Thrombotic thrombocytopenic purpura with clinical neurological presentation - case report

Thrombotic thrombocytopenic purpura (TTP) is a microangiopathic hemolytic anemia classically characterized by the pentad of fever, hemolytic anemia, thrombocytopenia, renal, and neurologic deficits. TTP is a life-threatening multisystem disease characterized by thrombocytopenia and fluctuating neurological symptoms due to micro infarcts [12]. TTP is a thrombotic microangiopathy that can be classified as idiopathic or secondary to another disease [8, 9, 17]. In many cases of this coagulation disease, a greatly reduced activity of the ADAMTS 13 enzyme is observed (<10%) [8]. The disease is extremely rare, with a frequency of 3.7/1,000,000/year [25]. Cases of ischemic stroke (IS) due to TTP have been reported in scientific papers [6, 11, 20]. However, IS due to arterial thrombosis is rarely observed in patients with TTP [11].Objective: To present a clinical case of a patient with ischemic stroke and subarachnoid hemorrhage, as the first clinical manifestation of thrombotic thrombocytopenic purpura, emphasizing how key is rapid and accurate diagnosis and good collaboration between specialists from different clinical units for timely and correct treatment of patients with a similar type of multisystem disease.