Complications of epilepsy and a ruptured pyonephrosis: Radiology to the rescue in the Brooks murder case

Abstract

A woman and her lover were accused of murdering the woman's husband. Five weeks after fracture/dislocations of both shoulders and a central fracture/dislocation of the right hip were diagnosed the woman's husband died of septicaemia consequent on a ruptured infected hydronephrosis. The shoulder and hip injuries and the ruptured hydronephrosis were attributed to a beating with a blunt instrument. A review of the medical records of the deceased, particularly his radiological examinations, led the authors to conclude that his joint injuries and ruptured kidney were not due to the alleged assault. The joint injuries were the consequence of epileptic seizures and the ruptured kidney was also due to natural causes. These medical opinions provided evidence that led to acquittal of the accused.

Acetabular Central Fracture Dislocation after Generalized Seizure during Lumbar Myelography with Iohexol

“…Although contrast media have been used routinely for excretory urography, CT, and angiography for the past 30 years and are relatively safe, adverse reactions can be expected; the overall rate ranges from 5% to 8% [6]. The incidence of seizure induced by myelography in nonepileptic patients is very low, ranging from 0 to 0.847% [7].…”

高齢者のけいれん発作に合併した非外傷性寛骨臼骨折の1例(Nontraumatic acetabular fracture associated with convulsive seizure in an older patient: a case report)

“…本症例は，バイタルサインと血液検査値異常の評価のための画像診断所見から，活動性出血を伴う寛骨臼骨折の診断に至った。初診時に腰痛 17)や臀部痛 18)などを訴えている症例があるが，発作後は意識障害が遷延することがあり，自覚症状のみからのアプローチでは十分とはいえない。本症例でもけいれん後の覚醒が不十分であったため，自ら症状を訴えることができなかった。骨折のリスク因子としては，5分間持続する強直間代性けいれんであったこと，抗けいれん薬を内服していることが挙げられる。骨盤輪骨折と比較し，寛骨臼骨折では合併する後腹膜出血による循環動態への影響が少ないとされる。しかし，循環血液量減少性ショックにより診断されている症例 19)や，寛骨臼骨折を契機として死亡に至った症例の報告 10), 17), 18), 19)がある。一方，これまでに経カテーテル動脈塞栓術による止血例の報告はない。…”