Lightning that traverses the lower extremities during a stride potential pathway may cause vasomotor instability and the aforementioned phenomenon of keraunoparalysis. Paresis, blue, cold, and pulseless lower extremities characterize this transient form of paralysis. 12 Keraunoparalysis is thought to be caused by endogenous catecholamines and does not usually require surgical intervention. Some victims will develop permanent paralysis and paresthesias due to prolonged vasospasm. Initially, keraunoparalysis may be difficult to distinguish from acute spinal cord injury.
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