Hypokalemia mimicking a herniated vertebral disc.
BACKGROUND
A herniated vertebral disc is a common cause of paralysis. Other causes include infections, tumors, and neurologic diseases. A rare and dangerous but in most cases easily treatable cause is hypokalemia. Clinically, the acute symptoms may resemble a herniated vertebral disc, but hypokalemia per se is life-threatening by causing heart arrest through ventricular tachycardia or fibrillation.


OBJECTIVE
A patient with back pain and neurologic deficit in the lower extremities after a history of a herniated vertebral disc presented, who finally receives the diagnosis of hypokalemia.


METHODS
Case report.


METHODS
A 25-year-old female patient presenting after a fall with muscle weakness in both legs was followed clinically and radiographically.


RESULTS
Neurological examination showed a lower extremity muscle weakness with three-fifths muscular strength of the quadriceps and tibialis anterior muscle on both sides. Reflexes were diminished bilaterally, anal sphincter tone was normal. Plain radiography suggested a posterior rim fracture of L5, but computed tomography did not confirm this diagnosis. The laboratory investigation revealed a hypokalemia of 1.7 mEq/L. On electrolyte replacement, the patient recovered immediately.


CONCLUSIONS
This report describes a misleading diagnostic case of back pain and neurologic deficit after a trauma and sensitizes for the possible life-threatening diagnosis hypokalemia, which is rare but easily treatable.
Klinikum rechts der Isar, Technical University Munich, Department of Trauma Surgery, Ismaningerstrasse 22, D-81675 Munich, Germany. Electronic address: Patrick.Delhey@mri.tum.de.
Patrick Roman
PR
Delhey
Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave., Kelvin Grove, QLD 4059, Australia.
Boris Michael
BM
Holzapfel
Klinikum rechts der Isar, Technical University Munich, Department of Trauma Surgery, Ismaningerstrasse 22, D-81675 Munich, Germany; Department of Surgery, Campus Innenstadt, Ludwig-Maximilians-University, Nussbaumstr. 20, D-80336 Munich, Germany.
Karl-Georg
KG
Kanz
Department of Orthopaedic Surgery, Campus Großhadern, Ludwig-Maximilians-University, Marchioninistr. 15, D-81377 Munich, Germany.
Susanne
S
Mayer-Wagner
D000328:Adult; D001416:Back Pain / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000150:complications / Q000175:diagnosis*; D007405:Intervertebral Disc Displacement / Q000175:diagnosis*; D018908:Muscle Weakness / Q000209:etiology*; D009460:Neurologic Examination
Herniated vertebral disc; Hypokalemia; Life-threatening; Muscle weakness