This study presents a unique case of a 54-year-old male patient with a history of stroke, liver cirrhosis, portal vein thrombosis, hypertension, diabetes, and bladder cancer, who experienced multiple episodes of intracranial hemorrhages, stroke and worsening confusion over the past five years. The patient‘s clinical presentation raised suspicion for an underlying occult vasculopathy. Digital subtraction angiography (DSA) revealed multiple curvilinear, irregular, bilateral pial vessels with early high-flow arteriovenous shunting, consistent with vascular shunting that is associated with liver cirrhosis. The patient‘s multiple cortical bleeds of different ages, compounded by coagulopathy from cirrhosis, increased the suspicion for cerebral amyloid angiopathy (CAA) etiology as well. The patient was scheduled for outpatient follow-up for a brain biopsy to prognosticate CAA and liver transplant candidacy. This case highlights the importance of considering complex interactions between liver and cerebral vascular pathologies in patients with atypical presentations and comorbidities.
Disclosures B. Aljeradat: None. M. Koneru: None. R. Oliveira: None. H. Shaikh: None.
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