Cirrhosis of the liver has been linked to several changes in risk of cerebrovascular disease and may increase the risk of hemorrhage while reducing the risk of ischemic stroke. 1,2 The pathophysiology underlying these changes remains unclear, though intracranial hemorrhage and vascular malformations related to liver disease have been described. 1,3 Cirrhosis may be complicated by hepatopulmonary syndrome (HPS), in which distal pulmonary arteries dilate, become tortuous, produce shunt physiology, and often produce arteriovenous (AV) malformations. 4. © © 2018 American Academy of Neurology.