A previously healthy  34 year old woman is transferred to your hospital intubated and ventilated with a history of a prolonged generalized tonic-clonic convulsion. On arrival, she is deeply unconscious  with a GCS of 3, fixed dilated pupils, absent  tendon  reflexes and bilateral up-going plantar reflexes. An admission CT scan shows bilateral intracerebral haemorrhages. A full blood count report is as follows:

1) Hb 78 g/l                            (130-150),
2) WCC 14.5 x 106/mm3          (4.0-11.0), 
3) Platelets  43 x 106 /mm3      (150-300)

Blood picture:  Thrombocytopaenia, fragmented cells and reticulocytosis

Based on the history, CT scan and the hematology  report, provide three possible differential diagnoses

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College Answer

Eclampsia
Thrombotic thrombocytopaenic purpura
HUS
Meningococcal meningitis with DIC …(although big bleed is unlikely)

Vasculitis.

Discussion

This question is identical to Question 15.2 from the second paper of 2011.