Atypical presentations of thrombotic thrombocytopenic purpura

Thrombotic thrombocytopenic purpura (TTP) usually presents in a fulminant fashion with marked hematologic abnormalities often associated with fever and neurologic and renal abnormalities. Two cases of TTP are reported in which neurologic deficits were initially the dominant findings, followed weeks later by the pronounced hematologic manifestations. Young patients with unexplained neurologic findings, even if there is only minimal anemia or thrombocytopenia, should be monitored for subsequent manifestations of TTP so that treatment may be instituted promptly.