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Primary medullary hemorrhage in a patient with coagulopathy due to alcoholic cirrhosis: A case report.

Abstract 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.
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29620649
OWN - NLM
STAT- MEDLINE
DCOM- 20180416
LR  - 20180425
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 14
DP  - 2018 Apr
TI  - Primary medullary hemorrhage in a patient with coagulopathy due to alcoholic
      cirrhosis: A case report.
PG  - e0292
LID - 10.1097/MD.0000000000010292 [doi]
AB  - RATIONALE: 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. PATIENT CONCERNS: 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. DIAGNOSES:
      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. INTERVENTIONS: Liver protection therapy and the management
      of coagulation disorders. OUTCOMES: 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. LESSONS: 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.
FAU - Shen, Guangxun
AU  - Shen G
AD  - Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin
      Province, China.
FAU - Gao, Yu
AU  - Gao Y
AD  - Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin
      Province, China.
FAU - Lee, Kwee-Yum
AU  - Lee KY
AD  - School of Medicine, University of Queensland, Brisbane Australia.
FAU - Nan, Guangxian
AU  - Nan G
AD  - Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin
      Province, China.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Blood Coagulation Disorders/*complications
MH  - Brain Stem
MH  - Humans
MH  - Intracranial Hemorrhages/*etiology
MH  - Liver Cirrhosis, Alcoholic/*complications
MH  - Male
MH  - Middle Aged
PMC - PMC5902286
EDAT- 2018/04/06 06:00
MHDA- 2018/04/17 06:00
CRDT- 2018/04/06 06:00
PHST- 2018/04/06 06:00 [entrez]
PHST- 2018/04/06 06:00 [pubmed]
PHST- 2018/04/17 06:00 [medline]
AID - 10.1097/MD.0000000000010292 [doi]
AID - 00005792-201804060-00027 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Apr;97(14):e0292. doi: 10.1097/MD.0000000000010292.