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Neža Prezelj, Maja Trošt, Dejan Georgiev and Dušan Flisar

) can generate induction currents in implanted electrodes and even damage the brain. 1 , 2 In addition, naturally generated EMFs in the environment can also pose a threat to patients receiving DBS. We report a case in which a nearby lightning strike caused inadvertent deactivation of a patient’s IPG. To the best of our knowledge, this is the first report of such an event. Case Report A 66-year-old woman was treated with bilateral globus pallidus internus DBS (Activa RC neurostimulator, Medtronic) for neck dystonia over a period of 5 years with a very good clinical

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Hormuzdiyar H. Dasenbrock, Courtney Pendleton, Matthew J. McGirt, Daniel M. Sciubba, Ziya L. Gokaslan, Alfredo Quiñones-Hinojosa and Ali Bydon

lumber, amputated, postamputation neuralgias presenting symptoms shooting lightning pains in rt abdomen & chest, numbness in chest bilaterally rt hemiplegia, rt arm hyperesthesia, spasticity & contractures debilitating neuralgia in left (amputated) leg findings on physical exam numbness & anesthesia btwn nipples & groin, Argyll Robertson pupil, Romberg sign rt hemiplegia, rt hyperreflexia w/ clonus, spastic gait prior BTK amputation, hyperesthesia in lt L1–3 region location & no. of nerve roots divided thoracic, division of 4 posterior roots

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Stewart B. Dunsker and Frank H. Mayfield

C arbamazepine is an anticonvulsant drug which, for unknown reasons, is effective in treating tic douloureux, 10 glossopharyngeal neuralgia, 5 painful posttraumatic paresthesias, 2 denervation hyperpathia, 7 and tabetic lightning pains. 1, 3, 4 We have seen five patients who described episodes of repetitive flashing pains following various operative procedures. Because of the similarity of these flashing pains to those of tic douloureux and tabetic lightning pains, carbamazepine (Tegretol) was tried and found to be effective. Case Reports Case 1

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Takahito Miyazawa, Shinji Fukui, Naoki Otani, Nobusuke Tsuzuki, Hiroshi Katoh, Shoichiro Ishihara, Hiroshi Nawashiro, Kojiro Wada and Katsuji Shima

-onset headache with “lightning” and visual hallucinations in November 1994. She was well oriented and had no sleeping disorder. There was no other focal neurological deficit. Representative drawings of the patient's hallucinations are presented in Fig. 1 . Most of the visual hallucinations were vivid, colorful, and geometric ( Fig. 1 upper left ). The patient also saw various colored suns shining brightly among colorful clouds ( Fig. 1 upper right ). Occasionally, she imagined several unknown people, with monochromatic clothing, appearing around her bed. Surrounding these

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Elon Eisenberg and Hanan Waisbrod

electrocution. Lancet 1 : 1163 – 1167 , 1934 Pritchard EAB: Changes in the central nervous system due to electrocution. Lancet 1: 1163–1167, 1934 11. Stanley LD , Suss RA : Intracerebral hematoma secondary to lightning stroke: case report and review of the literature. Neurosurgery 16 : 686 – 688 , 1985 Stanley LD, Suss RA: Intracerebral hematoma secondary to lightning stroke: case report and review of the literature. Neurosurgery 16: 686–688, 1985

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Jason Sheehan and Nader Pouratian

Neurosurgical Focus represents a snapshot of contemporary radiosurgical practice. References 1 Flickinger JC , Steiner L : Radiosurgery and the double logistic product formula . Radiother Oncol 17 : 229 – 237 , 1990 2 Hoh DJ , Liu CY , Pagnini PG , Yu C , Wang MY , Apuzzo ML : Chained lightning. Part I: exploitation of energy and radiobiological principles for therapeutic purposes . Neurosurgery 61 : 14 – 28 , 2007 3 Hopewell JW , Millar WT , Ang KK : Toward improving the therapeutic ratio in stereotactic radiosurgery

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Rajesh Reddy, T. T. Hong Duong, Jacob M. Fairhall, Robert I. Smee and Marcus A. Stoodley

arteriovenous malformations: gamma knife surgery . J Neurosurg 97 : 753 – 755 , 2002 19 Hoh DJ , Liu CY , Chen JC , Pagnini PG , Yu C , Wang MY , : Chained lightning, part II: Neurosurgical principles, radiosurgical technology, and the manipulation of energy beam delivery . Neurosurgery 61 : 433 – 446 , 2007 20 Hoh DJ , Liu CY , Chen JC , Pagnini PG , Yu C , Wang MY , : Chained lightning: part III—Emerging technology, novel therapeutic strategies, and new energy modalities for radiosurgery . Neurosurgery 61 : 1111 – 1130

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Rolando A. Tenuto, Horacio M. Canelas, Oswaldo Ricciardi Cruz and L. C. Mattosinho França

, and analgesia in the territory of distribution of the left trigeminal nerve. Five months later, the symptomatology of intracranial hypertension became more manifest, and a ventriculogram demonstrated a ventriculocisternal block. Surgical opening of the lamina terminalis then was performed, and the patient was discharged without any further developments. Two and a half years after the first admission the patient was reexamined and was well. Case 2 . Reg. HC 619236. M.M., a 38-year-old white male, had lightning pains in the territory of the 2nd branch of the right

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Dhirendra S. Mehta, Gauri Bazaz Malik and Jawahar Dar

Report Clinical Features This 26-year-old man was admitted in December, 1969, with a 2-year history of severe spasmodic pain starting in the right lower molar tooth and shooting up to the preauricular region. He described the pain as “lightning, electric shocks” few in number and in rapid succession; the tongue on the right side felt sore and smarted. He experienced 2 to 20 such attacks a day and in between was absolutely all right. Examination There was no neurological or general physical deficit, nor sensory impairment. Blood and urine tests were normal

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Laurie L. Ackerman, Timothy C. Ryken, G. Patrick Kealey and Vincent C. Traynelis

– 331 , 1976 . (Ger) 9 Janus TJ , Barrash J : Neurologic and neurobehavioral effects of electric and lightning injuries . J Burn Care Rehabil 17 : 409 – 415 , 1996 10 Johansen C , Olsen JH : Mortality from amyotrophic lateral sclerosis, other chronic disorders, and electric shocks among utility workers . Am J Epidemiol 148 : 362 – 368 , 1998 11 Kalita J , Jose M , Misra UK : Myelopathy and amnesia following accidental electrical injury . Spinal Cord 40 : 253 – 255 , 2002 12 Lee RC , Zhang D , Hannig J : Biophysical