Minimal cerebral dysfunction in children with chronic thrombocytopenia

Chronic cases of idiopathic thrombocytopenic purpura (ITP) follow a relatively benign course in the majority of cases. A conservative attitude is, therefore, generally adopted in dealing with these cases. A disproportionately high incidence of the syndrome of minimal cerebral dysfunction (MCD) has been observed in a series of 20 patients with chronic ITP closely followed over a period of years. Six patients had serious behavior problems and learning difficulties. Psychological testing revealed a visuomotor deficiency and an impaired capacity for abstraction. The clinical and psychological picture was consistent with the diagnosis of MCD. This diagnosis was supported by EEG findings, which showed abnormalities in all six patients. Psychological indicators of MCD and EEG abnormalities were prominent in the group of 20 patients as a whole. These findings could be accounted for by multiple minute capillary bleeding. Considerations of prognosis in chronic ITP should be modified in view of this evidence for an organic brain lesion.