The importance of imaging for status epilepticus patients to rule out fractures – A case report
Bibliographic record
Abstract
Status epilepticus could be the first presentation of underlying epilepsy or may occur in patients with known epilepsy. The literature has reported many cases of seizures severe enough to cause dislocations or fracture-dislocations of the shoulder or hip joints and death from hemorrhaging. Although shoulder and hip injuries due to seizures are rare, such events are known to occur, especially in patients with a history of osteoporosis or other risk factors for fractures. We describe a case of a 35-year-old healthy male with no history of osteoporosis or reduced bone density. His first presentation of epilepsy manifested with status epilepticus. This prolonged seizure resulted in bilateral acetabular fracture with left proximal humerus fracture without any trauma or falls. Although fractures associated with seizures have been reported in the literature, dislocation and fractures from seizures involving both the hip and the shoulder joints have only been described in a few cases. Two of these cases involved patients with known epilepsy, osteoporosis and osteomalacia. To the best of our knowledge, this is the first described case of a patient with bilateral hip and one shoulder fracture that had no previous history of epilepsy or seizures, except for febrile seizure as a child, which did not requiring any treatment. He was also not taking any antiepileptic medications, which are known to reduce bone density. This case shows the severity of status epilepticus and the importance of screening for fractures in patients, especially in those with risk factors for reduced bone density. يمكن أن تكون الحالة الصرعية هي الظهور الأول لمرض الصرع وقد تحدث عند مرضى الصرع المعروفين. وفي الأدبيات البحثية المنشورة هناك تقارير عدة عن حالات كانت فيها النوبة شديدة بدرجة أدت إلى خلع أو كسر في الكتف أو الورك, كما قد تسبب الوفاة نتيجة النزف. ومع أن إصابة الكتف والورك نتيجة النوبة نادرة ولكنها ممكنة, خاصة عند المرضى الذين لديهم تاريخ مرضي لهشاشة العظام أو عوامل خطر أخرى لحدوث الكسور. نعرض هنا حالة مريض عمره 35 عاما صحيح البنية, وليس لديه تاريخ مرضي لهشاشة العظام أو انخفاض في كثافة العظام. وكان الظهور الأول للصرع لديه هو الحالة الصرعية التي كانت عبارة عن نوبة طويلة أدت إلى كسر في الحق على الجهتين مع كسر في أدنى العضد الأيسر. مع أن هناك تقارير كتبت عن حالات كسور وخلوع في الأوراك والأكتاف مصاحبة لنوبات حدثت, ولكنها حدثت في حالات قليلة فقط. حالتان منها كانت لمرضى يعانون من صرع وهشاشة ولين العظام. وحسب معرفتنا فإن هذه الحالة هي الأولى في الأدبيات المنشورة التي حدث لها كسور في الوركين والكتف وليس لديها تاريخ مرضي لصرع أو نوبات. باستثناء نوبة حموية قبل سن الخامسة لم تستدع العلاج, ولم يستعمل أي علاج آخر للصرع يمكن أن يسبب انخفاض في كثافة العظام. توضح هذه الحالة شدة الحالة الصرعية وأهمية المسح الكامل للكسور في المرضى المصابين, خاصة من لديهم عوامل خطر أخرى لحدوث انخفاض في كثافة العظام.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".