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J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1744-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.01.003. Epub 2014 Mar 25.

Stroke in thrombotic thrombocytopenic purpura induced by thyrotoxicosis: a case report.

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Department of Neurology, Hôpital de Tivoli, La Louvière, Belgium. Electronic address:
Department of Neurology, Hôpital de Tivoli, La Louvière, Belgium.
Department of Hematology, Hôpital de Tivoli, La Louviere, Belgium.


Thrombotic thrombocytopenic purpura (TTP) is a hematologic disease involving the platelet aggregation and resulting in hemolytic anemia, thrombocytopenia, and microvascular occlusion. Although frequent neurologic features are headache and confusion, focal deficit is described in 30% of the cases. There are a lot of causes inducing thrombotic thrombocytopenic, but reports are lacking when associated with Grave disease. We describe the case of a 51-year-old Caucasian woman presenting a 24-hour story of sudden onset of dysarthria and left superior limb palsy. Four months before, she developed severe hyperthyroidism associated with petechiae, hemolytic anemia, thrombocytopenia, and schistocytes at blood film examination. Relapse of TTP in association with Grave disease was diagnosed. There are few reports describing association between Grave disease and TTP with only mild neurologic involvement. We described, to our knowledge, the first case of acute ischemic stroke secondary to thrombotic thrombocytopenic induced by thyrotoxicosis.


Stroke; cerebrovascular disease; hematologic disease; hyperthyroidism; steroids; thrombotic angiopathy

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