Dentist Visit May Have Triggered Rare Brain Bleed in Patient : ScienceAlert

An Australian man in his 60s was diagnosed with a rare disease that causes blood vessels in the brain to shrink after a simple tooth extraction surgery brought him to the emergency room with nausea, dizziness and skewed vision.

While it's impossible to say with certainty that bleeding and dental surgery are linked, the authors of a recently published case study suspect that a sharp increase in blood pressure is the trigger for what's known in medical terms as a brain hemorrhage.

Even in the emergency room, patients' blood pressure is understandably high. His eyes swung sharply to the left, his gait was unsteady, and his posture lurched sharply to the right, and it was clear that something was not quite right neurologically.

One of the first diagnoses to rule out in this situation is stroke. An emergency CT scan immediately revealed a small amount of bleeding in the tissue of the patient's lower left half of the brain, causing pressure.

As an extremely important organ, the blood vessels that provide nutrients to the brain do not leak randomly. In fact, they are excellent at keeping all but the most essential substances away from sensitive neurons and their supporting cells.

Therefore, determining the cause of cerebral hemorrhage becomes a top priority. The patient had recently been suspected of having Parkinson's disease and had had a simple CT scan just six weeks earlier.

As far as blood vessels are concerned, there were no clear signs of concern, although there were clear signs of white matter disease – broadly referring to damage to the brain's supporting “white blood cells” due to reduced blood flow.

The medical team used MRIs to take a more detailed look, mapping the areas and types of brain tissue affected. Focal areas of white matter disease again suggest deeper, more chronic pathology.

The abbreviation CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) describes a rare medical condition that affects blood flow in small vessels, particularly those that pass through the brain substance .

The condition is thought to affect only 2 in 10 people, but is often missed or misdiagnosed, making it difficult to determine how common it is.

Due to a mutated gene encoding a specific receptor protein, the muscles surrounding blood vessels die prematurely, weakening capillaries until they become clogged. The end result is usually leukoencephalopathy, or the death of the brain's white matter.

DNA testing for the damaged NOTCH3 gene was later performed, and the patient was diagnosed. Although he recovered from the hemorrhage over the next few months, he was put on long-term aspirin therapy to keep his blood flowing more easily and took medication to help control his blood pressure.

Blockage may be common in patients with CADASIL, but bleeding is uncommon, at least compared to other abnormalities that cause stroke. In fact, this case study is the first to describe cerebral hemorrhage in a dental patient with CADASIL.

The medical literature mentions only three other cases of brain hemorrhages occurring in the dentist's chair. One case reported over 30 years ago was a 52-year-old woman who suffered from a painful abscess and unfortunately did not survive due to severe intracerebral hemorrhage.

Before you look for this rare example of nerve damage as an excuse to avoid your next checkup, remember that the dentist is your brain's best friend.

Having gum disease for many years may increase your risk of developing Alzheimer's disease by up to 70%. Likewise, poor oral hygiene may shrink areas of the brain associated with memory.

Stay calm and say “ah.” Chances are you'll still be smiling for decades to come.

This research was published in BMJ Case Report.

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