Pearls and oy-sters: acute ischemic stroke caused by atypical thrombotic thrombocytopenic purpura

Abstract

Thrombotic thrombocytopenic purpura (TTP) is an episodic microangiopathic coagulopathy characterized by profound thrombocytopenia and hemolytic anemia. Neurovascular complications, including stroke and TIA, occur commonly upon initial TTP presentation, and the underlying etiology of such neurologic manifestations is usually hinted by the concomitant hematologic abnormalities.

Figure. Brain MRI upon initial presentation with left-sided hemianesthesia, left tongue numbness, and dysarthria

Acute ischemic brain infarct is demonstrated by sagittal views of diffusion-weighted MRI sequence corresponding to a conspicuous area of restricted diffusion in the right insular cortex. Punctate foci of restricted diffusion were also seen in the right medial temporal lobe and right occipital cortex.