Innumerable cerebral microbleeds in hepatitis B virus-related decompensated liver cirrhosis: a case report

BMC Neurology

Chi Hyuk Oh¹  Jin San Lee² 

[1] Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, 02447, Seoul, South Korea;Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, #23 Kyunghee-daero, Dongdaemun-gu, 02447, Seoul, South Korea;

关键词: Cerebral microbleeds;    Cerebral amyloid angiopathy;    Hepatic encephalopathy;    Chronic liver disease;    Case report;   

DOI  :  10.1186/s12883-021-02291-9

来源: Springer

【 摘 要 】

BackgroundCerebral microbleeds (CMBs) are small, rounded, dark-signal lesions on brain MRI that represent cerebral hemosiderin deposits resulting from prior microhemorrhages and are neuroimaging biomarkers of cerebral amyloid angiopathy (CAA). Here, we report a case of innumerable CMBs in a patient with hepatic encephalopathy underlying decompensated liver cirrhosis.Case presentationAn 83-year-old woman diagnosed with hepatitis B virus-related liver cirrhosis 40 years before was referred to our neurology clinic for progressive disorientation of time and place, personality changes, and confusion with somnolence over 2 weeks. Based on the laboratory, neuroimaging, and electrophysiological findings, we diagnosed the patient with hepatic encephalopathy, and her symptoms recovered within 12 h after proper medical management. Brain MRI showed innumerable CMBs in the bilateral frontal, parietal, temporal, and occipital lobes. Since the distribution of CMBs in the patient was mainly corticosubcortical and predominantly in the posterior cortical regions, and the apolipoprotein E genotype was ε4/ε4, we speculated that CAA and hepatic encephalopathy coexisted in this patient.ConclusionsWe suggest that severe liver dysfunction associated with long-term decompensated liver cirrhosis may be related to an increased number of CMBs in the brain. Our findings indicate that decompensated liver cirrhosis may be a risk factor for the development of CMBs and corroborate a link between the liver and the brain.

【 授权许可】

CC BY