Table 2.

Details of stroke during remission after recovery from TTP (n = 18)

Patient no.Sex/age at stroke, yTime from TTP to stroke, moClinical presentation and MRI/MRA findingsStroke during acute TTPPlatelet count at stroke diagnosis, ×109/LLDH at strokeRemission ADAMTS13 activity near stroke*
1 F/43 7 Gait abnormalities, imbalance, and cerebellar stroke on MRI/MRA. No 156 350† 63 
2 M/23 2 Right hemiparesis, aphasia, and left MCA stroke on MRI/MRA. Yes 186 N/A 51 (+1 mo) 
3 M/55 8 Right hemiparesis and expressive aphasia; large left MCA infarct on MRI/MRA. No 276 N/A 45 (+4 mo) 
4 F/52 87 Left hemiparesis, posterior MCA infarct on MRI/MRA. No 179 244 29 (+3 mo) 
5 F/31 12 Aphasia, right hemiparesis, and left MCA infarct on MRI/MRA. No 213 N/A N/A 
6 F/49 45 Left upper extremity weakness, right precentral gyrus infarct on MRI; no MRA lesion identified. No 201 150 30 
7 F/51 140 Diplopia, facial numbness, infarcts in centrum semiovale and pons on MRI, no MRA abnormalities. No 249 N/A N/A 
8 F/26 1 Aphasia, and left MCA infarct on MRI/MRA. No 176 N/A 59 
9 F/20 66 Left arm weakness; right MCA infarct on MRI/MRA. No 283 N/A N/A 
10 F/41 19 Right hemiparesis, seizure, left MCA infarct on MRI. No 177 249 42 (−1 wk) 
11‡ F/64 41 Aphasia. MRA showed acute infarcts of the left posterior perisylvian, parieto-occipital, and parietal lobes in addition to chronic microvascular disease. MRA was suboptimal due to patient motion but showed irregular narrowing of both MCA with prominent loss of flow in the distal branches of the left MCA. No 150 277 N/A 
12 F/67 59 Right hemiparesis followed by obtundation. Died due to massive left MCA stroke, with hemorrhagic conversion on MRI. No 217 248 N/A 
13‡ F/75 173 Right upper extremity weakness, aphasia, and left MCA and ACA stroke. No 302 199 N/A 
14 F/72 165 Right hemiparesis; left MCA stroke. No 180 237 N/A 
15‡ F/49 22 Left leg weakness, dysarthria, and dysphagia. Acute pontine stroke on MRI, no lesions on MRA. No 188 211 25 
16‡ F/60 36 Slurred speech, facial droop, blurry vision, leg weakness, and unstable gait; biparietal and left cerebellar acute infarcts on MRI. Yes 164 173 N/A 
17 F/59 120 Aphasia, right hemiparesis, left MCA infarct on MRI/MRA. No 265 N/A N/A 
18 F/50 17 Expressive aphasia, right hand weakness; acute temporoparietal infarction; MRA showed no abnormality in circle of Willis and carotid arteries. Yes 159 231 N/A 
Patient no.Sex/age at stroke, yTime from TTP to stroke, moClinical presentation and MRI/MRA findingsStroke during acute TTPPlatelet count at stroke diagnosis, ×109/LLDH at strokeRemission ADAMTS13 activity near stroke*
1 F/43 7 Gait abnormalities, imbalance, and cerebellar stroke on MRI/MRA. No 156 350† 63 
2 M/23 2 Right hemiparesis, aphasia, and left MCA stroke on MRI/MRA. Yes 186 N/A 51 (+1 mo) 
3 M/55 8 Right hemiparesis and expressive aphasia; large left MCA infarct on MRI/MRA. No 276 N/A 45 (+4 mo) 
4 F/52 87 Left hemiparesis, posterior MCA infarct on MRI/MRA. No 179 244 29 (+3 mo) 
5 F/31 12 Aphasia, right hemiparesis, and left MCA infarct on MRI/MRA. No 213 N/A N/A 
6 F/49 45 Left upper extremity weakness, right precentral gyrus infarct on MRI; no MRA lesion identified. No 201 150 30 
7 F/51 140 Diplopia, facial numbness, infarcts in centrum semiovale and pons on MRI, no MRA abnormalities. No 249 N/A N/A 
8 F/26 1 Aphasia, and left MCA infarct on MRI/MRA. No 176 N/A 59 
9 F/20 66 Left arm weakness; right MCA infarct on MRI/MRA. No 283 N/A N/A 
10 F/41 19 Right hemiparesis, seizure, left MCA infarct on MRI. No 177 249 42 (−1 wk) 
11‡ F/64 41 Aphasia. MRA showed acute infarcts of the left posterior perisylvian, parieto-occipital, and parietal lobes in addition to chronic microvascular disease. MRA was suboptimal due to patient motion but showed irregular narrowing of both MCA with prominent loss of flow in the distal branches of the left MCA. No 150 277 N/A 
12 F/67 59 Right hemiparesis followed by obtundation. Died due to massive left MCA stroke, with hemorrhagic conversion on MRI. No 217 248 N/A 
13‡ F/75 173 Right upper extremity weakness, aphasia, and left MCA and ACA stroke. No 302 199 N/A 
14 F/72 165 Right hemiparesis; left MCA stroke. No 180 237 N/A 
15‡ F/49 22 Left leg weakness, dysarthria, and dysphagia. Acute pontine stroke on MRI, no lesions on MRA. No 188 211 25 
16‡ F/60 36 Slurred speech, facial droop, blurry vision, leg weakness, and unstable gait; biparietal and left cerebellar acute infarcts on MRI. Yes 164 173 N/A 
17 F/59 120 Aphasia, right hemiparesis, left MCA infarct on MRI/MRA. No 265 N/A N/A 
18 F/50 17 Expressive aphasia, right hand weakness; acute temporoparietal infarction; MRA showed no abnormality in circle of Willis and carotid arteries. Yes 159 231 N/A 

ACA, anterior cerebral artery; F, female; M, male; LDH, lactate dehydrogenase; MCA, middle cerebral artery; MRA, magnetic resonance angiography; N/A, not available.

*

Only remission ADAMTS13 activity within 3 months of the stroke is included in this table. If there are no times in parenthesis, then the ADAMTS13 activity was checked at stroke presentation. The time in parenthesis indicates the interval from stroke to ADAMTS13 activity evaluation.

†

Patient 1 had persistently elevated LDH levels at stroke diagnosis but did not develop recurrent TTP. The LDH elevation was attributed to severe autoimmune myositis in the setting of SLE (peak creatine kinase 1940 U/L and peak LDH 770 U/L), which resolved after treatment with corticosteroids and methotrexate. ADAMTS13 activity was 63%, which also argues against ongoing TTP.

‡

Patients who had recurrent strokes after recovery from TTP.

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