Estol C J, Pessin M S, Martinez A J
Department of Neurology, Tufts University School of Medicine, Boston, MA.
Neurology. 1991 Jun;41(6):815-9. doi: 10.1212/wnl.41.6.815.
We analyzed 55 autopsy cases in 1,357 patients undergoing orthotopic liver transplantation at the University of Pittsburgh and found that 13 (23.6%) patients had intracranial bleeding, and five (9%) had infarcts. Eight patients had bleeding localized to one intracranial compartment: intracerebral hemorrhage (three patients); subarachnoid hemorrhage (three patients); and subdural hematoma (two patients). Five patients had combinations of multiple sites of bleeding: three with subarachnoid hemorrhage-intracerebral hemorrhage, one with subarachnoid hemorrhage-intracerebral hemorrhage-subdural hematoma, and one with subdural hematoma-intracerebral hemorrhage. Coexistent CNS infections (fungal or bacterial) were associated with hemorrhagic infarcts and intracerebral hemorrhage in four patients. Cerebral embolism and hemorrhagic infarction from bacterial endocarditis occurred in one patient. Five patients died of intracranial bleeding. Severe coagulopathy was the major cause of intracranial bleeding and was associated with systemic bleeding in 12 patients. Significant systemic or metabolic complications were present in all patients and masked the focal signs of the intracranial process in more than one half.
我们分析了匹兹堡大学1357例接受原位肝移植患者中的55例尸检病例，发现13例（23.6%）患者发生颅内出血，5例（9%）发生梗死。8例患者的出血局限于一个颅内腔隙：脑出血（3例）；蛛网膜下腔出血（3例）；硬膜下血肿（2例）。5例患者有多个出血部位的组合：3例为蛛网膜下腔出血 - 脑出血，1例为蛛网膜下腔出血 - 脑出血 - 硬膜下血肿，1例为硬膜下血肿 - 脑出血。4例患者并存的中枢神经系统感染（真菌或细菌）与出血性梗死和脑出血有关。1例患者发生细菌性心内膜炎导致的脑栓塞和出血性梗死。5例患者死于颅内出血。严重凝血障碍是颅内出血的主要原因，12例患者伴有全身出血。所有患者均存在明显的全身或代谢并发症，超过一半的患者掩盖了颅内病变的局灶性体征。
