title: Cervical fracture from chronic steroid usage presenting as a stroke: A case report.
abstract: BACKGROUND
  Misdiagnosis of Brown-Séquard-like presentations can delay treatment; potentially endangering the positive outcomes a patient might otherwise have had. Stroke mimics can be perceived as signaling the end of urgent investigation and care once stroke is ruled out; however, stroke mimics themselves can require prompt care. Herein, we discuss an extremely rare case where stroke was ruled out, resulting in a lapse in care that lead to an exacerbated hemiparesis over the following week.
  
  
  METHODS
  We present a patient with an occult cervical spine fracture with extension of the neck, caused by reduced bone density from a chronic steroid regimen. Nine days after the initial onset of her neurological symptoms, the patient presented to the ED with the complaint of left sided weakness and right-sided sensory loss. She was determined to have a left- sided Brown Séquard syndrome, which resolved following anterior cervical discectomy and fusion at C4-C6 and a laminectomy from C4-C6.
  
  
  CONCLUSIONS
  This case indicated that patients with dangerously low bone density should be weaned off chronic steroid therapy to prevent the onset of osteoporotic symptoms early in adulthood. Furthermore, this case emphasizes the importance of continued investigation of symptoms if a stroke is ruled out and the need for more diligent monitoring of bone density of chronic steroid users.
  
  
  CONCLUSIONS
  Stroke mimics can require the same urgency in care and diagnosis as strokes themselves.
authors.affiliation: Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United States. Electronic address: christian.fisahn@swedish.org.
authors.forename: Christian
authors.initials: C
authors.lastname: Fisahn
authors.affiliation: Department of Neurosurgery, Wayne State University Detroit, MI, United States.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Moisi
authors.affiliation: Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States.
authors.forename: Shiveindra
authors.initials: S
authors.lastname: Jeyamohan
authors.affiliation: Seattle Science Foundation, Seattle, WA, United States.
authors.forename: Mary
authors.initials: M
authors.lastname: Wingerson
authors.affiliation: Seattle Science Foundation, Seattle, WA, United States.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States.
authors.forename: Charles
authors.initials: C
authors.lastname: Cobbs
authors.affiliation: Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States.
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Oskouian
authors.affiliation: Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States.
authors.forename: Jens R
authors.initials: JR
authors.lastname: Chapman
keywords: Cervical fracture; Cervical fusion; Cervical trauma; Spine; Steroid usage; Stroke mimics