A 28-year-old man presented to the emergency department after a witnessed GTC seizure. The patient had a history of systemic lupus erythematosus, previous subarachnoid hemorrhage, and pulmonary embolism. He was on regular methylprednisolone 16 mg, enoxaparin 60 mg once daily, and levetiracetam (LEV) 500 mg twice daily. The patient had recently stopped taking LEV. There was no trauma in the history. Neurological examination was normal. He had severe lower back pain that failed to subside despite treatment with analgesics and opioids; therefore, this patient had an indication for radiological imaging. Urgent non-contrast computerized tomography (CT) scan of the lumbar spine revealed a burst fracture of L1. Non-contrast lumbar magnetic resonance imaging (MRI) revealed a bursal fracture in the L1 vertebral corpus that caused approximately 50% height loss, and there was compression of the posterior corpus of the vertebra on the thecal sac; however, no stenosis of the spinal canal was detected. At this level, there was bone marrow edema in the vertebral corpus (Figure 1,2). He was transferred to the neurosurgery department. Written informed consent was obtained from the patient for the publication of this case.