retinal detachments and even optic nerve injury have been reported.

Myoglobinuria, peripheral nerve lesions and tympanic membrane rupture of the ear:

In addition to thermal injuries, persons surviving lightning strikes may develop diverse serious complications such as myoglobinuria,  peripheral nerve lesions and tympanic membrane rupture.


Myoglobinuria          Three Faces of Multinucleated Giant Cells in Pathology

Lightning does a great deal of damage throughout the world.

It has one good effect, the flash causes the nitrogen and the oxygen in the air to combine and dissolve in the raindrops which fall to earth and soak into the soil, thus supplying it with nitrates.

Nitrates are a valuable fertilizers, which means that they help plants and crops to grow.

Thunderstorms are of great benefit to plant life.


Visit: Joy of walking in the Hills: Walking is the healthiest of all outdoor activities

Visit: Falling Sick in the Mountains - Pathology of Altitude Related Illness.

Visit: Achilles: The Tendon and the Hero of the Trojan War

Visit:  "Brr! It's so cold outside"- Human body responses to cold and hypothermia


Further reading:

All diagrams and cartoons created by Dr S.Roy.

Arborescent vascular dilatation mimicking Lichtenberg figures from lightning.

Lichtenberg figures and lightning: case reports and review of the literature.

Lightning and Lichtenberg figures.

Lesions along the upper motor neuronal pathway with locked-in features after lightning strike and cardiac arrest: a case-review analysis.

Damage due to lightning when it strikes the face.

Simultaneous lightning injury in a group of people: case report.

Cataract after lightning injury--case report.

A Lightning Strike Causing a Cholesteatoma: A Unique Form of Otologic Blast Injury.

Myocardial infarction due to lightning strike.

Lightning and thermal injuries.

Central hyperadrenergic state after lightning strike.

Blast injury of the lungs due to lightning.

Lightning injury with lung bleeding in a tracheotomized patient.


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Dr  Sampurna Roy  MD

Consultant Histopathologist (Kolkata - India)







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