Altered Mental Status in Cirrhosis: What's the Chance of Intracranial Hemorrhage?

Altered mental status (AMS) due to hepatic encephalopathy is a common complication of cirrhosis. But how likely is intracranial hemorrhage (ICH) as an alternate cause of AMS in this population?

In a retrospective study, investigators examined the diagnostic yield of computed tomography (CT) of the head for acute ICH in patients with cirrhosis and AMS who were admitted or treated in the emergency department of a single U.S. tertiary care center.

Among 357 patients (65.6% men; mean age, 57 years; mean Model for End-Stage Liver Disease [MELD] score, 18.5; alcohol-related liver disease prevalence, 41.1%), 14 of 462 total head CT scans (3%) showed evidence of a new acute ICH. Patients with a history of ICH or who presented with falls, trauma, or f…