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Abstract Details

Thrombotic Thrombocytopenic Purpura Atypically Presenting as Acute Ischemic Stroke
Cerebrovascular Disease and Interventional Neurology
P9 - Poster Session 9 (5:30 PM-6:30 PM)
13-006
Thrombotic thrombocytopenic purpura (TTP) is considered a hematological emergency which requires early diagnosis and treatment given that there is a 90% mortality rate in patients left untreated. However, diagnosis can be challenging because it can initially present with severe, atypical neurologic manifestations.
We present a case of TTP which atypically presented itself as acute ischemic stroke.
Case report
A 43-year-old African-American female with hypertension, hyperlipidemia, and recent stroke presented with right-sided weakness and difficulty speaking. On exam, the patient had right hemianopia, right lower facial droop, dysarthria, aphasia, and weakness and loss of pinprick sensation in the right hemi-body. CTA was significant for left MCA (M1) occlusion. MRI showed acute infarcts in the left MCA territory and chronic bilateral cerebellar infarcts. She was administered tPA and urgently taken to IR where she received a thrombectomy with TICI 3 revascularization. She was found to be thrombocytopenic (PLTs 36) and anemic (Hgb 7.6) with evidence of chronic renal impairment (baseline eGFR 30-45). Of note, hemoglobin from 5 months prior was normal. Peripheral blood smear showed a moderate amount of schistocytes. Haptoglobin was low (<10) and LDH was elevated (462). ADAMTS13 activity was <5% and there was presence of ADAMTS13 inhibition as well as a measurable antibody titer. These findings are consistent with acquired TTP which was deemed the likely etiology of her stroke. The patient received emergent PLEX and was also started on high-dose prednisone.  At discharge, platelets had improved to 282 and Hgb improved to 8.9. Antithrombotic and statin therapy were started for secondary stoke prevention.

In any patient with acute ischemic stroke and thrombocytopenia, a clinician should consider TTP as a diagnosis. Clinicians should also be familiar with common neurologic manifestations of TTP including expressive aphasia, visual disturbances, paresthesia, ataxia, headaches, seizures, altered mental status, or coma.

Authors/Disclosures
Sukriye Damla Kara, MD (University of Mississippi Medical Center)
PRESENTER
Dr. Kara has nothing to disclose.
Kelsey Carolyn Hillhouse, MD Dr. Carr has nothing to disclose.
Ryan Pinosky (University of Mississippi Medical Center) Mr. Pinosky has nothing to disclose.
Sameer Sharma, MD, MBBS (UMMC, department of neurology) Dr. Sharma has nothing to disclose.