Cerebral infarction in idiopathic thrombocytopenic purpura: a case report

Abstract

Cerebral infarction is a rare but recognised complication of idiopathic thrombocytopenic purpura. With traditional therapies including antiplatelets precluded in such patients and little guidance in the literature, the optimal treatment strategy is unknown. This report describes a case of ischaemic stroke in a patient with idiopathic thrombocytopenic purpura and deteriorating neurology. A successful outcome was made possible using a sequential approach initially improving platelet levels with steroids and intravenous immunoglobulin and then commencing antiplatelet agents. A possible mechanism for thrombosis in idiopathic thrombocytopenic purpura is considered.

A Case Associated with Comorbidities Among Cerebral Infarction, Idiopathic Thrombocytopenic Purpura, and Triple X Syndrome

“…In a case similar to ours, successful results were made possible by improving platelet levels with steroids and intravenous immunoglobulin in the beginning, followed by treatment with antiplatelet agents [3]. …”

“…Pathophysiology of the disease is thought to be the destruction and impaired production of platelets by autoantibodies [3]. Recent studies indicate that genes located on the X chromosome play a major and unique role in autoimmunity [4].…”

“…According to a recent large retrospective analysis, the incidence of thromboembolic events was 6.9% in ITP patients [3]. …”

Vertebral Artery Thrombosis in Chronic Idiopathic Thrombocytopenic Purpura

“…In two of them, antiplatelet therapy was given and there were no hemorrhagic events [4, 7]. On the other hand, antiplatelet therapy was withheld in three cases without any further adverse thrombotic events [5, 8, 10]. Other treatments such as calcium channel blockers were given in two cases.…”

Idiopathic Thrombocytopenic Purpura in Patients with Ischaemic Heart Disease - A Therapeutic Challenge

“…On the other hand, ITP tends to increase the risk of cardiovascular diseases (CVD) e.g., IHD, stroke, transient ischemic attack and heart failure. 1 ITP may even lead to a prothrombotic state which may be related to endothelial damage caused by antigenic mimicry between platelets and endothelial cells 2 or, related to administration of intravenous immunoglobulin (IVIG) for the treatment of ITP 3 .Occurrence of acute coronary syndrome 4-6 , deep vein thrombosis and pulmonary embolism 7,8 , and ischaemic stroke [9][10][11] has been described in association with ITP. Thrombolytic and antiplatelet therapy, the integral part of standard management of these patients, certainly increases the risk of bleeding in the context of already compromised platelet function.…”