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Updated: Jul 8, 2025
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Thrombotic thrombocytopenic purpura presenting as stroke mimics with normal diffusion-weighted MRI
1Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
Background:
Thrombotic thrombocytopenic purpura (TTP) is a rare and fatal thrombotic microangiopathy-based hematologic disease. Stroke has been reported as atypical neurological manifestations of TTP in some cases.
Case Presentation:
A 65-year-old male presented with typical acute ischemic stroke symptoms including sudden-onset dysarthria, right-sided facial paralysis and hemiplegia. However, his CT and MRI scans were negative without showing any new ischemic lesions. He was diagnosed with TTP with severe thrombocytopenia, mild anemia, increased LDH, and low ADAMTS-13 activity. The symptoms and positive signs were rapidly resolved after administrating the plasma exchange therapy.
Conclusion:
Clinicians should consider the possibility of TTP when a patient presents with acute stroke-like symptoms and thrombocytopenia, especially in an emergency room, either with or without new stroke lesions on the brain CT and MRI.
Insights
Thrombotic thrombocytopenic purpura (TTP) can mimic stroke. Prompt diagnosis and plasma exchange therapy are crucial for rapid recovery from TTP-induced neurological symptoms.
Area of Science:
- Hematology
- Neurology
Background:
- Thrombotic thrombocytopenic purpura (TTP) is a rare, fatal hematologic disorder characterized by thrombotic microangiopathy.
- Neurological manifestations, including stroke, are atypical but reported complications of TTP.
Observation:
- A 65-year-old male presented with acute ischemic stroke symptoms: dysarthria, facial paralysis, and hemiplegia.
- Cranial CT and MRI scans revealed no new ischemic lesions, despite clinical stroke presentation.
- Diagnosis was TTP, confirmed by severe thrombocytopenia, mild anemia, elevated LDH, and low ADAMTS-13 activity.
Findings:
- The patient's stroke-like symptoms and signs resolved rapidly following plasma exchange therapy.
- This case highlights TTP as a potential cause of stroke-like neurological deficits.
Implications:
- Clinicians must consider TTP in patients presenting with acute stroke-like symptoms and thrombocytopenia, particularly in emergency settings.
- Diagnostic imaging for stroke may be negative in TTP, necessitating a broader differential diagnosis.
- Early recognition and treatment of TTP are vital to prevent severe morbidity and mortality from neurological complications.
