title: Postictal hemifacial purpura.
abstract: Non-traumatic stereotyped postictal purpura is rare. A 25-year-old woman presented with right facial, cheek and periorbital purpuric eruptions that occurred after secondarily generalized tonic-clonic seizures. The stereotyped, invariably right-sided facial skin eruption, which resolved in 48 hours, falsely raised concerns of spousal abuse. Possible pathophysiological mechanisms include: (a) valsalva-induced capillary hypertension with secondary purpura, (b) ictal corticolimbic stimulation of the autonomic nervous innervation of facial vasomotor structures, and (c) trigeminal-mediated local release of vasoactive substances. Although rare, such stereotyped patterns of purpura should be recognized to avoid incorrect attribution of spousal abuse.
authors.affiliation: Johns Hopkins Bayview Medical Center, Department of Neurology, Baltimore, MD 21224, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Reis
authors.forename: P W
authors.initials: PW
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004830:Epilepsy, Tonic-Clonic / Q000150:complications*; D005145:Face; D005151:Facial Injuries / Q000175:diagnosis; D005260:Female; D006801:Humans; D011693:Purpura / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013179:Spouse Abuse; D014666:Vasomotor System