Nonconvulsive status epilepticus in thrombotic thrombocytopenic purpura

Fluctuating neurologic symptoms, including confusion, stupor, and convulsions, are common signs in thrombotic thrombocytopenic purpura (TTP). We describe a patient with TTP who had a clinical seizure, intermittent stupor, and a declining course despite aggressive treatment. An EEG showed continuous rhythmic epileptiform discharges, and she improved with anticonvulsants. Fluctuating stupor in TTP has generally been attributed to microvascular occlusive disease, but nonconvulsive status epilepticus is a treatable condition that can cause similar symptoms.