PMC9577219_01
A series of brain CT over the disease course. (A) Brain CT revealed two lobar hemorrhages located in the left frontal and parietal lobes with perifocal edema. (B) Five hours later, the patient's brainstem reflex was lost, and brain CT showed progressive hemorrhage with diffuse cerebral edema and bilateral uncal herniation (arrow). (C) Contrast-enhanced brain CT obtained 5 days after craniectomy showed suboptimal vascular image quality due to prominent intracranial hypertension.
fneur-13-989730-g0001.jpg
PMC9577219_01_fneur-13-989730-g0001.jpg
F1
Brain CT revealed two lobar hemorrhages over the left frontal and parietal lobes with perifocal edema and mild midline shift (Figure 1A). The lobar hemorrhage extended into the subdural and subarachnoid spaces (Figure 1B). Although the patient's peripheral arterial oxygen saturation was maintained at 99%-100% before, during, and after surgery, head CT on day 6 showed diffuse brain edema and loss of gray-white matter junction, involving the bilateral cerebrum, basal ganglia, brain stem, and cerebellum with obliteration of all ventricles (Figure 1C).
(A) Heparin-induced platelet activation assay was used to detect of HIT antibodies. CD61 (glycoprotein IIIa) and CD62p (p-selectin) served as markers of platelet identification and activation, respectively. Adenosine diphosphate was used to confirm normal platelet activation. The proportion of activated platelets was at least >11% in the presence of heparin (0.1 or 0.3 IU/ml) compared with baseline (no heparin), and the activation could be suppressed by a high dose of heparin (100 IU/ml). There was obvious platelet activation in the presence of the patient's plasma and low concentration (0.1 and 0.3 U/ml) of heparin, which was suppressed by the high concentration of heparin (100 U/ml). (B) PF4-induced flow cytometry-based platelet activation (PIFPA) revealed that the percentage of activated platelets increased from 12.28% baseline, no PF4 addition) to 29.95% with addition of 5 mug/ml PF4.
fneur-13-989730-g0002.jpg
PMC9577219_01_fneur-13-989730-g0002.jpg
F2
The result of the platelet activation assay was consistent with VITT (Figure 2) thereby confirming the diagnosis of VITT.
Clinical course, the laboratory studies and therapeutic agents used.
fneur-13-989730-g0003.jpg
PMC9577219_01_fneur-13-989730-g0003.jpg
F3
No improvement in thrombocytopenia was observed after 3 days of plasmapheresis (days 2, 4, and 5 of admission, Figure 3). The platelet count improved to 60 x 103/mul and 105 x 103/mul on days 10 and 11 of admission, respectively (Figure 3).