Neurologic symptoms are typically classified either as immediate but transient or as delayed and usually progressive. However, some neurologic injuries can be severe, immediate, and permanent.11 Immediate but transient symptoms include confusion and amnesia, loss of consciousness, temporary lower extremity paralysis, and temporary upper extremity paralysis.10 Lower extremity paralysis (keraunoparalysis) is often a consequence of step-voltage injury and is usually associated with paleness, sensory loss, loss of pulses, and vasomotor changes.12 These immediate but transient symptoms typically resolve within 24 h. Delayed and usually progressive disorders include seizures, spinal muscular atrophy, amyotrophic lateral sclerosis, parkinsonian syndromes, progressive cerebellar ataxia, myelopathy and neuropathy, paraplegia and quadriplegia, paresthesias, and chronic pain syndromes.
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