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Large vessel stroke as initial presentation of thrombotic thrombocytopenic purpura
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Large vessel stroke as initial presentation of thrombotic thrombocytopenic purpura
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Journal Article
Large vessel stroke as initial presentation of thrombotic thrombocytopenic purpura
2018
Overview
A 67-year-old right-handed woman presented with dysarthria, left upper extremity weakness and right-sided neglect of 3 hours duration. Imaging of the brain revealed acute right middle cerebral artery stroke; however, tissue plasminogen activator could not be administered due to severe thrombocytopenia. A peripheral smear revealed schistocytes and the patient was treated empirically for thrombotic thrombocytopenic purpura (TTP) with therapeutic plasma exchange. An extensive workup revealed no embolic source or other cause for stroke, and a diagnosis of large vessel infarct secondary to TTP was made. After a prolonged hospital course, the patient had partial neurological recovery and was discharged to a rehabilitation facility. Although transient neurologic deficits due to small vessel occlusions are well described in TTP, large vessel infarct can occur as well. This diagnosis should be considered in patients presenting with concomitant stroke and thrombocytopenia, as untreated TTP is nearly always fatal.
Publisher
BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
Subject
Adrenal Cortex Hormones - therapeutic use
/ Aged
/ Aphasia
/ Dysarthria - physiopathology
/ Female
/ haematology (drugs and medicines)
/ haematology (incl blood transfusion)
/ Humans
/ Ischemia
/ Kidneys
/ Ostomy
/ Patients
/ Plasma
/ Purpura
/ Purpura, Thrombotic Thrombocytopenic - diagnosis
/ Purpura, Thrombotic Thrombocytopenic - physiopathology
/ Purpura, Thrombotic Thrombocytopenic - therapy
/ Steroids
/ Stroke
