TY - JOUR
T1 - Relapsed thrombotic thrombocytopenic purpura presenting as an acute cerebrovascular accident
AU - Downes, Katharine A.
AU - Yomtovian, Roslyn
AU - Tsai, H. M.
AU - Silver, Bernard
AU - Rutherford, Cynthia
AU - Sarode, Ravindra
PY - 2004
Y1 - 2004
N2 - 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.
AB - 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.
KW - ADAMTS13 protease activity
KW - Cerebrovascular accident
KW - Stroke
KW - Therapeutic plasma exchange
KW - Thrombotic thrombocytopenic purpura
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U2 - 10.1002/jca.20007
DO - 10.1002/jca.20007
M3 - Article
C2 - 15274201
AN - SCOPUS:3442881602
SN - 0733-2459
VL - 19
SP - 86
EP - 89
JO - Journal of Clinical Apheresis
JF - Journal of Clinical Apheresis
IS - 2
ER -