Postictal Rash: A Rare Case Reporting to Neurology

Generalized epileptic seizures are usually followed by a postictal phase that is often characterized by drowsiness, lethargy, weakness, and confusion. In rare cases, it can present with cutaneous manifestations. Here, we present the case of a 45-year-old male who experienced a seizure and subsequently developed a pinpoint rash with non-blanchable petechiae on various parts of his body. The rash appeared during transport to the emergency department and was resolved after seven days once the seizures were controlled. Initial imaging and basic labs were unremarkable other than a slight increase in postictal markers. No other cause behind this new rash was identified. Our case emphasizes the importance of postictal skin manifestations to aid in diagnosing seizures and avoid unnecessary investigations. The possible pathophysiology behind these generalized non-blanchable petechiae has been attributed to hemodynamic changes and neurogenic inflammation triggered in response to the seizures. Further research into the underlying mechanism and prompt recognition of these symptoms can improve the management of epilepsy care.