Cryptogenic stroke in the patient with thrombotic thrombocytopenic purpura

초록

Thrombotic thrombocytopenic purpura(TTP) is one of rare hematologic disorders that is related to the blood clots forming in small arteries throughout the body. A low platelet count and low red blood cells are observed combined with kidney, heart and brain dysfunction. Here we present the patients with multiple small embolic infarction combined with TTP. which revealed no significantly abnormality. We tried dual antiplatelet agent(ASP+CLP) and intensive statin. The platelet count on the discharge was 12,300/mm3. Three weeks later, the patient revisited to ER for no improvement of dizziness. The follow-up MRI indicated new embolic lesions on DWI and the platelet counts decreased to 8,000/ mm3. We rechecked the platelet count 2hours later and the platelet counts decreased to 5,000/ mm3. We also found the purpura on the skin of both legs and arms. The patient wanted to transfer for the further evaluation and we received the patient’s information and heard that the tentative diagnosis was TTP combined with stroke.TTP is an rare and severe disease with an incidence of 3.7cases/million year in adults. Cerebral infarction is rare complication in TTP and the early diagnosis and treatment like plasma exchange are associated with good outcomes.Patients with cryptogenic stroke, especially when small multiembolic lesions are combined, require TTP to be considered and subsequent evaluation of platelet count despite initial normal test results.