Lightning strike injuries are distinct from industrial electrocution. Which finding is PATHOGNOMONIC (virtually unique) to lightning strike injury?

• A Widespread deep tissue burns with charring
• B Lichtenberg figures (keraunographic markings / arborescent burns) on the skin ✓
• C Bilateral tympanic membrane rupture
• D Cardiac arrest from ventricular fibrillation

Explanation

Lichtenberg figures (Keraunoparalysis patterns, arborescent/fern-like or feathering burns) are pathognomonic skin markings seen only in lightning strike survivors. They are caused by electron avalanche tracking of the lightning discharge across the skin surface, producing characteristic branching reddish-brown patterns that fade within 24 hours. They are not true burns but a skin vascular reaction. While tympanic membrane rupture and cardiac arrest can occur, they are not pathognomonic; bilateral tympanic rupture is characteristic but also occurs in blast injuries.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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Written and medically reviewed by the StethoPrep medical team.