Spontaneous intracerebral hemorrhage and liver dysfunction.

Abstract

We evaluated liver function and coagulation parameters in 117 patients with spontaneous intracerebral hemorrhage (68 men and 49 women) admitted to our clinic within 24 hours after onset. Liver dysfunction was more common among men than women due to differences in alcohol consumption. Number of thrombocytes and fibrinogen concentrations were lower, especially among men with elevated concentrations of glutamic oxaloacetic transaminase or glutamic pyruvic transaminase and/or elevated y-globulin fraction. Five of the 78 patients undergoing stereotactic hematoma aspiration and one of the 39 treated nonsurgically rebled. All six of the patients who rebled were men, heavy alcohol consumers with liver dysfunction. Fibrinogen concentration was abnormally low in four of the six and at the lower end of the normal range in one. Two showed thrombocytopenia and one case showed prolonged prothrombin time. These facts suggest that liver disorders produce a state in which hemorrhage occurs more readily and that this hemorrhagic tendency may be one of the causal factors of spontaneous intracerebral hemorrhage. A lthough hypertension is considered the cause L \ of bleeding in the majority of spontaneous A. \ . intracerebral hemorrhage cases, 1 -3 the existence of cases in which a hemorrhagic diathesis is the cause must be considered when deciding upon surgical therapy. Prior to November 1985, we performed computed tomography (CT)-guided stereotactic aspiration in 125 patients with intracerebral hematoma. 4 Among those patients, eight rebled subsequent to the surgery. When those patients in whom the rebleeding due to problems in postoperative care or the technique used for aspiration of the hematoma were excluded, there remained three patients with a history of liver disease.Those three patients drew our attention to the possible involvement of chronic liver disorders in spontaneous intracerebral hemorrhage and, specifically, to the possibility that patients might develop a tendency to bleed due to liver dysfunction. To clarify the degree to which such a tendency is involved in intracerebral hemorrhage, we studied alcohol consumption, liver function, and coagulation parameters in 117 patients admitted to our clinic with spontaneous intracerebral hemorrhage. Received August 13, 1987; accepted February 26, 1988. Subjects and MethodsBetween December 1985 and February 1987, we evaluated 202 patients with spontaneous intracerebral hemorrhage in whom diagnoses of aneurysm, arteriovenous malformation, or moyamoya disease had been excluded by cerebral angiography. Of those patients, 85 had been admitted to our clinic >24 hours after onset or had received incomplete examinations on admission. Therefore, only 117 patients met the criteria for this study. There were 68 men and 49 women. The men ranged in age from 30 to 77 (mean ± SD 54.9 ±9.9) years and the women from 33 to 84 (mean±SD 60.1 ±9.7) years. The sites of bleeding were the putamen in 66 patients, the thalamus in 38, the cerebellum in 6, the cerebral subcortex in 3, the caudate nucl...

Intracerebral Hemorrhage in Patients With Chronic Liver Disease

“…Six of 117 patients with ICH experienced rebleeding. 12) All six showed liver dysfunction, and just two displayed clinical worsening. In our series, only 1 patient in the CLD group died due to hematoma enlargement.…”

“…Some studies have examined the relationships between intracerebral hemorrhage (ICH) and LC, 1,6) and abnormalities in laboratory data reflecting liver function reportedly correlate with ICH volume and rebleeding. 3,4,11,12) Few investigations have focused on the characteristics of ICH in patients with chronic liver disease (CLD). This study compared ICH between patients with and without CLD in terms of baseline characteristics, level of consciousness at onset, hematoma location, and prognosis.…”

Spontaneous intracerebral hemorrhage: a review

“…94 The liver is responsible for synthesis of most clotting factors and fibrinogen, as well as playing a major role in metabolism of platelets.…”

Effects and Complications of Stereotactic Aspiration for Spontaneous Intracerebral Hemorrhage

“…The incidence of rebleeding in patients with liver dysfunction is approximately three times greater than that in patients with normal liver function. 2,4,6,15) Fibrinogen is a product of the liver, and liver dysfunction also affects the platelet count and prolonged PT or activated partial thromboplastin time. These factors can be indicators of liver function and hemorrhagic tendency.…”

“…The most important factors for enlargement of ICH may be liver dysfunction and hemorrhagic tendency. 4,15) Patients with rebleeding after stereotactic aspiration of ICH tend to have liver dysfunction, 15) as highlighted by a few recent reports. 2,6) The present study evaluated the effects and com-Stereotactic Aspiration for Spontaneous ICH plications of stereotactic aspiration for the treatment of ICH, particularly aspiration pneumonia and rebleeding.…”