Ischemic stroke/transient ischemic attack in adults with primary immune thrombocytopenia: a meta-analysis

Pan, Lishou; Leng, Huilin; Huang, Yin; Xia, Ningyan; Ling-jin, Jin; Zhang, Han‐Ting

doi:10.1007/s10072-020-04746-2

Cited by 5 publications

(7 citation statements)

References 42 publications

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“…ITP often presents clinically with bleeding or on routine lab work revealing thrombocytopenia, such as in this case. Prior case reports of neurologic manifestations in ITP have described ischemic strokes, transient ischemic attacks, mononeuropathy multiplex, and polyneuropathy [6][7][8][9][10][11][12][13][14]. There have been case reports of patients with ITP and neurological deficits found to have intraneural microhemorrhage on autopsy [5,10].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical manifestations of ITP often present with malfunction of primary hemostasis leading to bleeding; however, neurological manifestations in ITP without clinically significant bleeding are rare. Immune-mediated neuropathy and intraneural hemorrhage have rarely been reported [5][6][7][8][9][10][11][12]. The following case describes a patient with ITP who presents with an isolated cranial nerve III palsy.…”

Section: Introductionmentioning

confidence: 97%

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Oculomotor Nerve Palsy as a Manifestation of Immune Thrombocytopenic Purpura: A Case Report

Manfra¹,

Tun²,

Chang³

et al. 2022

Cureus

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Immune thrombocytopenic purpura (ITP) is caused by alterations in the immune system resulting in platelet destruction. It often manifests clinically with bleeding or on routine lab work revealing thrombocytopenia in asymptomatic individuals. Neurologic manifestations of this condition are sparsely documented in the literature. Among the symptoms reported were case reports of ischemic strokes, transient ischemic attacks, mononeuropathy multiplex, and polyneuropathy as neurological complications from immune thrombocytopenic purpura. Isolated cranial nerve palsies are uncommon. The following case describes a patient with immune thrombocytopenic purpura who presented with an isolated cranial nerve III palsy. A 55-year-old presented with pain in the right eye that was found in a downward and lateral gaze paralysis. There was no evidence of central or peripheral neurovascular etiology on imaging. However, workup revealed isolated thrombocytopenia with platelets <2000/ml 3 . Other possible etiologies, such as human immunodeficiency virus (HIV) and infectious etiologies, were evaluated and excluded. Thrombotic thrombocytopenia purpura was excluded with the results from ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity. The patient was appropriately transfused with platelets and was treated with methylprednisolone, which improved his platelets. At the time of discharge, the patient continued to have cranial nerve III palsy and was referred to follow up with hematology on an outpatient basis. In prior case reports where ITP presented as neurological deficits, there was evidence of intraneural microhemorrhage. Our case is unique in that the primary neurologic presentation without central nervous system pathology eventually led to the diagnosis of ITP. The symptoms were attributed to microhemorrhages that were not detected in imaging studies. Further studies are warranted to explore any correlation or causative association between ITP and neurological symptoms. This case report highlights the need to consider uncommon but possible manifestations of conditions that may initially appear seemingly irrelevant to the patient's chief complaint.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Oculomotor Nerve Palsy as a Manifestation of Immune Thrombocytopenic Purpura: A Case Report

Manfra¹,

Tun²,

Chang³

et al. 2022

Cureus

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“…Immune-associated thrombocytopenia (IAT), previously known as idiopathic thrombocytopenic purpura, is an autoimmune condition of decreased blood platelets (<100 × 10 9 /L) that may be a primary disorder or secondary to other systemic disease or exposure. IAT is often asymptomatic, but thrombocytopenia may increase risk for hemorrhage, including intraparenchymal or subarachnoid hemorrhage, and complicates decision making for patients regarding antithrombotic therapy 34 . Paradoxically, IAT has also been reported in association with ischemic stroke, likely because of accumulating platelet microparticles and endothelial damage leading to intravascular occlusion 34-36 .…”

Section: Immune-associated Thrombocytopeniamentioning

confidence: 99%

“…IAT is often asymptomatic, but thrombocytopenia may increase risk for hemorrhage, including intraparenchymal or subarachnoid hemorrhage, and complicates decision making for patients regarding antithrombotic therapy. 34 Paradoxically, IAT has also been reported in association with ischemic stroke, likely because of accumulating platelet microparticles and endothelial damage leading to intravascular occlusion. [34][35][36] Treatment in such cases warrants steroids or possibly long-term immunomodulatory therapy.…”

Section: Key Pointsmentioning

confidence: 99%

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Hematologic Disorders and the Nervous System

Mauermann¹,

Southerland²

2023

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article discusses the epidemiology, diagnosis, treatment, and prevention of neurologic complications of red blood cell, platelet, and plasma cell disorders. LATEST DEVELOPMENTS Cerebrovascular complications can occur in patients with blood cell and platelet disorders. Treatment strategies to prevent stroke are available for patients with sickle cell disease, polycythemia vera, and essential thrombocythemia. A diagnosis of thrombotic thrombocytopenic purpura should be considered in patients with neurologic symptoms, hemolytic anemia, thrombocytopenia, mild renal insufficiency, and fever. Plasma cell disorders can be associated with peripheral neuropathy, and classification of the monoclonal protein type and neuropathy aid in diagnosis. Patients with POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes) syndrome can present with arterial and venous neurologic events. ESSENTIAL POINTS This article discusses the neurologic complications of blood cell disorders and the most recent advances in prevention and treatment.

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Efficacy of mechanical thrombectomy for acute ischemic stroke in primary immune thrombocytopenia patient: Case report and literature review

Nakajima,

Tsuchiya,

Shimizu

et al. 2024

Brain Hemorrhages

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Ischemic stroke/transient ischemic attack in adults with primary immune thrombocytopenia: a meta-analysis

Cited by 5 publications

References 42 publications

Oculomotor Nerve Palsy as a Manifestation of Immune Thrombocytopenic Purpura: A Case Report

Oculomotor Nerve Palsy as a Manifestation of Immune Thrombocytopenic Purpura: A Case Report

Hematologic Disorders and the Nervous System

Efficacy of mechanical thrombectomy for acute ischemic stroke in primary immune thrombocytopenia patient: Case report and literature review

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