Citation: Palma S, Pereira P. Non-traumatic bilateral posterior fracture-dislocations of the shoulders. J Clin Images Med Case Rep. 2024; 5(9): 3251.

Description

A previously healthy 50-year-old man was brought to the Emergency Department, after presenting from sleep, sudden generalized involuntary movements. After recovering conscience, he complained of severe pain and functional limitation in shoulders. He was diagnosed comminuted fracture of the metaphysis at the level of the surgical neck and lower-posterior dislocation of humerus bilaterally and was treated surgically. CK was elevated (3141 UI/L). The EEG and the CSF study were innocent. Brain MRI identified multiple bilateral frontals and parietal T2 hyperintensities, without restriction to diffusion. The cerebrovascular investigation established the diagnosis of antiphospholipid syndrome with secondary epilepsy. The patient started levetiracetam and warfarin, without recurrence of crisis four years later. Emergency doctors should be aware that spontaneous bilateral posterior fracture-dislocations of the shoulders detected on Xray, is highly suggestive of epileptic etiology, even on the absence of previous history of epileptic crisis. Other causes can be electrocution and extreme trauma (known as “triple E syndrome”).

Figure 1: Clinical image.