Thrombotic Thrombocytopenic Purpura Presenting as a Sudden Headache With Focal Neurologic Findings,☆☆,

https://doi.org/10.1016/S0196-0644(96)70304-9Get rights and content

Abstract

We report a case of thrombotic thrombocytopenic purpura presenting as a sudden headache with associated neurologic deficits. The diagnosis of this rare disorder is discussed, with special attention given to a potential pitfall in evaluation and treatment—platelet transfusion.

[Bridgman J, Witting M: Thrombotic thrombocytopenic purpura presenting as a sudden headache with focal neurologic findings. Ann Emerg Med January 1996;27:95-97.]

Section snippets

INTRODUCTION

Thrombotic thrombocytopenic purpura (TTP) was first described in 1923 by Moschowitz, but was not formally named until 1954.1 TTP is one of the endothelioses, a spectrum of disease including hemolytic uremic syndrome and postpartum kidney failure. It occurs in approximately 5 to 10 cases per 50,000 hospital admissions. No single age group is more heavily affected, but a female predominance of approximately 10 to 1 has been noted.1 Untreated, TTP has a mortality rate of 90%.2 Neurologic and

CASE REPORT

A 49-year-old black woman with a history of borderline diabetes and hypertension was referred to the University of Maryland Medical Center emergency department for evaluation of a bifrontal headache that had begun earlier in the day. The referring physician had noted drowsiness and slurred speech, in addition to a blood pressure of 180/120 mm Hg. The headache occurred suddenly, with maximal intensity at onset, and the patient had associated nausea and vomiting. She had experienced intermittent

DISCUSSION

The pathophysiology underlying TTP has yet to be completely understood. Endothelial cell damage with hyaline thrombus formation is the hallmark histologic finding in TTP. Proposed mechanisms for the endothelial cell wall injury include abnormal antibody formation, immune complexes, and alterations in the coagulation and fibrinolytic systems. No platelet-aggregating factor, prostacyclin inhibitor, or abnormal antibody has consistently been identified. Discussion continues as to whether the

References (8)

There are more references available in the full text version of this article.

Cited by (7)

View all citing articles on Scopus

From the Division of Emergency Medicine, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland.

☆☆

Address for reprints: Michael Witting, MD, 419 West Redwood Street, Suite 280, Baltimore, Maryland 21201, 410-328-8025, Fax 410-987-3263

Reprint no. 47/1/69694

View full text