Sudden death from pelvic hemorrhage after bilateral central fracture dislocations of the hip due to an epileptic seizure.
Fracture and dislocation of major joints may be caused by the forceful tonic muscular contractions of seizure activity. A 77-year-old man who was found dead in bed with no sign of external trauma had bilateral central fracture dislocations of the femoral head through the acetabular floor with fatal pelvic hemorrhage and extensive pulmonary fat and bone marrow embolism. He had epilepsy, but the last seizure was 6 years earlier, and he had long discontinued medication. The fractures were attributed to a new unwitnessed seizure. This is the twentieth case of central fracture dislocation of the hip since 1970, when better anesthesia eliminated convulsive therapy-induced fractures. The authors review these 20 cases. Seizures followed inflammation, infarction or neoplasia of the brain, eclampsia, metabolic or iatrogenic causes, or epilepsy (6 cases, 2 of which had no prior seizures for 5 years). There were 11 men (mean age, 64 years) and 9 women (mean age, 47 years). Fractures were unilateral in 13 and bilateral in 7. Additional fractures (in vertebrae, shoulders, or femur) were present in eight. Only eight had prior bone disease. Local symptoms led to diagnosis in most, but two were identified incidentally on imaging. The current patient was the only one to die suddenly, but six other patients presented with shock and three died (one of whom had injuries that led to a suspicion of manslaughter). Central fracture-dislocation of the hip is a rare and little known consequence of seizures, with strong potential for misdiagnosis and lethal complications.
Hughes
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CA
Department of Histopathology, Saint James's Hospital and Trinity College Medical School, Dublin, Ireland.
O'Briain
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DS
D000077:Acetabulum / Q000293:injuries; D000368:Aged; D003645:Death, Sudden / Q000209:etiology*; D004620:Embolism, Fat / Q000150:complications; D004827:Epilepsy / Q000150:complications*; D005260:Female; D005270:Femur Head / Q000293:injuries; D006470:Hemorrhage / Q000209:etiology*; D006620:Hip Fractures / Q000150:complications* / Q000209:etiology; D006801:Humans; D008297:Male