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Large vessel stroke as initial presentation of thrombotic thrombocytopenic purpura
  1. Ryan Sugarman1,2,
  2. Andrea M Tufano2,3,
  3. Johnson M Liu1,2
  1. 1Hematology-Oncology, Monter Cancer Center, Northwell Health, Lake Success, New York, USA
  2. 2Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, New York, USA
  3. 3Internal Medicine, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
  1. Correspondence to Dr. Ryan Sugarman, Rsugarman{at}


A 67-year-old right-handed woman presented with dysarthria, left upper extremity weakness and right-sided neglect of 3 hours duration. Imaging of the brain revealed acute right middle cerebral artery stroke; however, tissue plasminogen activator could not be administered due to severe thrombocytopenia. A peripheral smear revealed schistocytes and the patient was treated empirically for thrombotic thrombocytopenic purpura (TTP) with therapeutic plasma exchange. An extensive workup revealed no embolic source or other cause for stroke, and a diagnosis of large vessel infarct secondary to TTP was made. After a prolonged hospital course, the patient had partial neurological recovery and was discharged to a rehabilitation facility. Although transient neurologic deficits due to small vessel occlusions are well described in TTP, large vessel infarct can occur as well. This diagnosis should be considered in patients presenting with concomitant stroke and thrombocytopenia, as untreated TTP is nearly always fatal.

  • haematology (drugs and medicines)
  • haematology (incl blood transfusion)
  • neuroimaging
  • stroke

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  • Contributors RS contributed to the planning, drafting of the manuscript, data review and literature review. AMT contributed to the literature review, data review and made significant edits to the manuscript. JML contributed to edits as well as mentorship for the planning of this manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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