Thrombotic thrombocytopenic purpura: A neurological perspective

We report 17 cases of thrombotic thrombocytopenic purpura (TTP) admitted to Indiana University Medical Center (IUMC) between January 1985 and December 1994. There were 11 women and 6 men ranging in age from 17 to 70 years. Fifteen patients had impaired mental status during hospitalization, and seven had seizures. Patients were treated with different therapeutic modalities including corticosteroids, aspirin, plasma transfusions, splenectomy, and plasma exchange. Neither neurological status on admission nor seizures was predictive of outcome. Presence of underlying disorders did not alter outcome or treatment response. Three patients died during hospitalization, and three developed end-stage renal disease. The presence of confusion, seizures, thrombocytopenia, microangiopathic hemolytic anemia, and renal failure should alert the clinician to the possibility of TTP and the need for prompt administration of plasma exchange.