Shen Guangxun, Gao Yu, Lee Kwee-Yum, Nan Guangxian
Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin Province, China School of Medicine, University of Queensland, Brisbane Australia.
Medicine (Baltimore). 2018 Apr;97(14):e0292. doi: 10.1097/MD.0000000000010292.
Mild-to-moderate alcoholic cirrhosis of the liver is related to spontaneous intracerebral hemorrhage (ICH). In terms of spontaneous brainstem hemorrhage, pontine is considered as the most common site in contrast to medulla oblongata where the hemorrhage is rarely seen. This rare primary medullary hemorrhage has been attributed so far to vascular malformation (VM), anticoagulants, hypertension, hemorrhagic transformation, and other undetermined factors.
Herein, we describe a 53-year-old patient with 35-year history of alcohol abuse was admitted for acute-onset isolated hemianesthesia on the right side. He was normotensive on admission. A neurological examination revealed isolated hemihypoaesthesia on the right side. He had no history of hypertension, and viral hepatitis, and nil use of anticoagulants.
Brain computed tomography (CT) image demonstrated hemorrhagic lesion in dorsal and medial medulla oblongata which was ruptured into the fourth ventricle. Brain magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA) demonstrated no evidence of VM. The laboratory tests implied liver dysfunction, thrombocytopenia, and coagulation disorders. Abdominal ultrasound, and CT image showed a small, and nodular liver with splenomegaly, suggestive of moderate alcoholic cirrhosis.
Liver protection therapy and the management of coagulation disorders.
After 14 days, he was discharged with mild hemianesthesia but with more improved parameters in laboratory tests. At the 6-month follow-up, brain MRI, MRA, and non-contrast MRI showed no significant findings except for a malacic lesion.
We conclude that the patient had alcoholic cirrhosis with coagulopathy, and this may have resulted in primary medullary hemorrhage. This is a first case to report alcoholic cirrhosis as etiology of primary medullary hemorrhage.
轻度至中度酒精性肝硬化与自发性脑出血（ICH）有关。就自发性脑干出血而言，脑桥被认为是最常见的部位，而延髓出血则很少见。迄今为止，这种罕见的原发性延髓出血被归因于血管畸形（VM）、抗凝剂、高血压、出血性转化和其他未确定的因素。
在此，我们描述一名有35年酗酒史的53岁患者，因急性发作的右侧孤立性半身麻醉入院。入院时血压正常。神经系统检查发现右侧孤立性半身感觉减退。他没有高血压病史、病毒性肝炎病史，也未使用抗凝剂。
脑部计算机断层扫描（CT）图像显示延髓背侧和内侧有出血性病变，并破入第四脑室。脑部磁共振成像（MRI）和磁共振血管造影（MRA）未显示VM迹象。实验室检查提示肝功能障碍、血小板减少和凝血障碍。腹部超声和CT图像显示肝脏小且呈结节状，伴有脾肿大，提示中度酒精性肝硬化。
保肝治疗和凝血障碍的处理。
14天后，患者出院，仍有轻度半身麻醉，但实验室检查参数有所改善。在6个月的随访中，脑部MRI、MRA和非增强MRI除了有一个软化灶外，未发现明显异常。
我们得出结论患者患有酒精性肝硬化伴凝血病，这可能导致了原发性延髓出血。这是首例报告酒精性肝硬化作为原发性延髓出血病因的病例。
