Although spinal cord dysfunction is a known consequence in 3-7%[1][2] of high voltage electrical burns, imaging and electromyographic studies do not appear reliable in diagnosing or determining the extent or level of injury. We present a case study of a 28-year-old male who sustained high voltage electrical burns resulting in paraplegia and bilateral upper limb amputations. MRI repeated over a 5 month interval did not demonstrate radiological evidence of a spinal cord injury, yet his clinical exam showed complete loss of power below L2. Nerve conduction studies were not normal but difficult to interpret.
We review the limited cases of spinal cord injury post high voltage electrical burns in the English literature. Our case highlights the limitation of regular MRI to visualise abnormalities in both the acute and late phases despite obvious clinical dysfunction. For our patient, the lack of MRI findings meant that he could not receive certain supports reserved for spinal cord injury patients, as the criteria for access to these supports requires radiologic evidence. In the patient with a high voltage electrical burn, modified criteria should be made to allow for the diagnosis of spinal cord injury without radiographic findings. This becomes an equity of access issue when these patients are denied spinal injury specific supports despite having a clear mechanism and abnormal physical exam.