Among patients with acute thrombotic thrombocytopenic purpura who experience neurological symptoms, there is an increased probability of abnormal findings following cerebral magnetic resonance imaging (MRI), which is associated with an increased risk for cognitive impairment, according to research published in the British Journal of Haematology.

TTP is a rare microangiopathy with a mortality rate of up to 90% in the absence of treatment, though survival with treatment also approaches 90%. While clinicians are aware that TTP is linked with neurological issues, including psychiatric complications, depression, and post-traumatic stress disorder, there has been little research into the persistent cognitive difficulties associated with acute TTP.

Previous data on MRI in this setting suggest that there may be MRI findings in 82% of evaluated patients, compared with 25% of patients when computerized tomography is used. For this study, researchers aimed to evaluate the frequency of neurological and cognitive symptoms using cerebral MRI and neuropsychological testing among patients who had experienced an acute TTP.

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Overall, 131 patients were included, all of whom had been diagnosed with acute TTP from 2005 to 2019; 23% were men, 53% were White, and the median age at the time of clinical presentation was 42 years (range, 13 to 93). At presentation, the most frequently observed neurological symptoms were severe headache (38%), stroke-like symptoms (30%), and confusion/agitation (9%).

Among all patients, abnormal MRI images were noted in 56% of the cohort; the majority of these patients had neurological symptoms compared with headache only (80% vs 18%, respectively; P <.0001). During remission, cognitive symptoms were noted in 27% of patients, the most common of which was impaired memory (66%).

Patients with an abnormal MRI had a lower verbal intelligence quotient (IQ; median score, 85 vs 99 among those without an abnormal MRI; P =.02), as well as a lower performance IQ (median scores, 83 vs 100, respectively; P =.02).

“In conclusion, we report that experiencing neurological symptoms during an acute episode of TTP is associated with an increased probability of an abnormal cerebral MRI scan,” the authors wrote. “Anxiety and depression are frequent findings in TTP survivors, regardless of neurological involvement at presentation, and should be addressed before formal neurocognitive assessment.”

Disclosures: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Alwan F, Mahdi D, Tayabali S, et al. Cerebral MRI findings predict the risk of cognitive impairment in thrombotic thrombocytopenic purpura. Br J Haematol. Published online October 22, 2020. doi:10.1111/bjh.17126