Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-05T21:02:21.911Z Has data issue: false hasContentIssue false

Chapter 3.4 - Disseminated Intravascular Coagulation and Moschkowitz Syndrome

from 3 - Hypercoagulable Causes of Stroke

Published online by Cambridge University Press:  06 October 2022

Anita Arsovska
Affiliation:
University of Ss Cyril and Methodius
Derya Uluduz
Affiliation:
Istanbul Üniversitesi
Get access

Summary

Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by intravascular coagulation activation, which can arise from different causes. The diagnosis of DIC is based on a combination of clinical features, underlying condition and laboratory testing. Neurologic manifestations of DIC result in either cerebral thromboses or bleeding. Seizures, hemiparesis, aphasia, visual field disorders are common clinical signs. In the treatment of DIC, the first step would be to treat the underlying causes and thrombotic or haemorrhagic complications. Treatment with low-molecular-weight heparin in DIC may be preferred to unfractionated heparin in DIC with thrombotic complications.Thrombotic thrombocytopenic purpura (TTP) is the most common type of thrombotic microangiopathy. Pathophysiology of the acquired TTP (Moschkowitz syndrome) is combined with an increase of Willebrand factor due to a congenital or acquired deficiency of its cleaving metalloprotease (ADAMTS13). The causes of secondary Moschkowitz syndrome can be drug-associated, pregnant and postpartum patients and those with HIV or systemic autoimmune diseases. Diagnostic pentad of clinical manifestations includes microangiopathic haemolytic anaemia, severe thrombocytopenia, fever, renal involvement and various neurologic symptoms. Brain CT or MRI usually reveals small and multiple ischemic lesions, involving different arterial territories in both anterior and posterior circulations. Plasma exchange therapy, corticosteroid therapy, and rituximab (refractory or relapsed forms of the disease) are effective in patients with TTP. Oral aspirin may be prescribed at a preventive dose range until the termination of corticosteroid use

Type
Chapter
Information
Rare Causes of Stroke
A Handbook
, pp. 168 - 173
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH), Taylor, FB Jr, Toh, CH, Hoots, WK, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. ThrombHaemost. 2001;86: 13271330.Google Scholar
Wada, H, Matsumoto, T, Yamashita, Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. J Intensive Care. 2014;2(1): 15.CrossRefGoogle ScholarPubMed
Sarode, R, Bandarenko, N, Brecher, ME, et al. Thrombotic thrombocytopenic purpura: 2012 American Society for Apheresis (ASFA) consensus conference on classification, diagnosis, management, and future research. J Clin Apher. 2014;29(3): 148167.CrossRefGoogle ScholarPubMed
Moncayo-Gaete, J, Correa, P. Thrombotic thrombocytopenic purpura. In: Caplan, LR, Biller, J (Eds). Uncommon Causes of Stroke. Cambridge: Cambridge University Press; 2018. 347355.CrossRefGoogle Scholar
Amorosi, E, Ultmann, J. Thrombotic thrombocytopenic purpura: report of 16 cases and review of the literature. Medicine (Baltimore). 1966;45: 139159.CrossRefGoogle Scholar
Rojas, JC, Banerjee, C, Siddiqui, F, Nourbakhsh, B, Powell, CM. Pearls and oy-sters: acute ischemic stroke caused by atypical thrombotic thrombocytopenic purpura. Neurology. 2013;80(22): e235e238.CrossRefGoogle ScholarPubMed
Matsumoto, M, Fujimura, Y, Wada, H, et al. Diagnostic and treatment guidelines for thrombotic thrombocytopenic purpura (TTP) 2017 in Japan. Int J Hematol. 2017;106(1): 315.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×