Thrombotic thrombocytopenic purpura and neurologic manifestations – Case report and integrative review

Abstract

Introduction: Thrombotic thrombocytopenic Purpura (TTP) is a rare and pontentially life-threatening condition, it occurs due a deficiency of ADAMTS13 enzyme complex, leading to formation of microthrombi in the microvasculature, what may cause manifestations in several organs. The most common tissues afected are the renal and neurological ones, with some severe complications. The best treatmente nowadays is Plasma Exchange (PEx). The most commom neurologic manifestation of TTP is Headache, but stroke, mental confusion and others can also be present. Objective: To describe a case of atypical neurologic manifestation of TTP and to perform na integrative review. Case Report: Female patient, 59 years old was admitted to the emergency room with importante dyspneia. She also presented hypotension, tachycardia and low oxygen-hemoglobin saturation. After these symptoms were estabilized, she was hospitalized for further investigation. During her hospitalization, she developed microangiophatic anemia, thrombocytopenia and renal failure, she also had a historic of neurologic manifestations such as strenght decrease in lower and upper limbs, gagging, dysphagia. She was diagnosed with TTP and and it was indicated hospital transference to her for realizing this procedure, Although, in the thirteenth day of hospitalization, the patient had and irreversible cardiac arrest. Discussion: The Thrombotic thrombocytopenic purpura is a rare disease that affects priorly women and its a rara condition in many countries around the world. We present a case of atypical neurologic manifestations in a patient with no risk factors. We also know that this disease is treatable with Plasma Exchange and this procedure changed the morality rate which used to be about 80% and after PEX is about of 20%. The most common neurologic manifestation is headache. Conclusion: We have to be alert in patients in the emergency departament with neurologic manifestations. Once the patient did not present any of the most commom neurologic symptons, it is a rare case.