Thrombotic thrombocytopenic purpura (TTP) is a disease caused by excessive platelet thrombi and multisystem vasculopathy. We report a young patient with refractory TTP who has developed multiple multifocal cerebral microbleeds on his brain magnetic resonance imaging scans. TTP-associated thrombotic microangiopathy resulting in diffuse microthrombi formation in the microcirculation and hypoperfusion might be an underlying etiology.