Consultant. Vol. 47 No. 1

Pages: 1 2

WHAT'S YOUR DIAGNOSIS?

Profoundly Impaired Woman With Bilateral Unexplained Upper-Thigh Bruises

By HENRY SCHNEIDERMAN, MD—Series Editor—and SWEET F. VER, MD
Dr Schneiderman is vice-president, medical services/physician-in-chief at Hebrew Health Care, West Hartford, Conn. He is also professor of medicine (geriatrics) and associate professor of pathology at the University of Connecticut Health Center, Farmington. He is a recipient of the American Geriatrics Society Clinician of the Year award and recently received the Laureate award of the Connecticut chapter of the American College of Physicians. Dr Ver is a fellow in geriatrics at the University of Connecticut's Center on Aging, currently on-service at Hebrew Health Care.
| January 1, 2007

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(Drug information on 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(Drug information on warfarin) or aspirin(Drug information on 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.)

Pages: 1 2

TOPIC INDEX

Developmental/Genetic

Nutritional/Metabolic

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Profoundly Impaired Woman With Bilateral Unexplained Upper-Thigh Bruises

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