Objective To explore the features of neuroimaging and its influence on the prognosis of patients with acute thrombotic thrombocytopenic purpura ( TTP ) with nervous and mental manifestations. Methods The patients with acute TTP with nervous and mental manifestations who were admitted to the departments of neurology and haematology, the first affiliated hospital of Guangxi medical university during 2004 to 2009 were retrospectively analyzed. The data of clinical manifestations, cranial CT and MRI in acute stage and followed up were collected. Results Twelve cases with acute TTP were studied, including 8 females and 4 males. the higher incidence in nervous and mental symptoms were headache ( 66.7％ ),consciousness disorders ( 50％ ), psychiatric disorder( 50％ ), aphasia( 25％ ). Cranial MRI could detect brain lesions in 11 cases (91.7％) whereas CT only detected brain lesions in 3 cases ( 25％ ). Primary brain lesions mainly involved the subcortical white matter, partly extended to the boundary of gray and white matter or the cortex. Those lesions appeared as plaque-like, blurred boundary, low T1 , high T2 and high T2 FLAIR signal or mixed signal in MRI imaging. The abnormal MRI signals could decrease or disappear when the symptoms improved. Conclusions MRI is superior to CT in detecting acute TTP with nervous and mental manifestations. The characteristic manifestations of lesions in MRI are muti foci in the subcortical white matter with plaque-like , blurred boundary , low T1 , high T2 and high T2 FLAIR signal or mixed signal. Reduction or disappearance of abnormal MRI signals suggests the symptom improvement whereas persistent abnormal MRI signals indicate unfavorable prognosis.%目的 探讨具有神经精神表现的急性血栓性血小板减少性紫癜(thrombotic thrombocytopenic purpura,TTP)的神经影像学特点及其对疾病转归的影响.方法 回顾性分析2004～2009年广西医科大学第一附属医院神经内科或血液内科住院治疗,具有神经精神症状的急性TTP患者,急性期及随访的头颅CT、MRI等临床资料.结果 本组符合条件的患者12例,其中女8例,男4例.神经精神症状以头痛(66.7%)、意识障碍(50%)、精神异常(50%)、失语(25%)等多见;头颅MRI显示11例(91.7%)脑内存在异常病灶,CT显示仅3例(25%)异常.MRI显示病变主要表现为皮质下白质、部分延伸至灰白质交界或皮质的斑片状、边缘欠清的长T1、长T2及T2FLAIR高信号的病灶,部分病灶为混杂信号.随访的MRI显示上述病灶可随症状改善而减少或消失.3例MRI显示为多病灶融合的、大面积多发脑梗死,其中1例伴出血的患者,因病情严重而死亡.结论 具有神经精神表现急性TTP的影像学检查,MRI优于CT.其MRI特征性病变为:皮质下白质斑片状、边缘欠清的长T1、长T2及T2FLAIR高信号、部分为混杂信号的病灶,而且上述病灶可随症状改善而减少或消失.MRI显示病变严重者,预后不良.
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