The reader is encouraged to write possible diagnoses for each case before turning to the discussion. We invite readers to contribute case presentations and discussions. Please inquire first by contacting Dr Deepak Kamat at DKamat@med.wayne.edu. An 8-month-old boy presents to the emergency department with a right-sided facial droop for 1 day and blackish bruising around both his eyes resembling raccoon eyes for a week. His mother reports that the child had fallen from a couch 2 weeks earlier. The child has also been fussy, with decreased feeding for 3 days. He has no history of fever, and findings from a review of his systems are otherwise unremarkable. Medical history, family history, and social history are also unremarkable. On examination, the child is fussy but alert. Vital signs are normal: temperature, 98.7°F (37.0°C); heart rate, 108 beats per minute; respiratory rate, 32 breaths per minute; and blood pressure, 98/60 mm Hg. Anterior fontanelle is soft and flat. There is right-sided ptosis and drooping of the right side of the mouth, especially apparent when the child cries. There are no other focal deficits, and the rest of the neurologic examination findings are normal. Ecchymoses are seen extending, approximately a centimeter, circumferentially around both eyes. The liver is firm and palpable 3 cm below the right costal margin. The rest of the physical examination findings are normal. Initial laboratory evaluation reveals the following: hemoglobin, 7.7 g/dL (77 g/L); mean corpuscular volume, 80.7 fL; white blood cell count, 12,390/μL (12.39 × 109/L); and platelet count, 298 × 103/μL (298 × 109/L). Computed tomography (CT) of the head without contrast reveals no evidence of intracranial bleeding. Further investigations reveal an explanation for the child’s constellation of symptoms and anemia. A 13-year-old girl presents to the emergency department with a …