Patients with thrombotic thrombocytopenic purpura (TTP) can present with devastating neurological abnormalities.1Mortality may be as high as 95%, but current treatment has reduced this to about 10% and early treatment improves the rate of recovery.2 We describe two patients who presented with predominantly neurological symptoms and signs who, because of a delay in making a diagnosis of TTP, were referred for treatment at a late stage. Both patients were reviewed by neurological and haematological experts, who considered that the prognosis was poor.

The first case was a 49 year old woman with a longstanding diagnosis of schizophrenia and a previous left sided cerebrovascular accident. She was admitted to her local hospital with a 3 day history of drowsiness, confusion, epistaxes, and spontaneous bruising, having been noted to be increasingly agitated and disoriented over the preceding 6 weeks. Her only medication was trifluperazine and paroxetine. The second case was a 58 year old man, previously fit …