Full neurologic recovery after fulminant thrombotic thrombocytopenic purpura with status epilepticus.
Thrombotic thrombocytopenic purpura (TTP) is an ischemic vasculopathy frequently associated with neurological dysfunction including seizures. However, status epilepticus (SE) has rarely been reported in this condition. We report on a 70-year-old woman with fulminant TTP who developed convulsive SE despite high therapeutic serum levels of phenytoin and phenobarbital. Her electroencephalogram (EEG) was characterized by bilateral independent periodic lateralizing epileptiform discharges (BIPLEDs) propagating into clinical and electrographic seizures. She recovered completely after intensive plasmapheresis and treatment with pentobarbital induced coma for 5 days. This case illustrates that aggressive treatment with pentobarbital and plasmapheresis may prevent permanent neurologic deficits when TTP is complicated by SE and that periodic lateralizing epileptiform discharges (PLEDs) in this syndrome can be the manifestation of a reversible ischemic insult.
Beydoun
Ahmad
A
Department of Neurology, University of Michigan Hospitals, 1500 East Medical Center Drive, UH1B300/0036, Ann Arbor, MI 48109, USA. beydoun@umich.edu
Vanderzant
Chris
C
Kutluay
Ekrem
E
Drury
Ivo
I
D000368:Aged; D004569:Electroencephalography; D005260:Female; D018757:GABA Modulators / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D010424:Pentobarbital / Q000627:therapeutic use; D010949:Plasma; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000188:drug therapy; D020127:Recovery of Function; D013226:Status Epilepticus / Q000150:complications* / Q000188:drug therapy
D018757:GABA Modulators; D010424:Pentobarbital