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Wolfgang Miesbach։ Hidden Brain Damage and Progressive Cognitive Decline in iTTP Survivors
Wolfgang Miesbach/LinkedIn
Feb 6, 2026, 14:54

Wolfgang Miesbach։ Hidden Brain Damage and Progressive Cognitive Decline in iTTP Survivors

Wolfgang Miesbach, Professor of Medicine at Frankfurt University Hospital, shared a post on LinkedIn, about a recent article by Fahad Hannan et al, published in Journal of Thrombosis and Haemostasis:

”Hidden Brain Damage: Advanced Neuroimaging Reveals Progressive Cognitive Decline in iTTP Survivors—Even After Remission.

This Canadian multicenter prospective study (2016-2024) tracked 22 immune-mediated TTP survivors over 12 months using a dual-imaging approach rarely applied in thrombotic microangiopathy research:

Advanced MRI Techniques

Diffusion tensor imaging (DTI) with 64-directional tractography to map white matter integrity across 8 cognitive pathways—assessing fractional anisotropy, radial diffusivity, and microstructural damage
CT-Perfusion Imaging

150-second protocol on 256-slice scanners quantifying cerebral blood flow, cerebral blood volume, and blood-brain barrier permeability through permeability-surface product measurements
Validated Cognitive Testing

Creyos/Cambridge Brain Sciences battery across memory, reasoning, verbal ability, and concentration domains

 What They Found:
Despite achieving clinical remission, all patients (100%) exhibited compromised blood-brain barrier integrity at both timepoints. 82% showed structural brain abnormalities at baseline, with progressive deterioration:

  • Significant gray and white matter volume loss continued throughout follow-up
  • White matter tract damage worsened in pathways critical for memory and verbal processing
  • Cognitive impairment persisted significantly below control levels—memory (-0.94 vs -0.25) and verbal domains (-1.05 vs -0.28)
  • BBB permeability improved slightly (p=0.04) but remained substantially compromised

The Clinical Challenge:
Brain injury in iTTP extends far beyond the acute phase. Persistent vascular dysfunction drives ongoing neurological decline independent of clinical recovery—yet current care protocols rarely include long-term neurological monitoring.

This research advocates strongly for:

  •  Standardized longitudinal brain health assessments in iTTP survivors
  • Early neuroprotective intervention strategies
  • Aggressive relapse prevention
  • Reconsideration of treatment accessibility (rituximab, novel agents)

Congratulations to Shih-Han Susan Huang and co authors Journal of Thrombosis and Haemostasis (JTH).”

Title: Endothelial Injury to Cognitive Decline: A 12-month Follow-up Using CT-Perfusion and Diffusion MRI in Immune-mediated Thrombotic Thrombocytopenic Purpura

Authors: Fahad Hannana, Jonathan D. Thiessen, Christopher J. Patriquin, Katerina Pavenski, Leandro Tristao, Ting-Yim Lee, Daniel Mendes, Stefan Poirier, Jean Théberge, Jennifer Mandzia, Melissa Al-Jaishi, Kerri Gallo, Shih-Han Susan Huang

Read the Full Article on Journal of Thrombosis and Haemostasis․

Wolfgang Miesbach։ Hidden Brain Damage and Progressive Cognitive Decline in iTTP Survivors

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Christopher J. Patriquin Daniel Mendes Fahad Hannana Health Hematology Hemostasis Hemostasis News Hemostasis Today Jean Théberge Jennifer Mandzia Jonathan D. Thiessen Journal of Thrombosis and Haemostasis Katerina Pavenski Kerri Gallo Leandro Tristao Melissa Al-Jaishi Shih-Han Susan Huang Stefan Poirier thrombosis Ting-Yim Lee Wolfgang Miesbach
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