VERTEBRAL FRACTURES-AN UNCOMMON COMPLICATION FOLLOWING FIRST EPISODE OF A CONVULSIVE SEIZURE PRESENTING AUTHOR : DR.NALLI .R .GOPINATH JUNIOR CONSULTANT DR.MEHTA’S HOSPITAL, CHENNAI-34 TAMIL NADU,INDIA ABSTRACT NO : 35846 PROF.DR.NALLI .R .UVARAJ’s UNIT DR.MEHTA’S HOSPITAL, CHENNAI-34 TAMIL NADU,INDIA

.PATIENT ADMITTED WITH C/O - PRESENTING HISTORY Mr. S – 18 YRS /M .PATIENT ADMITTED WITH C/O - : FEVER WITH CHILLS AND RIGOR – 6 DAYS : EPIGASTRIC PAIN &VOMITING OF BLOOD -- 2 DAYS : LOSS OF APPETITE H/O PRESENTING ILLNESS- DEVELOPED AN EPISODE OF SEIZURE FOR THE FIRST TIME ON THE NIGHT AFTER ADMISSION TO THE HOSPITAL WHEN HE WAS SITTING IN BED. PATIENT HAD NO FALL. NEXT DAY HE COMPLAINED OF PAIN IN THE CHEST AND BACK PAST HISTORY – NO SIGNIFICANT TRAUMA NO H/O TUBERCULOSIS NOT A KNOWN EPILEPTIC

CLINICAL FINDINGS G/E: MODERATELY BUILT NOT ANAEMIC/ICTERIC/NO PEDAL EDEMA/ NO CYANOSIS/CLUBBING/NO LYMPHADENOPATHY NO MASS PER ABDOMEN EXAMINATION OF THE SPINE: NO SPINAL DEFORMITIES. TENDERNESS OVER THE SPINE – MID DORSAL REGION MOVEMENTS WERE NORMAL NO NEUROLOGICAL DEFICIT. INVESTIGATIONS Mantoux , ESR, CRP - NORMAL Sr.Ca,P ,SALP = NORMAL

D4

HOW WE MANAGED? FOLLOW UP. ADVISED COMPLETE BED REST, ANALGESICS, STARTED ON ANTI EPILEPTIC DRUGS. FOLLOW UP. Pain at fracture site persisted for 2 weeks. Antiepileptic drugs continued for 6 months. No further seizures reported.

2 YRS FOLLOW UP.....

DISCUSSION SEIZURES AND FRACTURE Vertebral compression fractures are well known complications of convulsive tonic clonic seizures(mostly unwitnessed)Matson et al.2004 DUE TO FALL /ACCIDENT – 1 TO 16% -Pederson et al 1976,Youssef et al 1995 DUE TO PARASPINAL MUSCLE SPASM ALONE – 0.3% -Finelli et al 1989,Vernay et al 1990 Vertebral compression fractures are well known complications of convulsive seizures(mostly unwitnessed) 15% ARE ASYMPTOMATIC Most frequent during nocturnal attacks& In known status epilepticus M:F ratio 3:1 , adults> children MC in mid-thoracic spine (T3-T8) Lumbar vertebral involvement rare

THE CAUSE? Strong muscular contractions during a “fit” can collapse the vertebrae - Lehndorff,1907 Violent muscular contractions of the posterior spinous and abdominal muscles flexes the spine forward and subjects it to axial loading and flexion compression forces. COMPRESSION FRACTURES-TYPICAL BURST FRACTURES-OCCASIONAL Nocturnal vertebral compression fractures may be the presenting feature of unwitnessed convulsive seizures Evaluation for epilepsy should be considered in what may appear to be an idiopathic vertebral compression fracture. Nocturnal vertebral compression fracture-A presenting feature of unrecognized epileptic seizure .,Amer G, Aboukasm,MD ,Brian J. Smith, MD ARCH FAM MED/VOL 6,MARCH/APR 1997

CONCLUSION Seizure-induced injuries can appear clinically asymptomatic and can easily be overseen due to absence of trauma and post-ictal amnesia. CRITICAL EXAMINATION OF PATIENTS WITH SEIZURES FOR FRACTURES ESPECIALLY OF THE SPINE OR LIMBS IS ESSENTIAL Epilepticky zachvat s nasledkem fraktury bederni patere= A.T MEHLHORN.PC STROHM.O.HAUSSCHILDT et al