{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:29:08Z","timestamp":1790051348290,"version":"4.0.1"},"reference-count":13,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,1,17]]},"abstract":"<jats:p>A 67-year-old right-handed woman presented with dysarthria, left upper extremity weakness and right-sided neglect of 3\u2009hours duration. Imaging of the brain revealed acute right middle cerebral artery stroke; however, tissue plasminogen activator could not be administered due to severe thrombocytopenia. A peripheral smear revealed schistocytes and the patient was treated empirically for thrombotic thrombocytopenic purpura (TTP) with therapeutic plasma exchange. An extensive workup revealed no embolic source or other cause for stroke, and a diagnosis of large vessel infarct secondary to TTP was made. After a prolonged hospital course, the patient had partial neurological recovery and was discharged to a rehabilitation facility. Although transient neurologic deficits due to small vessel occlusions are well described in TTP, large vessel infarct can occur as well. This diagnosis should be considered in patients presenting with concomitant stroke and thrombocytopenia, as untreated TTP is nearly always fatal.<\/jats:p>","DOI":"10.1136\/bcr-2017-221857","type":"journal-article","created":{"date-parts":[[2018,2,6]],"date-time":"2018-02-06T02:25:09Z","timestamp":1517883909000},"page":"bcr-2017-221857","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Large vessel stroke as initial presentation of thrombotic thrombocytopenic purpura"],"prefix":"10.1136","volume":"2018","author":[{"given":"Ryan","family":"Sugarman","sequence":"first","affiliation":[{"name":"Hematology-Oncology, Monter Cancer Center, Northwell Health, Lake Success, New York, USA"},{"name":"Donald and Barbara Zucker School of Medicine, Hofstra\/Northwell, Hempstead, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea M","family":"Tufano","sequence":"additional","affiliation":[{"name":"Donald and Barbara Zucker School of Medicine, Hofstra\/Northwell, Hempstead, New York, USA"},{"name":"Internal Medicine, North Shore University Hospital, Northwell Health, Manhasset, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnson M","family":"Liu","sequence":"additional","affiliation":[{"name":"Hematology-Oncology, Monter Cancer Center, Northwell Health, Lake Success, New York, USA"},{"name":"Donald and Barbara Zucker School of Medicine, Hofstra\/Northwell, Hempstead, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,2,5]]},"reference":[{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.1","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-009-0476-1"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199108083250604"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.3","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2015.1.631"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.4","first-page":"1194","article-title":"Thrombotic thrombocytopenic purpura: prospective neurologic, neuroimaging and neurophysiologic evaluation","volume":"86","author":"Meloni","year":"2001","journal-title":"Haematologica"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.5","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.22.8.1087"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.6","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1161\/01.STR.25.6.1297","article-title":"Silent brain infarct in thrombotic thrombocytopenic purpura","volume":"25","author":"Wijdicks","year":"1994","journal-title":"Stroke"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.7","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.50.4.1157"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.8","doi-asserted-by":"publisher","DOI":"10.1159\/000078756"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.9","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfh596"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.10","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20276"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.11","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2012-008426","article-title":"Stroke due to typical thrombotic thrombocytopenic purpura treated successfully with intravenous thrombolysis and therapeutic plasma exchange","volume":"2013","author":"Boattini","year":"2013","journal-title":"BMJ Case Rep"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.12","doi-asserted-by":"publisher","DOI":"10.1093\/omcr\/omv001"},{"key":"2025082722115846000_2018.feb05_1.bcr-2017-221857.13","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181aaea1b"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-221857","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:12:09Z","timestamp":1756357929000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-221857"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,5]]},"references-count":13,"alternative-id":["10.1136\/bcr-2017-221857"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-221857","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,5]]}}}