Thrombotic Thrombocytopenic Purpura with Concomitant Progressive Cerebral Microbleeds

Cerebral MRI findings predict the risk of cognitive impairment in thrombotic thrombocytopenic purpura

“…Of the remaining eight, only one was found to have cognitive impairment on neuropsychology testing. This indirectly suggests a possible causative mechanism behind the cognitive decline being secondary to cerebral ischaemia resulting from microthrombi, and is in keeping with similar findings in other disorders such as sickle cell disease 29 . In our opinion, this illustrates the value of MRI as a screening tool to identify patients at high risk of cognitive compromise.…”

“…In two case studies that looked beyond the acute period, small cerebral infarcts were found to persist beyond clinical remission. 16,28 However, in other disease areas, evidence suggests silent CNS ischaemia in sickle cell anaemia is linked with cognitive dysfunction, 29 and similar findings are seen relating to cerebral microhaemorrhage in patients with haemophilia A. 30 To investigate further the frequency and aetiology of neurocognitive symptoms, we investigated the utility of cerebral MRI and formal neuropsychology testing in TTP.…”

Nervous System Involvement in Coronavirus Disease 2019: Results from a Retrospective Consecutive Neuroimaging Cohort

“…Interestingly, the corpus callosum is also a predilection site for Susac's syndrome, characterized by autoimmune-mediated occlusions of precapillary arterioles due to endothelial autoantigens ( 22 ). The distribution of SWI abnormalities is also reminiscent of previous reports in thrombotic thrombocytopenic purpura ( 23 ), critical illness ( 24 ), H1N1-influenza with extracorporeal membrane oxygenation (ECMO)-treatment ( 25 ), high-altitude sickness ( 26 ), cerebral malaria ( 27 ), and hepatic encephalopathy ( 28 ). In our sample, only 1/10 ECMO-treated patients underwent brain MRI; that person had SWI abnormalities but with a low microbleed anatomical rating scale (MARS) score of 2.…”

Rituximab Prevents Stroke Recurrences in Atypical Chronic Immune-Mediated Thrombotic Thrombocytopenic Purpura

“…10 11 The main ESUS etiologies are rare cardioembolic diseases 12 13 and congenital or acquired thrombophilic states (myeloproliferative neoplasms, antiphospholipid syndrome, 13 paroxysmal nocturnal hemoglobinuria, heparin-induced thrombocytopenia, and TTP). 14 15 The chronic, insidious evolution of this patient's iTTP during the 30 years after the initial diagnosis raises questions and supports the hypothesis of managing iTTP as a chronic disease, rather than an acute one, with possible repeated flares, and suggests considering any idiopathic stroke with thrombocytopenia, even mild, potentially iTTP. 16 Notably, an LDH concentration >10 times above the ULN is a poor prognosis factor for iTTP, because it reflects organ damage.…”