Thrombotic microangiopathy and the brain. In iTTP, autoantibodies against ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) prevent the cleavage of VWF multimers, leading to microthrombus formation and endothelial damage and resulting in ischemic end-organ damage, particularly in the central nervous system. SCIs are common in patients with iTTP while in remission and carry significant risks of associated morbidity and mortality. PTSD, posttraumatic stress disorder. Professional illustration by Patrick Lane, ScEYEnce Studios.