以神经系统症状首发的血栓性血小板减少性紫癜3例报道并文献复习

目的总结以神经系统症状首发的血栓性血小板减少性紫癜(thrombotic thrombocytopenic purpura,TTP)的临床特点,提高其诊断水平。方法回顾性分析我院确诊的3例TTP患者的病历资料,并复习相关文献。结果 TTP经典的五联征为发热、血小板减少性紫癜、微血管病性溶血、神经系统症状及肾损害。以脑损害为首发表现的TTP容易被误诊为脑卒中、颅内感染等。早期行血浆置换治疗效果好。结论以神经系统症状首发的血栓性血小板减少性紫癜临床表现复杂,容易误诊,要注意早期诊断和早期治疗。

Neurological manifestations as initial presentations of thrombotic thrombocytopenic purpura：3 cases report and review of literatures

Objective To summarize the clinical characteristics of thrombotic thrombocytopenic purpura（TIP） presenting neurological manifestations as initial symptoms and improve the diagnostic levd. Methods Clinical data of 3 cases of TTP were retrospective analyzed with literatures review. Results Fever, microvascular platelet clumping resulting in thrombocytopenia, microangiopathic hemolysis, neurological abnormality, and renal dysfunction were the characteristics of TIP. The initial symptom shown as neurological disfunction was easily misdiagnosed as stroke and intracranial infection. Early plasma exchange therapy should be effective. Conclusions The TIP presenting neurological manifestations as initial symptoms is easily misdiagnosed and should be early diagnosed and treated.