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Ischemic Stroke in Immune-Mediated Thrombotic Thrombocytopenia Purpura: Diagnostic and Management Challenges

Year: 2025

Type: article

Abstract: A 34-year-old woman presented to the emergency department with left sided weakness and facial droop.Her medical history included obesity, obstructive sleep apnea, and abnormal uterine bleeding.Her hemoglobin and platelet count were mildly decreased; creatinine was mildly elevated (see Table 1).She underwent brain magnetic resonance imaging (MRI), and head/neck computed tomography angiography (CTA; see Figure 1).MRI showed an acute right middle cerebral artery (MCA) stroke and chronic left parietal infarct.CTA showed a proximal occlusion of the MCA's right M2 branch.Her initial National Institutes of Health Stroke Score (NIHSS) was 2. Within 2 hours of presentation, she received alteplase.However, stroke symptoms worsened (NIHSS2→6).Therefore, 48 hours later, she underwent a thrombectomy with resolution of neurological deficits.As part of the stroke evaluation, she underwent a transesophageal echocardiogram and lower extremity MRI.While the echocardiogram revealed a patent foramen ovale (PFO), the MRI showed a right common femoral vein thrombus.With the concern for an embolic stroke, she initiated therapeutic apixaban (10 mg by mouth twice (PO) daily for 1 week, followed by 5 mg PO twice daily).

Source: Stroke

DOI: 10.1161/strokeaha.124.049578

Authors: Allison O. Taylor, Alexandre Soares Ferreira Junior, Braydon L. Dymm, Wuwei Feng, Nada El Husseini, Oluwatoyosi A. Onwuemene