# A Paradox Unveiled: A Case Report of Cerebral Infarctions in a Patient With Severe Thrombocytopenia

## TL;DR

A 75-year-old woman with low platelet count unexpectedly had a stroke, highlighting the need for careful diagnosis in such cases.

## Contribution

This case report highlights the rare occurrence of stroke in a patient with immune thrombocytopenia.

## Key findings

- A patient with immune thrombocytopenia presented with an ischemic stroke despite low platelet count.
- Physicians should consider thrombosis in immune thrombocytopenia patients for timely treatment.

## Abstract

Thrombocytopenia is a condition in which the platelet count is less than 150,000/μL, which can be congenital or acquired. The condition can be further sub-classified. Nevertheless, the causes include infection, medication-mediated, liver diseases, or heart diseases. Moreover, diagnosis is straightforward only on a few occasions. Here, we are presenting a patient with a conundrum of immune thrombocytopenia (ITP) and a stroke. A 75-year-old female patient with a past medical history of hypertension was brought to the emergency department (ED) for altered mental status (AMS). Initial blood workup showed a platelet count of 27,000/μL and hemoglobin level of 6.2 g/dl, and brain magnetic resonance imaging (MRI) revealed ischemic stroke. Rarely, ITP patients can paradoxically develop arterial and venous thrombosis. Hence, physicians must remain vigilant in promptly and accurately diagnosing thrombotic events in ITP to ensure appropriate treatment, including antiplatelet and anticoagulant therapy, alongside ITP-specific interventions to improve outcomes.