Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran.
BMC Neurol. 2023 Jan 28;23(1):47. doi: 10.1186/s12883-023-03073-1.
Thrombotic thrombocytopenic purpura (TTP) considers a rare cause of ischemic stroke (IS). We reported a case of a newly diagnosed patient with acquired immune-mediated TTP (iTTP), in whom two IS events developed during 48 h.
A 59-year-old diabetic male was presented to the hospital 24 h after symptoms onset, including left hemiparesis, dysarthria, and decreased consciousness. A brain CT scan was performed with the suspicion of acute IS, indicating infarct lesions in the right middle cerebral artery (MCA) territory. The patient was not eligible for thrombolytic therapy due to admission delay. Over the next 24 h, the patient's neurological condition deteriorated, and the second brain CT scan showed new ischemic lesions in the left MCA territory. Initial laboratory evaluation indicated thrombocytopenia without evidence of anemia. However, in the following days, thrombocytopenia progressed, and microangiopathic hemolytic anemia (MAHA) developed. The ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity and inhibitors assay confirmed the diagnosis of iTTP. The patient underwent plasma exchange activity and inhibitors assay confirmed the diagnosis of iTTP. The patient underwent and pulse IV methylprednisolone. Rituximab was also added due to the refractory course of the disease. After a prolonged hospital course, he had considerable neurologic recovery and was discharged.
Clinicians should consider two points. First, TTP should be considered in any patient presenting with IS and having thrombocytopenia or anemia without other symptoms of TTP. Second, worsening the patient's condition during hospitalization may indicate a new stroke and should be investigated immediately.
血栓性血小板减少性紫癜（TTP）被认为是缺血性卒中（IS）的罕见病因。我们报告了一例新诊断的获得性免疫介导性 TTP（iTTP）患者，该患者在 48 小时内发生了 2 次 IS 事件。
一名 59 岁糖尿病男性，在症状发作后 24 小时被送往医院，表现为左侧偏瘫、构音障碍和意识下降。脑 CT 扫描怀疑为急性 IS，提示右侧大脑中动脉（MCA）区域梗死病灶。由于入院延迟，患者不符合溶栓治疗条件。在接下来的 24 小时内，患者的神经状况恶化，第二次脑 CT 扫描显示左侧 MCA 区域出现新的缺血性病灶。初始实验室评估表明血小板减少，无贫血证据。然而，在随后的几天里，血小板减少进展，出现微血管性溶血性贫血（MAHA）。ADAMTS-13（一种具有血小板反应蛋白 1 型基序的金属蛋白酶 13）活性和抑制剂检测证实了 iTTP 的诊断。患者接受了血浆置换治疗，并抑制剂检测证实了 iTTP 的诊断。患者接受了和脉冲 IV 甲基强的松龙治疗。由于疾病的难治性过程，还添加了利妥昔单抗。经过长时间的住院治疗，他的神经功能得到了很大的恢复并出院。
临床医生应考虑两点。首先，任何出现 IS 且血小板减少或贫血而无 TTP 其他症状的患者，都应考虑 TTP。其次，住院期间病情恶化可能表明发生新的卒中，应立即进行调查。
