Diagnosis of vertebral fractures in post-ictal patients

The violent forces generated by the strong paraspinal muscles during generalised tonic-clonic seizures are known to be associated with numerous musculoskeletal injuries. Vertebral fractures following epileptic seizures are typically compression fractures, occurring in the mid thoracic region, usually without resultant neurological deficit. Despite the relative frequency of vertebral compression fractures complicating tonic-clonic seizures, burst fractures are rare. We report a case of a burst fracture resulting in conus medullaris syndrome following generalised motor seizures. Clinicians managing post-ictal patients should maintain a high degree of suspicion for secondary injury and conduct a detailed clinical examination. If there remains any doubt regarding diagnosis, appropriate imaging should be employed.