Radiology Review

Seizure Prompts Man to Fall

Author and Disclosure Information


A 70-year-old man is brought to your facility by EMS following a new-onset, witnessed seizure. He reportedly fell down some steps. On arrival, he has returned to baseline but is complaining of left-sided weakness and right ankle pain. Medical history is significant for mild hypertension. Vital signs are stable. The patient exhibits slight confusion. He reports some mild weakness on his left side, especially in his lower extremity. There also appears to be moderate soft-tissue swelling of his right ankle, with a slight deformity noted. Dorsalis pedal pulse appears to be slightly diminished in that foot as well. You send the patient for noncontrast CT of the head, as well as a radiograph of the right ankle (the latter of which is shown). What is your impression?


 

References

ANSWER
The radiograph shows a fracture dislocation of the ankle. The distal tibia is dislocated medially relative to the talus, as evidenced by the widened joint space. There is also an oblique fracture of the distal fibula.

Since the patient was experiencing neurovascular compromise, the dislocation was promptly reduced in the emergency department. Subsequently, he was taken to the operating room for open reduction and internal fixation of his fibula fracture.

Next Article: