Thrombocytopenic thrombotic purpura: severe clinic with no CT, minor MRI, but a SPECT correlate

A 28-year-old woman with primarily therapy refractory TTP was followed neur oradiologically over 6 months. Despite pronounced neurological and neuropsy chiatric symptoms including hemiparesis and aphasia she had unremarkable CT scans on two occasions. Three MRI exams showed no correlate for her neurol ogical symptoms except a small petechial cortical hemorrhage in the right p arietooccipital gyrus which may account for her TTP-related anxiety disorde r. A cerebral HMPAO-SPECT showed long-standing right-sided hypoperfusion co mpatible with residual vasculature changes. The possible causes for the cli nico-neuroradiological discrepancies are discussed in view of the literatur e. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.