Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, 02447, South Korea.
Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, South Korea.
BMC Neurol. 2021 Jun 26;21(1):245. doi: 10.1186/s12883-021-02291-9.
Cerebral 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.
An 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.
We 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.
脑微出血（CMBs）是脑 MRI 上的小圆形暗信号病灶，代表由于先前微出血导致的脑含铁血黄素沉积，是脑淀粉样血管病（CAA）的神经影像学生物标志物。在此，我们报告了一例肝性脑病合并失代偿性肝硬化患者存在无数 CMB 的病例。
一名 83 岁女性，40 年前被诊断为乙型肝炎病毒相关肝硬化，因 2 周来逐渐出现时间和地点定向障碍、人格改变和伴嗜睡的意识混乱，被转至我院神经内科就诊。根据实验室、神经影像学和电生理学检查结果，我们诊断该患者为肝性脑病，经适当的药物治疗后，其症状在 12 小时内得到缓解。脑 MRI 显示双侧额、顶、颞和枕叶存在无数 CMB。由于该患者的 CMB 分布主要为皮质下和皮质后区为主，载脂蛋白 E 基因型为 ε4/ε4，我们推测该患者同时存在 CAA 和肝性脑病。
我们认为严重的肝功能障碍与长期失代偿性肝硬化有关，可能与脑内 CMB 数量增加有关。我们的发现表明，失代偿性肝硬化可能是 CMB 发生的危险因素，并证实了肝脏和大脑之间的联系。
