Thrombotic thrombocytopenic purpura masquerading as a stroke in a young man

A 40-year-old previously well man presented to an urgent care centre after the rapid onset of dysarthria and unilateral arm weakness. The symptoms resolved over 15 minutes. There were no atherosclerotic risk factors, and he did not report other signs. On examination, his vital signs were within normal limits, and there were no focal neurologic signs, icterus, petechiae, lymphadenopathy or hepatosplenomegaly. Thrombotic thrombocytopenic purpura is one of a relatively uncommon but potentially life-threatening group of hematologic emergencies known as thrombotic microangiopathies.1 Thrombotic microangiopathies occur because of abnormal platelet aggregation and resultant thrombi formation in small blood vessels, potentially resulting in end-organ injury in the brain, kidney, heart and gastrointestinal tract. They are characterized by microscopic hemolytic anemia with thrombocytopenia. Symptoms may include jaundice, icterus, petechiae, bruising, fever, neurologic changes or headache, and oligoanuria.