Fulminant Thrombotic Thrombocytopenic Purpura presenting through the FAST Stroke Pathway.

Q3 Medicine

Irish medical journal Pub Date : 2026-06-18

A Maroof, H Y R Huang, H Elsadig, S Maharaj, D Elderderi, N A B Ibrahim, T Ayeni, L Murray, P Kiely, F Malik

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引用次数: 0

Abstract

Presentation: A previously healthy woman in her mid-40s of African ancestry presented with sudden-onset left-sided weakness, aphasia, and collapse. On arrival, she was disoriented with a fluctuating GCS of 9-11. Neurological assessment revealed speech impairment and limb weakness.

Diagnosis: CT brain showed multifocal parietal and cerebellar infarctions. Laboratory tests revealed severe thrombocytopenia (20 × 10³/mm³), anaemia (Hb 9 g/dL), elevated creatinine (180 μmol/L), and high troponins (1139 ng/L). Peripheral smear confirmed red cell fragmentation, and ADAMTS13 activity was <10%, confirming fulminant Thrombotic Thrombocytopenic Purpura (TTP).

Treatment: Thrombolysis was contraindicated due to profound thrombocytopenia, and intensive supportive care was initiated, including vasopressors, transfusions, and planned plasma exchange. Despite aggressive management, she developed hemodynamic collapse and died within 24 hours.

Discussion: This case highlights fulminant TTP mimicking acute stroke, emphasizing the importance of early recognition in patients with severe thrombocytopenia. Prompt multidisciplinary intervention and TTP-specific therapy are essential to improve survival outcomes.

本刊更多论文

暴发性血栓性血小板减少性紫癜通过FAST卒中途径呈现。

病例：一名40多岁的健康女性，非洲血统，突然出现左侧虚弱、失语和崩溃。到达时，她迷失了方向昏迷指数为9-11。神经学评估显示语言障碍和肢体无力。诊断：CT显示多灶性顶叶及小脑梗死。实验室检查显示严重的血小板减少（20 × 10³/mm³）、贫血（Hb 9 g/dL）、肌酐升高（180 μmol/L）和高肌钙蛋白（1139 ng/L）。治疗：由于严重的血小板减少症，溶栓是禁忌，并开始了强化的支持治疗，包括血管加压剂、输血和计划的血浆交换。尽管进行了积极的治疗，她还是出现了血流动力学衰竭，并在24小时内死亡。讨论：本病例强调了暴发性TTP模拟急性卒中，强调了早期识别严重血小板减少患者的重要性。及时的多学科干预和ttp特异性治疗对于改善生存结果至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Irish medical journal Medicine-Medicine (all)

CiteScore

1.00

自引率

0.00%

发文量

139

期刊介绍： Since its inception in 1867, the Journal of the Medical Association of Ireland and now in its present format, the Irish Medical Journal, has provided the medical community in Ireland with an invaluable service. As one of the leading biomedical publications in Ireland, it has sought to continue the education of medical students and postgraduates through scientific research, review articles and updates on contemporary clinical practices while providing an ongoing forum for medical debate. A measure of our stature is that we are listed in the Index Medicus and issued annually with a citation factor from the Institute for Scientific Information.