1257 - Non-traumatic T12 ASIA Impairment Scale (AIS) Grade D Spinal Cord Injury Following Seizure

Case Diagnosis: Non-traumatic T12 ASIA Impairment Scale (AIS) Grade D Spinal Cord Injury Following Seizure

Case Description: A 38-year-old male with a history of alcohol use disorder and no prior diagnosis of epilepsy presented to the emergency department following a witnessed seizure with subsequent bilateral lower extremity weakness. The patient was travelling in a car when he began having multiple ensuing seizure-like episodes without any witnessed fall. Imaging revealed a T12 acute comminuted burst fracture with retropulsion and significant spinal canal narrowing. He underwent T11-T12 laminectomies and T10-L2 posterior instrumentation and arthrodesis. He was continued on levetiracetam for seizure prophylaxis and transferred to inpatient rehabilitation. Upon further review, patient was recently started on bupropion. Physical exam revealed T12 AIS Grade D spinal cord injury. Patient was noted to have absent deep anal sensation and voluntary anal contraction; however patient was able to ambulate 300 ft without an assistive device prior to discharge.

Discussions: While rare, burst fractures have been noted to occur in the thoracic and lumbar spine following epileptic seizures, even without concurrent trauma due to a fall or other impact. It is thought that the intense contractile forces of the spinal and abdominal musculature are the cause of the fracture. It is even more rare that these injuries lead to serious neurologic deficits seen in our patient. It is unlikely that his alcohol use precipitated his seizures as he reported his typical alcohol use on the day of his seizure. His recent bupropion prescription may have lowered his seizure threshold and precipitated the episode.

Conclusions: Non-traumatic thoracic burst fractures can occur following seizures, with potentially higher risk in healthy patients with increased spinal and abdominal musculature. Care should be taken to treat or prevent seizures in this population to avoid devastating neurologic injuries.