Generalized Tonic-Clonic Seizures Cause Lumbar Spine Fracture
Abstract
A 28-year-old man presented to the emergency department after a witnessed GTC seizure. The patient had a history of systemic lupus erythematosus, previous subarachnoid hemorrhage, and pulmonary embolism. He was on regular methylprednisolone 16 mg, enoxaparin 60 mg once daily, and levetiracetam (LEV) 500 mg twice daily. The patient had recently stopped taking LEV. There was no trauma in the history. Neurological examination was normal. He had severe lower back pain that failed to subside despite treatment with analgesics and opioids; therefore, this patient had an indication for radiological imaging. Urgent non-contrast computerized tomography (CT) scan of the lumbar spine revealed a burst fracture of L1. Non-contrast lumbar magnetic resonance imaging (MRI) revealed a bursal fracture in the L1 vertebral corpus that caused approximately 50% height loss, and there was compression of the posterior corpus of the vertebra on the thecal sac; however, no stenosis of the spinal canal was detected. At this level, there was bone marrow edema in the vertebral corpus (Figure 1,2). He was transferred to the neurosurgery department. Written informed consent was obtained from the patient for the publication of this case.
Keywords
References
- References 1. Walczak TS, Leppik IE, D'Amelio M, Rarick J, So E, Ahman P, Ruggles K, Cascino GD, Annegers JF, Hauser WA. Incidence and risk factors in sudden unexpected death in epilepsy: a prospective cohort study.Neurology. 2001;56(4):519-25
- 2. Napier RJ, Nolan PC. Diagnosis of vertebral fractures in post-ictal patients. Emerg Med J. 2011;28(2):169-70
- 3. Mehlhorn AT, Strohm PC, Hausschildt O, Schmal H, Südkamp NP. Seizure-induced muscle force can caused lumbar spine fracture. Acta Chir Orthop Traumatol Cech. 2007 Jun;74(3):202-5
- 4. Souverein PC, Webb DJ, Petri H, Weil J, Van Staa TP, Egberts T. Incidence of fractures among epilepsy patients: a population-based retrospective cohort study in the General Practice Research Database. Epilepsia. 2005;46(2):304-10
- 5. Gill JR, Murphy CG, Quansah B, Carrothers AD. Seizure induced polytrauma; not just posterior dislocation of the shoulder. BMJ Case Rep.2015;2015:bcr2015211445
- 6. Robles LA and Maldonado AG. Seizure-Induced Spinal Fractures: A Systematic Review.Int J Spine Surg 2022;16 (3):521-29 7. Mazziotti G, Canalis E, Giustina A. Drug-induced osteoporosis: mechanisms and clinical implications. Am J Med. 2010;123(10):877-84
- 8. Sheth RD, Gidal BE, Hermann BP. Pathological fractures in epilepsy. Epilepsy Behav. 2006;9(4):601-15
- 9. Pennisi P, Trombetti A, Rizzoli R. Glucocorticoid-induced osteoporosis and its treatment. Clin Orthop Relat Res. 2006;443:39-47.
- 10. Canalis E, Mazziotti G, Giustina A, Bilezikian JP. Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos Int. 2007;18(10):1319-28.
- 11. Pettilä V, Leinonen P, Markkola A, Hiilesmaa V, Kaaja R. Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin. Thromb Haemost. 2002;87(2):182-16.