以神经系统症状为首发表现的血栓性血小板减少性紫癜1例报告并文献复习62例临床分析  

Neurological manifestations as initial presentations of thrombotic thrombocytopenic purpura: the clinical analysis of 1 case and review of the literature

作　　者：姜文娟[1] 李晓曦[1] 刘文静[1] 何志义[2] 

机构地区：[1]中国医科大学附属第一医院老年神经内科,辽宁沈阳110001 [2]中国医科大学附属第一医院神经内科,辽宁沈阳110001

出　　处：《中风与神经疾病杂志》2018年第1期35-39,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的分析以神经系统症状为首发或主要表现的血栓性血小板减少性紫癜(TTP)的临床特点,提高临床医生尤其是神经科医生对于TTP的认识。方法收集以神经系统症状为首发表现的TTP患者1例,结合国内文献报道62例,对共计63例患者的临床特点进行分析。结果 63例患者中男性25例,女性38例,男∶女=1∶1.52,发病年龄19~89岁,平均发病年龄(45.68±15.79)岁。首发症状主要为意识障碍、发热、头痛、头晕、言语不清及肢体无力。疾病早期曾被诊断为颅内感染、脑卒中、Evans综合征、多发性肌炎。颅脑影像学可表现为正常、脑出血、脑梗死、脑水肿、静脉窦血栓。结论当患者的症状不能完全用脑卒中、颅内感染等神经科疾病解释,尤其伴有血小板减少、贫血等血液系统异常时,要想到TTP,及时完善破碎红细胞、乳酸脱氢酶、肝功能、肾功能、ADAMTS13等化验,及时给予血浆置换往往可以改善患者预后。Objective To improve the understanding of thrombotic thrombocytopenic purpura（ TTP）,we analyze the clinical features of TTP presenting neurological symptoms as initial manifestations. Methods Collect the clinical data of 63 patients presenting neurological symptoms as initial or main manifestations,1 case from department of geriatric neurology of the First Affiliated Hospital of China Medical University,62 patients from literature. Results The mean age at presentation was 45. 68 ± 15. 79（ range,19 to 89） years with a female predominance（ male： female ratio,1： 1. 52）. The initial presentations were consciousness disorders,fever,headache,dizziness,dysarthria and extremity weakness. The diagnosis of the early case includes intracranial infection,stroke,Evans syndrome and polymyositis. The cranial MRI or CT could detect no lesions,hemorrhage,infarction,encephaledema and venous sinus. Conclusion When the symptoms were not completely explained by stroke,intracranial infection and other neurological diseases,especially associated with thrombocytopenia,anemia and other hematologic abnormalities,the patients may be possible TTP. Plasma exchange should be initiated promptly to improve the prognosis.

关 键 词：血栓性血小板减少性紫癜 神经系统症状 临床特点 诊断 

分 类 号：R554.6[医药卫生—血液循环系统疾病]