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Year : 2014  |  Volume : 62  |  Issue : 5  |  Page : 582--583

Multiple hemorrhagic infarcts in thrombotic thrombocytopenic purpura

Jemshad Alungal1, Mansoor C Abdulla1, Jassim Mohammad Koya2, P Feroz Jenner1,  
1 Department of General Medicine, Muslim Educational Society Medical College, Perinthalmanna, Kerala, India
2 Department of Radiodiagnosis, Muslim Educational Society Medical College, Perinthalmanna, Kerala, India

Correspondence Address:
Jemshad Alungal
Department of General Medicine, M.E.S. Medical College, Perinthalmanna - 679 338, Kerala

How to cite this article:
Alungal J, Abdulla MC, Koya JM, Jenner P F. Multiple hemorrhagic infarcts in thrombotic thrombocytopenic purpura.Neurol India 2014;62:582-583

How to cite this URL:
Alungal J, Abdulla MC, Koya JM, Jenner P F. Multiple hemorrhagic infarcts in thrombotic thrombocytopenic purpura. Neurol India [serial online] 2014 [cited 2022 Sep 27 ];62:582-583
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Full Text

A 57-year-old male presented with low-grade fever and upper abdominal pain for 2 months. He was known to have Type 2 diabetes mellitus, systemic hypertension, and ischemic heart disease. He had pallor, jaundice, and had no other signs. He had severe thrombocytopenia and features of microangiopathic hemolysis. A diagnosis of thrombotic thrombocytopenic purpura (TTP) due to clopidogrel was made excluding the other causes, and he was started on plasmapheresis. After a few cycles of plasmapheresis, he developed altered behavior. Magnetic resonance imaging (MRI) of brain revealed multiple regions of restricted diffusion in both cerebral hemispheres, with cortical laminar necrosis and microhemorrhages within most lesions; suggestive of hemorrhagic infarcts [Figure 1]. Plasmapheresis was continued, but despite all efforts he succumbed to his illness 2 days later.{Figure 1}

End-organ dysfunction in TTP is due to microangiopathic disturbances. In TTP, thrombi formation occurs due to release of multimers of von Willebrand factor due to deficiency of ADAMTS13enzyme. Damage to endothelial cells within the blood vessel wall accelerates formation of platelet-rich microthrombi which cause microinfarctions of affected tissue and consequent neurological manifestations. [1] Imaging patterns in TTP include Frank hematoma, ischemic infarctions, and reversible bilateral cerebral edema. [2],[3] Multifocal hemorrhagic infarctions due to TTP is very rare. Only one single similar case has been described. [4] Plasma exchange remains the mainstay of treatment for TTP. Other treatment options include glucocorticoids, rituximab, and other immunosuppressants. We report a rare case of multifocal hemorrhagic infarcts in TTP.


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