Cervical fracture from chronic steroid usage presenting as a stroke: A case report

• This case highlights the important fact that stroke mimics can require the same urgency in care and diagnosis as strokes themselves.
• Such a case demonstrates that clinicians should carefully examine imaging of the cervical spine in cases of hemiparesis, even in cases where there is no recent history of trauma.
• The case of several cervical spine fractures resulting from a simple head tilt perhaps implicates that the bone mineral density of patients on long-term steroid use should be monitored starting at an early age and that a certain threshold of bone density should be impermissible.

IntroductionMisdiagnosis 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.Presentation of caseWe 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.DiscussionThis 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.ConclusionStroke mimics can require the same urgency in care and diagnosis as strokes themselves.