{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T21:09:15Z","timestamp":1762376955924,"version":"3.37.3"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,26]],"date-time":"2021-06-26T00:00:00Z","timestamp":1624665600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,26]],"date-time":"2021-06-26T00:00:00Z","timestamp":1624665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"crossref","award":["NRF-2021R1C1C1012429"],"award-info":[{"award-number":["NRF-2021R1C1C1012429"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Cerebral microbleeds (CMBs) are small, rounded, dark-signal lesions on brain MRI that represent cerebral hemosiderin deposits resulting from prior microhemorrhages and are neuroimaging biomarkers of cerebral amyloid angiopathy (CAA). Here, we report a case of innumerable CMBs in a patient with hepatic encephalopathy underlying decompensated liver cirrhosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>An 83-year-old woman diagnosed with hepatitis B virus-related liver cirrhosis 40\u00a0years before was referred to our neurology clinic for progressive disorientation of time and place, personality changes, and confusion with somnolence over 2\u00a0weeks. Based on the laboratory, neuroimaging, and electrophysiological findings, we diagnosed the patient with hepatic encephalopathy, and her symptoms recovered within 12\u00a0h after proper medical management. Brain MRI showed innumerable CMBs in the bilateral frontal, parietal, temporal, and occipital lobes. Since the distribution of CMBs in the patient was mainly corticosubcortical and predominantly in the posterior cortical regions, and the apolipoprotein E genotype was \u03b54\/\u03b54, we speculated that CAA and hepatic encephalopathy coexisted in this patient.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We suggest that severe liver dysfunction associated with long-term decompensated liver cirrhosis may be related to an increased number of CMBs in the brain. Our findings indicate that decompensated liver cirrhosis may be a risk factor for the development of CMBs and corroborate a link between the liver and the brain.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12883-021-02291-9","type":"journal-article","created":{"date-parts":[[2021,6,26]],"date-time":"2021-06-26T02:02:26Z","timestamp":1624672946000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Innumerable cerebral microbleeds in hepatitis B virus-related decompensated liver cirrhosis: a case report"],"prefix":"10.1186","volume":"21","author":[{"given":"Chi Hyuk","family":"Oh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5017-854X","authenticated-orcid":false,"given":"Jin San","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,6,26]]},"reference":[{"issue":"7","key":"2291_CR1","doi-asserted-by":"publisher","first-page":"1829","DOI":"10.1093\/brain\/awx047","volume":"140","author":"A Charidimou","year":"2017","unstructured":"Charidimou A, Boulouis G, Gurol ME, Ayata C, Bacskai BJ, Frosch MP, Viswanathan A, Greenberg SM. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain J Neurol. 2017;140(7):1829\u201350.","journal-title":"Brain J Neurol"},{"issue":"9","key":"2291_CR2","doi-asserted-by":"publisher","first-page":"e0139227","DOI":"10.1371\/journal.pone.0139227","volume":"10","author":"YD Kim","year":"2015","unstructured":"Kim YD, Song D, Heo JH, Kim SU, Kim BK, Park JY, Kim DY, Ahn SH, Kim KJ, Han KH. Relationship between cerebral microbleeds and liver stiffness determined by transient elastography. PloS one. 2015;10(9):e0139227.","journal-title":"PloS one"},{"issue":"1","key":"2291_CR3","doi-asserted-by":"publisher","first-page":"1814","DOI":"10.1038\/s41598-018-38357-x","volume":"9","author":"H Jang","year":"2019","unstructured":"Jang H, Kang D, Chang Y, Kim Y, Lee JS, Kim KW, Jang YK, Kim HJ, Na DL, Shin HY, et al. Non-alcoholic fatty liver disease and cerebral small vessel disease in Korean cognitively normal individuals. Sci Rep. 2019;9(1):1814.","journal-title":"Sci Rep"},{"issue":"6","key":"2291_CR4","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1002\/ana.22516","volume":"70","author":"A Viswanathan","year":"2011","unstructured":"Viswanathan A, Greenberg SM. Cerebral amyloid angiopathy in the elderly. Ann Neurol. 2011;70(6):871\u201380.","journal-title":"Ann Neurol"},{"issue":"7","key":"2291_CR5","doi-asserted-by":"publisher","first-page":"2382","DOI":"10.1161\/STROKEAHA.109.548974","volume":"40","author":"SM Greenberg","year":"2009","unstructured":"Greenberg SM, Nandigam RN, Delgado P, Betensky RA, Rosand J, Viswanathan A, Frosch MP, Smith EE. Microbleeds versus macrobleeds: evidence for distinct entities. Stroke. 2009;40(7):2382\u20136.","journal-title":"Stroke"},{"issue":"2","key":"2291_CR6","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1093\/gastro\/gox013","volume":"5","author":"P Ferenci","year":"2017","unstructured":"Ferenci P. Hepatic encephalopathy. Gastroenterology Rep. 2017;5(2):138\u201347.","journal-title":"Gastroenterology Rep"},{"issue":"11","key":"2291_CR7","doi-asserted-by":"publisher","first-page":"3436","DOI":"10.1161\/STROKEAHA.114.007112","volume":"45","author":"S Akoudad","year":"2014","unstructured":"Akoudad S, Darweesh SK, Leening MJ, Koudstaal PJ, Hofman A, van der Lugt A, Stricker BH, Ikram MA, Vernooij MW. Use of coumarin anticoagulants and cerebral microbleeds in the general population. Stroke. 2014;45(11):3436\u20139.","journal-title":"Stroke"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02291-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-021-02291-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02291-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,26]],"date-time":"2021-06-26T02:03:35Z","timestamp":1624673015000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-021-02291-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,26]]},"references-count":7,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2291"],"URL":"https:\/\/doi.org\/10.1186\/s12883-021-02291-9","relation":{},"ISSN":["1471-2377"],"issn-type":[{"type":"electronic","value":"1471-2377"}],"subject":[],"published":{"date-parts":[[2021,6,26]]},"assertion":[{"value":"28 January 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 June 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Institutional Review Board of the Kyung Hee University Hospital. Written consent was obtained from the patient\u2019s husband.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient\u2019s husband for publication of this case report and any accompanying images. A copy of the written consent is available for review by the editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"245"}}