ABSTRACT NUMBER: ESOC2026A114 THROMBOTIC MICROANGIOPATHY (TMA) SECONDARY TO MALIGNANT HYPERTENSION AS A CAUSE OF STROKE

Abstract Background and aims Hypertension causing thrombotic microangiopathy (TMA) is one of the several etiologies of TMA, which causes endothelial damage and thrombosis of microvasculature, leading to hemolytic anemia, thrombocytopenia, and ischemic organ damage. Damage to the renal and retinal microvasculature is most frequently seen in TMA. Methods We have observed a case of Thrombotic Microangiopathy (TMA) secondary to malignant hypertension as a cause of stroke. Results A 39-year-old African male was admitted to our department with ischemic stroke in multiple territories—the right anterior cerebral artery and the left middle cerebral artery. Our patient’s etiology of hypertension-induced TMA was confirmed with his history of uncontrolled blood pressure, severely elevated at presentation—220/100 mm Hg. He had a renal dysfunction, retinopathy, and cardiomyopathy at presentation, with a positive initial hemolysis assessment (presence of schistocytes, low haptoglobin level, and increase of LDH) with a low PLASMIC score of 2 without thrombocytopenia. He had normal ADAMTS-13 activity, and the workup of other secondary etiologies of TMA was negative. Conclusions TMAs have various etiologies, and the very early identification of the cause of TMA is essential. Due to the rarity of hypertension-induced TMA, it poses a diagnostic challenge to clinicians, especially in cases with mild or patchy microangiopathy or cases without full hematologic signs. The earliest possible diagnosis of hypertension-induced TMA and initiation of antihypertensive therapy in a timely manner have a favorable prognosis. Conflict of interest ZUBALOVA Lina: nothing to disclose , BOUFERACHE Khaoula: nothing to disclose, FOURNIER Maxime : othing to disclose, STANESCU Carmen : nothing to disclose, DAN Octavia: nothing to disclose, LI Lin : nothing to disclose, DUBUC-LEPETIT LYDIE: nothing to disclose se,