Article Text

Thoracocervicofacial purpura as the single manifestation of epileptic seizure
  1. PIETRO RUBEGNI,
  2. MICHELE FIMIANI,
  3. GIOVAMBATTISTA DE ALOE,
  4. LUCIO ANDREASSI
  1. Department of Dermatology of University of Siena, Italy
  2. Division of Geriatrics, Azienda Ospedaliera, Siena, Italy
  1. Dr Pietro Rubegni, Istituto di Scienze Dermatologica, Università degli Studi di Siena, Policlinico “Le Scotte”, Viale Bracci, 53100 Siena, Italy. Telephone 0039 577 585420; fax 0039 577 44238.
  1. MARIO RUBEGNI
  1. Department of Dermatology of University of Siena, Italy
  2. Division of Geriatrics, Azienda Ospedaliera, Siena, Italy
  1. Dr Pietro Rubegni, Istituto di Scienze Dermatologica, Università degli Studi di Siena, Policlinico “Le Scotte”, Viale Bracci, 53100 Siena, Italy. Telephone 0039 577 585420; fax 0039 577 44238.

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Petechial haemorrhage of the thoracocervicofacial area has been described as an unusual consequence of epileptic seizure.1-4 Here we report a case of thoracocervicofacial purpura as the unique manifestation of epileptic seizure.

A 44 year old woman who underwent ovariectomy due to bilateral ovarian cysts at the age of 29 followed by hormone replacement therapy for several years, was admitted to hospital after a generalised grand mal seizure. The patient had no history of epilepsy. Neurological examination on admission was negative; however, purpura of the thoracocervicofacial region was seen (figure). Routine blood chemistry (platelet count on FBC) and chest radiography were normal. Cranial CT and MRI did not show any parenchymal pathology. An EEG trace was within normal limits.

Purpura was described in association with generalised seizures by Bychowski.1 Guillaume proposed that this type of purpura was of mechanical origin5, due to intense contraction of the chest and abdominal muscles with the glottis closed during the tonic-clonic phase, as in the Valsalva manoeuvre.

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