J Korean Geriatr Soc.  2006 Dec;10(4):331-334.

Progressive Middle Cerebral Artery Infarction in a Patient with Thrombotic Thrombocytopenic Purpura

• Ha SW
• Yoo BG
• Kim MJ
• Kim JK
• Kim KS

Abstract

Thrombotic thrombocytopenic purpura (TTP) is frequently associated with small cortical and subcortical infarcts. However, major intracranial artery occlusion is rare. We report a case of progressive middle cerebral artery (MCA) infarction in a patient with TTP. A 76-year-old woman with hypertension was admitted due to right hemiparesis and transcortical motor aphasia. On laboratory findings, she had microangiopathic hemolytic anemia and thrombocytopenia. Brain MRI showed left subcortical multiple infarction, and MR angiogram revealed severe stenosis of left MCA main stem. She was treated with heparin and steroid but a few days later, there was neurologic deterioration attributed to progressive occlusive stroke in the left MCA territory. Follow-up brain CT demonstrated left malignant MCA infarction. TTP may be associated with progressive occlusion of large cerebral artery.

Keyword

Thrombotic thrombocytopenic purpura; Middle cerebral artery infarction; Stenosis

MeSH Terms

Aged
Anemia, Hemolytic
Aphasia, Broca
Arteries
Brain
Cerebral Arteries
Constriction, Pathologic
Female
Follow-Up Studies
Heparin
Humans
Hypertension
Infarction
Infarction, Middle Cerebral Artery*
Magnetic Resonance Imaging
Middle Cerebral Artery*
Paresis
Purpura, Thrombotic Thrombocytopenic*
Stroke
Thrombocytopenia
Heparin