Author(s): Rashmee Vijay Chavan1, Sandeep Sambhajirao Kadam2, Sheetal Kamalakar Desai3
PRESENTATION OF CASE
A 50 years old man, electrician by occupation, was brought by relatives after being found unconscious at working place with burns over head and thigh. There was witnessed history of patient sustaining electric shock and fall from electric pole of 4 metres height while working. On arrival patient had regained consciousness, but he was not able to recollect the event. He was disoriented and could not speak properly. On examination, vitals were within normal range. Local examination revealed 5% full thickness (bone deep) charred burns injury to scalp and 7% superficial burns injury to left front of thigh. Patient then received supportive treatment in the form of local dressing, intravenous fluids and antibiotics with monitoring of vitals. There was no cardiovascular or respiratory involvement. His past history was insignificant except for surgery for squamous cell carcinoma of left cheek 10 years back. Further patient was investigated in detail. From second day onwards, patient started developing progressive weakness in all four limbs with power 1 grade in both lower limbs and grade 2 in both upper limbs. Bowel and bladder reflexes were preserved. Deep tendon reflexes were exaggerated. Sensations were preserved. His MRI of brain and cervical spine revealed senile degenerative changes without any fracture dislocation of cervical spine. Findings were not correlating with his presentation. His other routine investigations were within normal range. On 8th day, patient was posted for derotation flap of scalp with skin grafting. From pre-anaesthetic examination, there was one finger mouth opening with limited neck extension making it difficult case for intubation.