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Acute neurological involvement is well described, but its long\u2010term impact requires evaluation. One\u2010hundred thirty\u2010one patients, following an acute TTP event, with severe headache or neurological symptoms had a cerebral MRI. Fifty\u2010six percent had abnormal imaging, more commonly in patients with neurological symptoms than headaches only (80% vs. 18%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00\u00b70001). In remission, 27% (<jats:italic>n<\/jats:italic>\u00a0=\u00a035) reported persistent cognitive symptoms: specifically, impaired memory (66%), difficulty concentrating (26%), and word\u2010finding difficulties not secondary to an acute stroke (26%). Sixty\u2010five percent also reported depression and 55% reported anxiety, regardless of presenting neurology. The frontal lobe was disproportionally affected in patients with marked intellectual impairment, seen in 67% of patients compared to 19% of patients without intellectual impairment (<jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b7002). The primary MRI finding in these patients was hyperintense white matter lesions. An abnormal MRI was associated with a lower median verbal IQ (85 vs. 99, <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b702) and performance IQ (83 vs. 100, <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b702). In conclusion, neurological symptoms are frequently associated with an abnormal cerebral MRI scan, and white matter frontal lobe lesions are particularly significant, leading to marked intellectual impairment. Anxiety and depression were evident in over half of patients, regardless of neurological involvement at presentation.<\/jats:p>","DOI":"10.1111\/bjh.17126","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T16:49:51Z","timestamp":1603385391000},"page":"868-874","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Cerebral MRI findings predict the risk of cognitive impairment in thrombotic thrombocytopenic purpura"],"prefix":"10.1111","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4698-9569","authenticated-orcid":false,"given":"Ferras","family":"Alwan","sequence":"first","affiliation":[{"name":"Department of Haematology University College London Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Mahdi","sequence":"additional","affiliation":[{"name":"Department of Haematology University College London Hospital London 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