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Case Reports
. 2019 Jul;9(3):169-171.
doi: 10.1177/1941874418805332. Epub 2018 Oct 15.

Licorice Root Associated With Intracranial Hemorrhagic Stroke and Cerebral Microbleeds

Hannah Shin  1 , Matthew Chung  2 , David Z Rose  2
Affiliations
Case Reports

Licorice Root Associated With Intracranial Hemorrhagic Stroke and Cerebral Microbleeds

Hannah Shin et al. Neurohospitalist. 2019 Jul.

Abstract

Chinese Licorice root "gan zao" (Glycyrrhiza uralensis) is an ancient, medicinal herb utilized in Traditional Chinese Medicine for its presumably antiulcer, anti-inflammatory, antiviral, antibacterial, and expectorant properties. One of the major biologically active components is glycyrrhizin, which when hydrolyzed to glycyrrhetinic acid in the human body, possesses significant hypertensive effects due to interaction with the enzyme 11-β-hydroxysteroid dehydrogenase-2.1 Glycyrrhizin and glycyrrhetinic acid also show antithrombotic properties, as orally active, direct inhibitors of blood coagulation factor Xa as well as of thrombin.2 To our knowledge, this is the first reported case of intracranial hemorrhagic stroke associated with Chinese Licorice Root, and first reported case of cerebral microbleeds (CMB) associated with it as well.

Keywords: cerebral microbleeds; hypertension; intracranial hemorrhage; licorice root; stroke.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Ms. Shin and Dr. Chung declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Dr. Rose has participated in clinical trials with and received honoraria for advisory board/speaker bureau from Boehringer Ingelheim, Boston Scientific, Medtronic, Chiesi and CSL-Behring.

Figures

Figure 1.
Figure 1.
Axial SWI sequence on brain MRI demonstrates blood products in the left basal ganglia as well as cerebral microbleeds (CMB) involving the deep brain structures. MRI indicates magnetic resonance imaging.
Figure 2.
Figure 2.
Ingredient list of Chinese herbal medicine used by patient.
See this image and copyright information in PMC

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