Thrombotic Thrombocytopenic Purpura Presenting as a Transient Ischemic Attack Mimic: A Case Report

Abstract

Background: Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy characterized by microangiopathic hemolytic anemia (MAHA), severe thrombocytopenia, and microvascular ischemia. Neurological involvement is common and may be transient, so TTP can be mistaken for a transient ischemic attack (TIA), delaying diagnosis. Prompt recognition and early treatment are critical to reduce mortality. Case Presentation: A 66-year-old woman presented with sudden aphasia and left-sided weakness that re-solved spontaneously within approximately 30 minutes; she was initially admitted as a suspected TIA. Examination revealed pallor and multiple ecchymoses, with no residual neurological deficit. Brain magnetic resonance imaging showed no ischemic changes. Laboratory evaluation revealed anemia (hemoglobin 7.8 g/dL), severe thrombocytopenia (platelets 15,000/μL), elevated lactate dehydrogenase (LDH) and bilirubin, reticulocytosis, and schistocytes on the peripheral blood smear, with a normal coagulation pro-file and preserved renal function. The PLASMIC score was 6, indicating a high probability of severe ADAMTS13 deficiency. Therapeutic plasma exchange and corticosteroids were started promptly without awaiting ADAMTS13 testing. She made a full neurological recovery and was discharged after two weeks with a hemoglobin of 11.2 g/dL and a platelet count of 194,000/μL. Conclusion: TTP should be considered in patients presenting with transient focal neurological deficits, particularly when accompanied by anemia and thrombocytopenia. Careful review of the full blood count in suspected TIA can uncover this diagnosis, and a high PLASMIC score should prompt immediate plasma exchange without waiting for ADAMTS13 results.