Seizure induced thoracocervicofacial petechiae

Thoracocervicofacial Purpura as a Presenting Symptom of Seizure Disorder: A Case Report

“…Similarly, conjunctival hemorrhage follows the same pathophysiology of thoracocervicofacial purpura indicating the transmission of high intrathoracic pressure through choroidal vessels, causing them to burst, which perfectly aligns with the presentation of this case [5,13]. In addition, the destructive effects of vasoactive mediators produced by neurons upon small capillaries are another proposed hypothesis for ictal purpuras [1,2,7,9,11]. De Souza et al [7] reported similar clinical presentation to our case; however, purpuric lesions disappeared within 48 h. Our patient's petechial rash took 2 weeks to clear after the first ictal episode, and 3 weeks after the second episode as…”

“…Postictal thoracocervicofacial purpura (mask phenomenon) is considered under-recognized uncommon secondary finding of epilepsy [1][2][3][4][5][6][7][8]. In relation to our presented case, postictal petechiae are characterized to be non-retiform, involving anterior chest, face, particularly periorbital areas, and neck, in addition to conjunctival hemorrhage [1,2,6,9,10].…”

“…), disorders of hemostasis (such as thrombocytopenia, platelet function abnormalities, coagulopathies, or disseminated intravascular coagulation). When applying the previous suggestions on our case, we discover that extravascular mechanism of unintentional prolonged increases intrathoracic or intra-abdominal pressure by at least 30-40 mm Hg (valsalva maneuver) caused by nocturnal convulsions [1,2,[8][9][10][11][12] that results in extravasation of blood cells due to capillary damage, is the main event for causing epilepsy induced thoracocervicofacial rash [1,2,[4][5][6][7][8][9][10][11]. Similarly, conjunctival hemorrhage follows the same pathophysiology of thoracocervicofacial purpura indicating the transmission of high intrathoracic pressure through choroidal vessels, causing them to burst, which perfectly aligns with the presentation of this case [5,13].…”

“…Postictal thoracocervicofacial purpura (mask phenomenon) is considered under-recognized uncommon secondary finding of epilepsy [1][2][3][4][5][6][7][8]. In relation to our presented case, postictal petechiae are characterized to be non-retiform, involving anterior chest, face, particularly periorbital areas, and neck, in addition to conjunctival hemorrhage [1,2,6,9,10]. Referring to the literature, no systematic reviews, cohort or cross-sectional studies were done as references for Case Reports in Dermatology this report, which supports the rareness of this phenomenon.…”

“…Dermatologists and other healthcare professionals should be aware of this cutaneous phenomenon since lesions can be misdiagnosed as drug-induced eruption or viral exanthem [1]. Moreover, this clinical symptom could be the only manifestation of an underlying epileptic disease and should be in the differential for any patient presents with petechiae or purpura localized to the upper body [2].…”