title: Stroke in a young patient treated by alteplase heralding an acquired thrombotic thrombocytopenic purpura.
abstract: OBJECTIVE
  Thrombotic thrombocytopenic purpura (TTP) is a life-threatening multisystem disorder characterized by thrombocytopenia and fluctuating neurological symptoms due to microinfarcts. In rare cases, large cerebral arteries can be occluded.
  We report on a 30-year-old woman with a first-ever acute stroke related to a right proximal MCA M1 occlusion. Platelet count was normal at admission and progressively decreased 6 days after intravenous thrombolysis with the occurrence of a hemolytic anemia with schistocytes. Most biological anomalies reversed after plasma exchange. No hemorrhagic complication occurred. Diagnosis of initial TTP was confirmed by low ADAMTS13 activity and positivity of anti-ADAMTS13 antibody.
  
  
  CONCLUSIONS
  This observation highlights the fact that even if platelet count and hemoglobin rate are normal in the beginning, an acute ischemic stroke in a young patient can be related to TTP. Faced with subsequent thrombopenia, practitioners should be aware of acquired TTP, and, thus, schistocytes, haptoglobin, and LDH assays should be performed. Early diagnosis is paramount to start the life-saving plasma exchanges.
authors.affiliation: Department of Internal Medicine, CHU Timone, Marseille, France. amandine.sevy@ap-hm.fr
authors.forename: Amandine
authors.initials: A
authors.lastname: Sevy
authors.forename: Emilie
authors.initials: E
authors.lastname: Doche
authors.forename: Christian
authors.initials: C
authors.lastname: Squarcioni
authors.forename: Pascale
authors.initials: P
authors.lastname: Poullin
authors.forename: Jacques
authors.initials: J
authors.lastname: Serratrice
authors.forename: Francois
authors.initials: F
authors.lastname: Nicoli
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Weiller
mesh_terms: D000328:Adult; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D010951:Plasma Exchange; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D020521:Stroke / Q000209:etiology*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D010959:Tissue Plasminogen Activator