Asked to evaluate bilateral unexplained upper-thigh bruises on a profoundly impaired woman newly admitted to our rehabilitation unit 2 weeks after an intracerebral hemorrhage. Patient received high-dose dexamethasone to reduce perihemorrhage edema.
A percutaneous gastrostomy was performed and is being used to administer nutrition, fluids, and medications.
Accompanying paperwork from the referring institution makes no mention of bruises. No known coagulopathy or thrombocytopenia; no warfarin or aspirin in the 2 weeks since her hemorrhagic stroke.
Vital signs normal. Unresponsive verbally. Left gaze preference. Dense right hemiparesis with apparent hemianesthesia. Upgoing toe on right. Upper thighs as shown; no perianal or vulvar ecchymosis, and no ecchymoses elsewhere on the body.
WHAT'S YOUR DIAGNOSIS?
(Answer on next page.)
1. Schneiderman H. Peculiar striped penile hematoma and local "doughnut hematoma" after transfemoral coronary angioplasty. Consultant. 1999;39: 2801-2809.
2. Schneiderman H. Follow-up: hematomas fade and resolve. Consultant. 1999; 39:3350.
3. Iloeje UH, Schneiderman H. Nontraumatic penoscrotal hematoma due to leakage from abdominal aortic aneurysm. Consultant. 1996;36:2023-2025.
4. Schneiderman H, Esstman E, Baker D, Gottschalk M. Severe facial ecchymoses, and the recognition and distinctions of multifactorial falls. Consultant. 2004;44:619-630.
5. Lane S, Grzhibek M, Schneiderman H. Amyloidosis in the skin and the mouth: periocular differentials illuminated by logic and coexistence of macroglossia. Consultant. 2006;46:1065-1070.
6. Schneiderman H. Conjunctival and orbital ecchymosis, either spontaneous or from occult trauma. Consultant. 2004;44:93-100.
7. Mosqueda L, Burnight K, Liao S. The life cycle of bruises in older adults. J Am Geriatr Soc. 2005;53:1339-1343.
8. Schneiderman H. Oral blood blisters with severe thrombocytopenia, and bedside assessment of bleeders. Consultant. 1992;32(4):131-132.
9. Schneiderman H. Perifollicular hemorrhages due to scurvy (vitamin C deficiency) in an American alcoholic. Consultant. 1991;31(1):49-50.
10. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118:219-223.