Acute foot drop secondary to lumbar disc prolapse after seizure

Generalised tonic-clonic seizures have been reported to cause musculoskeletal injuries including vertebral fractures usually without resultant neurological deficit. Lumbar disc prolapse resulting in neurological deficits following seizures has not been reported. We report a 43-year-old man who presented after a generalised seizure at which point he developed worsening of low back pain and left sciatica followed by an acute foot drop. His lumbo-sacral MRI demonstrated a diffuse disc bulge at L4-5 level and a large, caudally migrated, free disc fragment with resulting severe canal stenosis at L4/5 and left lateral recess stenosis at L5/S1. He underwent urgent left L4/5 and L5/S1 micro-discectomies with resolution of his symptoms. We illustrate a rare but important treatable complication of seizures. Detailed history and clinical examination in patients with post-ictal neurological deficit should be conducted to identify the specific cause. Appropriate imaging should be performed if there remains any doubt regarding diagnosis.

Automated summary

We report a case of lumbar disc prolapse resulting in neurological deficits following a generalized seizure. This is a rare but important treatable complication of seizures. Detailed history and clinical examination should be conducted in patients with post-ictal neurological deficit to identify the specific cause, and appropriate imaging should be performed if there remains any doubt regarding the diagnosis.