title: Clinical course, laboratory parameters and outcome of TTP pediatric patients presenting with posterior reversible encephalopathy syndrome.
abstract: OBJECTIVE
  The clinical course and outcome of children with thrombotic thrombocytopenic purpura and posterior reversible encephalopathy has not been observed and studied till date. The aim of the present study was to know the clinical course and outcome of children with thrombotic thrombocytopenic purpura and posterior reversible encephalopathy. Results from our observation invite potential insight for further research on this subject.
  
  
  METHODS
  From January 2005 to February 2013, seven children diagnosed with thrombotic thrombocytopenic purpura and posterior reversible encephalopathy syndromes were admitted in a tertiary care hospital in Srinagar, Kashmir. The demographic parameters, clinical characteristics and laboratory data were noted. The outcome was defined in the form of complete recovery or death. Thrombotic thrombocytopenic purpura was diagnosed on clinical grounds, laboratory parameters and renal biopsy. The diagnosis was established after an expert opinion from a hematologist. Posterior reversible encephalopathy syndrome was defined on neuroimaging.
  
  
  RESULTS
  The common clinical parameters which were shared by all the patients were hypertension and altered sensorium. Four (57.1%) patients showed clinical deterioration and died within one week of admission even after intensive management. Three (42.8%) patients improved clinically and recovered fully and were discharged in stable clinical condition. Repeat imaging on discharge was normal.
  
  
  CONCLUSIONS
  This series of seven pediatric patients is the first series on this subject. The presence of posterior reversible encephalopathy syndrome in pediatric patients with thrombotic thrombocytopenic purpura complicates the clinical course and worsens the prognosis.
authors.affiliation: a Department of Internal Medicine , Sher-i-Kashmir Institute of Medical Sciences , Srinagar , Kashmir , India .
authors.forename: Riyaz Ahmad
authors.initials: RA
authors.lastname: Bhat
authors.affiliation: b Department of Gastroenterology , Institute of Liver and Billiary Sciences , New Delhi , India .
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Wani
authors.affiliation: c Department of Orthopedics , Bones and Joint Hospital , Srinagar , Kashmir , India , and.
authors.forename: Syed
authors.initials: S
authors.lastname: Baasit
authors.affiliation: d Department of Internal Medicine , Sher-i-Kashmir Institute of Medical Sciences , Srinagar , Kashmir , India.
authors.forename: Imran
authors.initials: I
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006403:Hematologic Tests; D006801:Humans; D007150:Immunohistochemistry; D015278:Intensive Care Units, Pediatric; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Posterior reversible encephalopathy syndrome; renal failure; thrombotic thrombocytopenic purpura