Thrombotic thrombocytopenic purpura: prospective neurologic, neuroimaging and neurophysiologic evaluation.
OBJECTIVE
Neurologic symptoms are present in 60% of patients with thrombotic thrombocytopenic purpura (TTP) on initial examination and ultimately develop in about 90% of cases during the course of the disease. Despite central nervous system involvement being frequent, abnormalities in the brain of patients with TTP are infrequent on neuroimaging (CT/MRI) and neurophysiologic (EEG) evaluation, often reversible and mainly limited to symptomatic stages of the disease. The aim of our study was to establish the value of a complete neurologic screening as part of the work up of TTP.


METHODS
We prospectively evaluated 16 TTP patients, performing serial neurologic, neuroimaging and EEG examinations, independently of the presence of an objective central nervous system involvement.


RESULTS
Our study shows that a complete neurologic evaluation is of modest help in improving the diagnosis of TTP, but may be useful for the neurologic management.


CONCLUSIONS
Accurate neuroimaging and, especially, EEG evaluation and monitoring allowed us to identify patients who could benefit from anticonvulsive therapy, avoiding the unnecessary administration of the latter. The prognostic utility of complete neurologic screening in TTP remains to be conclusively demonstrated in larger prospective neurologic studies.
Meloni
G
G
Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza, Roma, Italy. meloni@bce.med.uniroma1.it
Proia
A
A
Antonini
G
G
De Lena
C
C
Guerrisi
V
V
Capria
S
S
Trisolini
S M
SM
Ferrazza
G
G
Sideri
G
G
Mandelli
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D009460:Neurologic Examination; D011446:Prospective Studies; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications*; D011859:Radiography