Liu Elizabeth D, Nituleasa Antonia, Amidon Ryan F, Ordookhanian Christ, Kaloostian Paul
Biochemistry, University of California Riverside, Riverside, USA.
Medical Physiology, Medical College of Wisconsin, Milwaukee, USA.
Cureus. 2021 Oct 5;13(10):e18518. doi: 10.7759/cureus.18518. eCollection 2021 Oct.
The post-operative realm for hepatic transplant patients presents many challenges, but of them all, we take a deeper dive into an increased risk of associated cerebrovascular events. Cerebrovascular diseases, such as cerebral arteriovenous malformation (AVM), are a leading cause of death following a liver transplant. We present a unique case of a liver transplant patient who presented with no brainstem reflexes three months into the post-transplant period. Imaging studies revealed a ruptured AVM within the foramen magnum and cervicomedullary junction, as well as substantial cerebral hemorrhage. While establishing the exact cause of the AVM is not as trivial as it may appear, side effects associated with post-transplantation management regimens and possible congenital factors do shed some light on notable considerations. Given the potential damage associated with ruptured AVMs, poor patient outcomes are unfortunately not as rare as one would hope. This case highlights a rare but highly possible occurrence for cerebrovascular complications, specifically AVM rupture linked to liver transplantation and the systemic changes associated with a procedure as invasive as liver transplantation.
肝移植患者的术后阶段面临诸多挑战，而在所有挑战中，我们深入探讨一下相关脑血管事件风险增加的问题。脑血管疾病，如脑动静脉畸形（AVM），是肝移植术后的主要死亡原因之一。我们呈现了一个独特的病例，一名肝移植患者在移植后三个月出现无脑干反射的情况。影像学研究显示，枕骨大孔和颈髓交界处有一个破裂的AVM，以及大量脑出血。虽然确定AVM的确切病因并非像看起来那么简单，但与移植后管理方案相关的副作用以及可能的先天性因素确实为一些值得注意的考虑因素提供了线索。鉴于破裂的AVM可能造成的损害，不幸的是，患者预后不佳的情况并不像人们希望的那样罕见。这个病例突出了一种罕见但极有可能发生的脑血管并发症，特别是与肝移植相关的AVM破裂以及与像肝移植这样的侵入性手术相关的全身变化。
