In the theater of the sky, where nature choreographs its spectacular performances, lightning and thunder take center stage as the dynamic duo that commands attention. Lightning being seen before the thunder given the speed of light moves much faster than the speed of sound. With a dazzling display of electric artistry, lightning illuminates the canvas of darkness, momentarily turning night into day. Accompanying this celestial light show is the resounding symphony of thunder, a booming percussion that echoes across the expanse. Together, they compose a symphony of the elements, a dance of energy and sound that captivates both the senses and the imagination, reminding us of the awe-inspiring power that resides in the heart of a storm.

The power of lightning is a force both mesmerizing and formidable. With temperatures reaching up to 30,000 degrees Celsius (54,000 degrees Fahrenheit), lightning transforms the air into a searing burst of plasma, emitting a brilliant flash that momentarily outshines the sun. Its swift and unpredictable movements, zigzagging across the sky, reveal the raw energy harnessed within the atmospheric charge. When it connects with the Earth, the force of lightning can carve through the strongest structures, sparking wildfires, and altering landscapes. In its intensity, lightning serves as a stark reminder of nature’s immense power, capable of both creation and destruction in a single, electrifying moment.

But what happens when lightning unfortunately strikes a human being? One of the newly observed phenomenon of lightning strikes is a diagnosis of Keraunoparalysis. Broken down this word means –  kerauno- (“lightning”) +‎ paralysis. This refers to the Transient weakness in limbs following a lightning strike, often associated with cold, mottled skin.

I will share a case report published in 2018 in the Indian Journal of Critical Care Medicine  – highlighting a 51 year old female brought to the hospital with noted loss of strength more on the right side than left side of her body with a distribution predominantly in her lower extremities. 

There was no history of diabetes or hypertension or past cerebrovascular accident (stroke). The patient was conscious and could narrate her problems lucidly but appeared terrified. Her vitals were normal, and her oxygen saturation was 98% in the room air (normal). She was afebrile, but the affected limbs felt cold (bilaterally). There were no external injuries or burns on her body. Examination of cardiovascular and respiratory systems was normal. Her peripheral pulses were felt equal and normal on either side. She was fully conscious and oriented with normal cranial nerves though there was a subjective feeling of numbness on the right side of the face. There was right hemiparesis with a power of 2/5 in her lower and upper limbs with hypotonia along with reduced deep tendon reflexes as compared to the left. The plantar reflex was flexor bilaterally. There was a marked impairment of all modalities of sensation on the affected right upper and lower limbs with a subjective feeling of numbness.

Her hemoglobin was 10.5 g/dl; hemogram, metabolic parameters, serum electrolytes, and urine analysis were within normal limits. Her cardiac enzymes were within normal limits, and the electrocardiography showed normal sinus rhythm with no arrhythmia. The chest X-ray and computed tomography scan of the head were normal.

The episode did occur on a stormy night with flashes of lightning and deafening thunderstorm striking every other minute in her location. A deep crack was noticed on one of the walls of the house due to the lightning strike, and pieces of broken window glass found scattered all over the room –  it was determined the patient had a lightning injury.

Thankfully – The patient made a remarkable recovery over a period of 2–4 h. Her motor weakness disappeared completely with near-normal sensations, except minimal numbness on the affected side. The patient was discharged later after 2 days. A follow-up after a week revealed minimal residual giddiness and numbness in the limbs.

This was deemed an episode of Keraunoparalysis. Lightning injuries are akin to electrical injuries and have multiple medical consequences. They could affect any system in the body, but, most of the time, nervous system. This is because lightning just like the electricity follows the path of least resistance and the nerves by offering least resistance become most susceptible.[1]

Several patients do manifest a transient paralysis of the limb muscles referred to medically as keraunoparalysis. This syndrome is a combination of vascular and neurological manifestations. The involved limbs show neurological symptoms such as total paralysis of the muscles along with varying sensory loss with simultaneous signs and symptoms of vascular insufficiency in the form of pallor, cold, and pulselessness. Fortunately, this nightmare is short lived and benign as the patient recovers quickly and automatically in a period of few hours.[1,2,3] The incidence of this kind of acute neurological event could be as high as 80% in the lightning injuries.[4] However, if there is no recovery, other causes such as spinal cord injury or musculoskeletal blunt injuries should be thought of. The diagnosis of keraunoparalysis is always a retrospective one and by way of exclusion and it comes under Class I manifestations of Cherington’s classification of neurological lightning injuries, which is an immediate and transient one.[5] Keraunoparalysis or also often referred to as Charcot’s paralysis usually affects the lower limbs more than the upper limbs.[2] However, it could be hemiparesis as described by Rahmani et al.[1] and as seen in our patient.

The Quran mentions in Surah Adh Dhaariyat:

Quran 51:44-45

But they defied the command of their Lord, so the lightning (al-sa’iqatu) struck them as they looked on. They could not rise up, nor could they find help.

٤٤ فَعَتَوْا عَنْ أَمْرِ رَبِّهِمْ فَأَخَذَتْهُمُ الصَّاعِقَةُ وَهُمْ يَنْظُرُونَ

٤٥ فَمَا اسْتَطَاعُوا مِنْ قِيَامٍ وَمَا كَانُوا مُنْتَصِرِينَ

“They could not rise up” today we know why – this is temporary paralysis from the lightning strike itself. Approx 1400 years ago –  the Quran notes the first case report of Keraunoparalysis! 

In Surah Fussilat (Quran41:53) – Allah (swt) says: We will show them Our signs in the universe and within themselves until it becomes clear to them that this ˹Quran˺ is the truth. Is it not enough that your Lord is a Witness over all things?