Late-diagnosed bilateral intertrochanteric femur fracture during an epileptic seizure

Abstract

Although spontaneous and simultaneous bilateral hip fractures without trauma are seen rarely, epileptic seizures may lead to these fractures. We present an 82-year-old female patient with poor bone quality and a 20-year history of epilepsy. She had been using anticonvulsant drugs for almost 20 years. Following a convulsive epileptic attack, bilateral intertrochanteric femur fractures occurred (causing bilateral hip pain), which was diagnosed on the 12th day. An earlier pelvic anteroposterior roentgenogram would be helpful for early diagnosis. It should not be forgotten that bone fractures may be observed without trauma in epilepsy patients.

Bilateral Neck of Femur Fractures in a Bilateral Below-Knee Amputee: A Unique Case

“…In addition to trauma, bilateral fractures due to epilepsy and electrocution have been described [8]. …”

Osteoporosis Associated with Epilepsy and the Use of Anti-Epileptics—a Review

“…Types of fractures reported during seizures most commonly include fractures of thoracic and lumbar vertebrae [46], therefore fractures should be examined for in the acute setting [47], particularly to avoid late detection and management [48]. Potentially serious complications have been published including case reports of a patient with a burst lumbar vertebral fracture during seizure which resulted in acute cauda equina / conus medullaris syndrome [46], and bilateral acetabular fractures and left proximal humerus fracture [49].…”

“…However, results of studies have suggested variation in the mechanisms of fracture, including that there is also higher risk of fracture through mechanisms other than seizures, and that monitoring for neurotoxicity is also important [116]. In the acute setting in post-ictal patients, the possibility of fracture should be considered on history and examination [47], and if there is clinical suspicion of fracture, relevant investigation, management and referrals should be requested, to avoid late detection [48]. Physician and patient education regarding bone disease and fracture risk in association with epilepsy will be important [33,32], as well as education regarding bone protective strategies [117,118], and being aware of (and successfully navigating) barriers to receiving appropriate screening and management of bone health in epilepsy care [119].…”

Vertebral Artery Dissection Associated with Generalized Convulsive Seizures: A Case Report

“…The muscular forces involved in the tonic-clonic phase of convulsive seizures are demonstrated by the occurrence of bone fractures in the spinal column and proximal skeleton [9]. Various fractures have been noted as resulting from convulsive seizures, including fractures of the vertebrae, pelvis, femoral neck and shoulder [9, 10, 11, 12, 13, 14]. Most vertebral fractures are compression fractures, but burst fractures with neurological complications can occur [15].…”