Relapsed thrombotic thrombocytopenic purpura presenting as an acute cerebrovascular accident

Katharine A. Downes, Roslyn Yomtovian, H. M. Tsai, Bernard Silver, Cynthia Rutherford, Ravindra Sarode

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Thrombotic thrombocytopenic purpura (TTP) is an uncommon but severe disorder that classically presents with microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and fluctuating neurological changes. Previously, it was impossible to make a diagnosis of TTP in the absence of thrombocytopenia or microangiopathic hemolysis (MAHA). We describe two cases of relapsing TTP that presented with acute cerebrovascular accident (CVA) without concurrent thrombocytopenia or MAHA after initial classical presentation of TTP. In both cases, the diagnosis of TTP as the cause of the CVA was attributed to severe deficiency of the von Willebrand factor cleaving protease, ADAMTS13 in plasma (11 and 12%, normal 79-127%). Each patient had a dramatic clinical improvement in response to therapeutic plasma exchange. The experience in these two cases suggests that TTP should be considered as a potential cause among patients presenting with a CVA, particularly if the patients have a history of TTP.

Original languageEnglish (US)
Pages (from-to)86-89
Number of pages4
JournalJournal of Clinical Apheresis
Issue number2
StatePublished - 2004


  • ADAMTS13 protease activity
  • Cerebrovascular accident
  • Stroke
  • Therapeutic plasma exchange
  • Thrombotic thrombocytopenic purpura

ASJC Scopus subject areas

  • Hematology


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