Intracranial Bleed Can Mimic Hepatic Encephalopathy In Cirrhotic

Abstract

Introduction- It is well said and proven in literature that important causes of cirrhosis of liver include alcohol intake, metabolic associated fatty liver disease and chronic hepatitis B & C. Less important causes include autoimmune & congenital liver disease, Wilson’s and alpha1 antitrypsin deficiency disease. There can occur gradual progression from chronic hepatitis to cirrhosis and in certain cases can further reach stage of hepatocellular carcinoma. Intracranial bleed is uncommon in cirrhotic patients.

Case report- We report a fourty seven-year-old male, a known case of alcoholic related liver disease with decompensated cirrhosis presented with sudden onset altered behaviour and a fall at home. He was thought to be in hepatic encephalopathy but after detailed evaluation was found to be having spontaneous intracranial bleed. He had normal serum ammonia levels, coagulopathy, thrombocytopenia and contrast enhanced computed tomography brain showed left basal ganglia bleed. He was managed conservatively and was discharged under haemodynamically stable condition after five days of indoor admission in ward. 

Conclusion- In cirrhosis there is increased bleeding tendencies at various sites, most commonly seen in gastro-intestinal including oral cavity, skin, subcutaneous, urine and stools. Intracranial bleed is not so common and spontaneous one is rare. The first possibility of altered behaviour in cirrhotic background is usually thought to be Porto-systemic encephalopathy (PSE) but intracranial bleed should also be ruled out.