In a brain-injured patient who presents with a swollen and painful leg, the differential diagnosis includes trauma (e.g., contusion, sprain, or fracture), DVT, heterotopic ossification, and reflex sympathetic dystrophy.25 Especially with individuals whose impaired language or cognition hinder the history and physical examination, a high index of suspicion and liberal use of ancillary studies are critical. Plain radiographs are usually adequate for evaluating trauma. Noninvasive venous studies (duplex Doppler) are usually adequate for evaluating DVT. Once fracture and DVT have been ruled out, referral to a physiatrist or other specialist in the care of patients with brain injury should be arranged.
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