dementia and ttp

On thursday we discussed a case of dementia and decreased ambulating

We touched on some reversible causes:
-B12 deficiency (which may manifest as subacute combined degeneration)
-NPH-(imparied reabsorption of CSF by the arachnoid granules)--> classic triad: cognitive changes, incontinence and trouble walking (may have a 'magnetic gate')

NPH is treated by large volume CSF drainage, and possiblly a shunt placement. 

here is a good review article on dementia from CMAJ, including when CT head should be included in the workup.



On Friday, Dr Thompson taught us about TTP that has many possible aetiologies.

TTP's Classic pentad:

1) Thrombocytopenia

2) Microangiopathic hemolytic anemia (MAHA; recognized by hemolysis with RBC fragments-shown above)

3) Neurological signs/symptoms

4) Renal failure

5) Fever

But our take home message was: 

Thrombocytopenia and MAHA without another cause is enough to start therapy!!

Here is a link to a review article on TTP. 

have a good long weekend :o)