Cerebral Small Vessel Disease in Patients with Immune-Mediated Thrombotic Thrombocytopenic Purpura During Acute Episodes and Remission Phases

By
Addolorata Truma
Francesco Maria Lo Russo
Giorgio Conte
Ilaria Mancini
Andrea Artoni
Juri Alessandro Giannotta
Barbara Ferrari
Pasquale Agosti
Maria Abbattista
Matteo Gagliardi
Eleonora Piccin
Marco Stroppi
Fabio Maria Triulzi
Flora Peyvandi
September 22, 2026

American Journal Of Hematology

Objective:

To establish the prevalence of cerebral small vessel disease (cSVD) among patients experiencing acute immune-mediated thrombotic thrombocytopenic purpura (iTTP) and to evaluate radiological changes on MRI after 1 year.

Approach:

Study Design: A prospective, single-center cohort study enrolling adults hospitalized for acute iTTP from January 2023 through July 2025, with brain MRI performed during admission and follow-up imaging after 12 months.
Patient Selection: Patients with pre-existing neurological disorders, major cerebrovascular disease, or contraindications to MRI were excluded. Age-frequency matched controls were healthy volunteers or individuals undergoing MRI for non-neurological reasons.
Outcome Measures: Primary outcome was the total cSVD score during the acute disease phase; secondary outcomes included follow-up cSVD score and acute ischemic lesions on MRI.

Key Findings:

Approximately 60% of iTTP cases involve neurological impairment due to microthrombotic ischemia.
MRI findings are crucial for diagnosing cSVD, with specific markers including white matter hyperintensities, lacunes, cerebral microbleeds, and enlarged perivascular spaces.
Each one-point increment in total cSVD score is associated with increased risk of subsequent stroke, dementia, and all-cause mortality.

Limitations:

Single-center study may limit generalizability.
Exclusion of patients with pre-existing neurological disorders may affect prevalence estimates.

Cerebral Small Vessel Disease in Patients with Immune-Mediated Thrombotic Thrombocytopenic Purpura During Acute Episodes and Remission Phases

Objective:

Approach:

Key Findings:

Limitations:

Original Source(s)

Cerebral Small Vessel Disease in Immune-Mediated Thrombotic Thrombocytopenic Purpura Patients During the Acute Phase and Disease Remission

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