In a study of survivors of immune thrombotic thrombocytopenic purpura (iTTP), researchers found evidence that brain infarction had been a common occurrence. Additionally, silent cerebral infarction (SCI) appeared to be linked to cognitive impairment in this study. The study’s findings were reported in the journal Blood.

“The strong association of SCI with cognitive impairment suggests that these lesions are neither silent nor innocuous,” the researchers conducting the study wrote in their report.

This prospective study included adult survivors of iTTP who were in clinical remission. The researchers estimated the prevalence of SCI in this patient population based on signs of brain infarction visible with magnetic resonance imaging (MRI), but without associated neurologic deficits identified. MRI analyses were conducted during enrollment and during annual follow-up visits.

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Additionally, the researchers explored whether SCI is associated with cognitive impairment. Cognitive function was evaluated through use of the National Institutes of Health ToolBox Cognition Battery. This battery includes subdomains of executive function, attention, episodic memory, processing speed, working memory, and language.

The study included 42 patients, of whom 36 underwent MRI analysis. SCI was identified in 18 (50%) of these patients. Among these patients, 8 (44.4%) had experienced prior overt stroke with 3 of these patients having experienced stroke during an acute iTTP episode.

The researchers estimated that cognitive impairment was present in 66.7% of the patients who had SCI, compared with 27.7% of patients who did not have SCI (P =.026). Major cognitive impairment appeared to be present in 50% of the patients who had SCI, compared with a rate of 5.6% in those without SCI (P =.010).

A logistic regression analysis, adjusted for stroke history and depression, indicated an association between SCI and any degree of cognitive impairment, with an odds ratio of 10.5 (95% CI, 1.45-76.63; P =.020). The odds ratio for an association between SCI and major cognitive impairment was 7.98 (95% CI, 1.11-57.27; P =.039) in an analysis adjusted for stroke history and depression.

“Until specific strategies to improve neurologic outcomes of iTTP are developed, aggressive screening and management of cardiovascular risk factors may reduce adverse neurovascular sequelae in patients who survived iTTP,” the researchers concluded in their report.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.


Chaturvedi S, Yu J, Brown J, et al. Silent cerebral infarction during immune TTP remission: prevalence, predictors, and impact on cognition. Blood. 2023;142(4):325-335. doi:10.1182/blood.2023019663