Fulminant Thrombotic Thrombocytopenic Purpura presenting through the FAST Stroke Pathway

Abstract

Presentation
A previously healthy woman in her mid-40s of African ancestry presented with sudden-onset left-sided weakness, aphasia, and collapse. On arrival, she was disoriented with a fluctuating GCS of 9–11. Neurological assessment revealed speech impairment and limb weakness.

Diagnosis
CT brain showed multifocal parietal and cerebellar infarctions. Laboratory tests revealed severe thrombocytopenia (20 × 10³/mm³), anaemia (Hb 9 g/dL), elevated creatinine (180 μmol/L), and high troponins (1139 ng/L). Peripheral smear confirmed red cell fragmentation, and ADAMTS13 activity was <10%, confirming fulminant Thrombotic Thrombocytopenic Purpura (TTP).

Treatment
Thrombolysis was contraindicated due to profound thrombocytopenia, and intensive supportive care was initiated, including vasopressors, transfusions, and planned plasma exchange. Despite aggressive management, she developed hemodynamic collapse and died within 24 hours.

Discussion
This case highlights fulminant TTP mimicking acute stroke, emphasizing the importance of early recognition in patients with severe thrombocytopenia. Prompt multidisciplinary intervention and TTP-specific therapy are essential to improve survival outcomes.