title: Thrombotic thrombocytopenic purpura with concomitant small- and large-vessel thrombosis, atypical posterior reversible encephalopathy syndrome and cerebral microbleeds.
abstract: We report a case of thrombotic thrombocytopenic purpura (TTP) with uncommon imaging features, namely concomitant small- and large-vessel thrombosis, atypical locations of posterior reversible encephalopathy syndrome (PRES) and microbleeds. A 58-year-old Chinese woman presented with slurred speech and multiple petechiae over lower limbs. Blood tests showed thrombocytopenia. Neuroimaging showed multiple acute small infarcts and PRES in the subcortical white matter, basal ganglia, thalamus, brainstem and occipital lobe. Microbleeds were noted. She was treated as TTP with infusion of cryo-reduced plasma (CRP). Patient subsequently developed dense right hemiplegia. Computed tomography of brain demonstrated a new major left middle cerebral artery territory infarct. She was stabilized after 2 weeks of treatment with daily CRP infusion, then received rehabilitation for major stroke. Early recognition of TTP provides the best chance of recovery as most lesions are reversible when TTP was treated. However, concurrent large artery thrombosis could cause major morbidity and mortality.
authors.affiliation: Department of Imaging and Interventional Radiology , The Chinese University of Hong Kong , Shatin , Hong Kong.
authors.forename: Wong Li
authors.initials: WL
authors.lastname: Yu
authors.affiliation: Department of Medicine and Therapeutics , The Chinese University of Hong Kong , Shatin , Hong Kong.
authors.forename: Thomas
authors.initials: T
authors.lastname: Leung
authors.affiliation: Department of Medicine and Therapeutics , The Chinese University of Hong Kong , Shatin , Hong Kong.
authors.forename: Yannie
authors.initials: Y
authors.lastname: Soo
authors.affiliation: Department of Medicine and Therapeutics , The Chinese University of Hong Kong , Shatin , Hong Kong.
authors.forename: Jessamyn
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Medicine and Therapeutics , The Chinese University of Hong Kong , Shatin , Hong Kong.
authors.forename: Ka Sing
authors.initials: KS
authors.lastname: Wong