دورية أكاديمية
Abstract 160: Recurrent Multi‐territorial Ischemic Stroke as an Initial Presentation of Thrombotic Thrombocytopenic Purpura
| العنوان: | Abstract 160: Recurrent Multi‐territorial Ischemic Stroke as an Initial Presentation of Thrombotic Thrombocytopenic Purpura |
|---|---|
| المؤلفون: | Grace Marie Nicole Biso, Noah Reichman, Aravind Reddy, Hesham Masoud |
| المصدر: | Stroke: Vascular and Interventional Neurology, Vol 3, Iss S2 (2023) |
| بيانات النشر: | Wiley, 2023. |
| سنة النشر: | 2023 |
| المجموعة: | LCC:Neurology. Diseases of the nervous system LCC:Diseases of the circulatory (Cardiovascular) system |
| مصطلحات موضوعية: | Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701 |
| الوصف: | Introduction Thrombotic thrombocytopenic purpura (TTP) is a rare hypercoagulable disorder characterized by acute hemolytic anemia, thrombocytopenia, neurologic deficits, and renal failure. Here, we describe a young patient with recurrent multi‐territory stroke, with the development of thrombocytopenia later in her course. Her prior diagnosis of etiologies for her ischemic stroke was confounded by the presence of grade 3 PFO and intrinsic arteriopathy attributed to accelerated atherosclerosis due to smoking tobacco with marijuana. Methods A 42‐year‐old woman, active tobacco and marijuana smoker, and recent cryptogenic ischemic and hemorrhagic stroke involving multiple vascular territories with hypercoagulable workup pending, presented with sudden left hemiplegia. Vessel imaging demonstrated irregularity and mild narrowing of the right posterior M2/M3 MCA branches without evidence of large vessel occlusion. MRI showed evidence of evolving left frontal encephalomalacia, prior ischemic stroke on the right inferior MCA and corpus callosum, and prior hemorrhagic stroke on the right parietal and left PCA. In addition, it showed T2 hyperintensities in bilateral anterior and posterior watershed areas. Work‐up was significant for grade 3 PFO/intrapulmonary shunt. Doppler ultrasound was negative for DVT. Basic labs showed LDL 56, A1c 4.8, and TSH 1.8. Hypercoagulable work‐up returned negative. Her platelet count during the admission was initially 169, and 208 on discharge to rehab on single agent antiplatelet (81mg aspirin) and high‐dose statin. After 11 days in rehab, she returned with sudden‐onset slurred speech and right‐sided hemiplegia. Vessel imaging was again negative for LVO and showed significant multi‐vessel arteriopathy. A repeat brain MRI showed a new stroke on the left precentral gyrus, left high frontal lobe, left medial parietal lobe, and left cerebellar hemisphere. The suspected mechanism of stroke was cardioembolic although the patient’s normal left atrial size was presumed to make this mechanism less likely. A few days into admission, her platelets began to decrease. With new‐onset thrombocytopenia (lowest platelet count was 38), ADAMTS screen was ordered and returned positive. The ADAMTS inhibitor Bethesda titer was notably high, 1.4 (nl |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 2694-5746 |
| Relation: | https://doaj.org/toc/2694-5746 |
| DOI: | 10.1161/SVIN.03.suppl_2.160 |
| URL الوصول: | https://doaj.org/article/36034d8fb072426f8ea5996acd96cb4c |
| رقم الأكسشن: | edsdoj.36034d8fb072426f8ea5996acd96cb4c |
| قاعدة البيانات: | Directory of Open Access Journals |
Full Text Finder | تدمد: | 26945746 |
|---|---|
| DOI: | 10.1161/SVIN.03.suppl_2.160 |