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Profoundly Impaired Woman With Bilateral Unexplained Upper-Thigh Bruises

Profoundly Impaired Woman With Bilateral Unexplained Upper-Thigh Bruises

 

HISTORY

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.

PHYSICAL EXAMINATION

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.)

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