Journal of Clinical Orthopaedics and Trauma
Case reportDelayed unrelated presentation of a lumbar burst fracture consequent to a remote episode of a single convulsive seizure: A diagnostic challenge
Introduction
Non-traumatic spinal fractures occurring solely because of the violent paraspinal muscle contractions produced during a convulsive episode are very rare.1,2 The diagnosis is easily missed at initial presentation, leading to serious complications like neurodeficit or symptomatic spinal instability. A majority of seizure-induced non-traumatic spinal fractures occurred in individuals with seizure-provoking risk factors (known epileptics with recurrent seizures, brain tumors, drug overdose/withdrawal, metabolic disorders, or electrolyte imbalance) or in those with an increased susceptibility to fracture due to decreased BMD following prolonged anticonvulsant therapy.3, 4, 5, 6, 7 To our existing knowledge, there are no case reports of a delayed presentation of a seizure-induced non-traumatic spinal fracture, unrelated to a remote episode of a single convulsive seizure.
Section snippets
Case report
A 52-year-old otherwise healthy non-epileptic male, construction worker presented with complaints of unrelenting low back pain of four months duration, following the first episode of a witnessed GTCS (generalized tonic clonic seizure) which he sustained four months ago while sitting in a chair at his house. He also had progressive numbness and weakness in both the lower limbs for ten days. A detailed inquiry revealed no history of a significant traumatic event either during the convulsive
Discussion
The incidence of spinal fractures in seizures varies from 0.95% to 16%.8 These fractures occur commonly due to a significant traumatic event during the seizure episode. However, a non-traumatic vertebral fracture occurring as a sole consequence of the violent muscle forces generated during a convulsive seizure is a rare clinical entity. Published literature shows that they commonly occur in individuals with risk factors (known epileptics with recurrent seizures, brain tumors, drug overdose,
Institutional review board (IRB) approval
The study was approved by the IRB and Ethics committee of Madras Medical College, Chennai, India.
Source of funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
CRediT authorship contribution statement
Aju Bosco: Conceptualization, Methodology, Formal analysis, Writing - original draft, Writing - review & editing, Software. Nalli Ramanathan Uvaraj: Conceptualization, Writing - review & editing, Visualization, Supervision. Eswar Ramakrishnan: Writing - original draft, Writing - review & editing, Software, Formal analysis.
Declaration of competing interest
The authors have no potential conflicts of interest.
Acknowledgements
NIL.
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