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Thrombotic thrombocytopenic purpura: Brain CT and MRI findings in 12 patients

From the Departments of Neurology (Drs. Bakshi, Shaikh, Bates, and Kinkel), Neuroimaging (Drs. Bakshi, Bates, and Kinkel), and Internal Medicine (Dr. Shaikh), University at Buffalo (SUNY) School of Medicine and Biomedical Sciences; and Dent Neurologic Institute and Millard Fillmore Hospital (Drs. Bakshi, Bates, and Kinkel), Buffalo, NY.

Address correspondence and reprint requests to Dr. Rohit Bakshi, Lucy Dent Imaging Center, 3 Gates Circle, Buffalo, NY 14209.

Clinical-neuroimaging analysis of 12 thrombotic thrombocytopenic purpura (TTP) patients revealed a variety of brain lesions. These included reversible cerebral edema lesions with MRI features of reversible posterior leukoencephalopathy syndrome (RPLS). Most of the RPLS patients had hypertension and renal dysfunction, suggesting RPLS due to hypertensive encephalopathy. Prompt treatment usually led to neurologic recovery and disappearance of edematous lesions. Those with infarcts or hematomas had a poorer outcome. TTP should be added to the expanding spectrum of RPLS and hypertensive encephalopathy.

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