Is coagulopathic liver disease a factor in spontaneous cerebral hemorrhage?

Purpose: Hepatic dysfunction is a common cause of thrombocytopenia and coagulopathy and has been reported as a causal factor in spontaneous intracranial hemorrhage. We attempt to define the prevalence of intracranial hemorrhage in patients with severe liver disease and coagulopathy. Method: We retrospectively reviewed the medical records, CT, and MRI acquired between January 1996 and August 1999 of patients with liver disease and a coagulopathy admitted for nontraumatic acute mental status changes. Results: In 138 CT and MR scans performed on the 100 patients described above, no cases of spontaneous intracranial bleeding were detected. Conclusion: Contrary to past reports, we find no instance of spontaneous intracranial hemorrhage in patients with coagulopathic liver disease presenting with acute mental status changes. Therefore, unless associated with trauma, spontaneous intracranial hemorrhage in coagulopathic liver disease is very uncommon.