A routine tooth extraction took a drastic turn for an Australian man in his 60s, resulting in a trip to the emergency room. Nausea, dizziness, and tilted vision plagued him, and upon further examination, he was diagnosed with a rare disorder that causes blood vessels in the brain to wither. While the exact connection between the dental procedure and the subsequent symptoms cannot be definitively determined, researchers suspect that a sudden spike in blood pressure triggered an intracerebral hemorrhage. This case study sheds light on the importance of vigilance during dental procedures and highlights the potential risks involved.
When the Australian man arrived at the emergency room, his blood pressure remained abnormally high. The neurological symptoms he experienced, including flickering eyes, unsteady gait, and a leaning posture, raised concerns about potential stroke. A CT scan revealed a small bleed in the lower left region of his brain. It is worth noting that blood vessels supplying the brain typically do not leak, making it crucial to identify the root cause of an intracerebral hemorrhage.
Just six weeks prior to the dental procedure, the patient had undergone a CT scan due to suspected Parkinson’s disease. While the scan did not reveal any alarming signs relating to blood vessels, it did show significant evidence of white matter disease. This condition refers to damage in the brain’s supporting “white cells” caused by reduced blood flow. Further examination through an MRI allowed the medical team to pinpoint the affected brain tissue. The presence of localized white matter disease suggested a deeper, chronic pathology.
CADASIL, short for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, emerged as the likely diagnosis. This rare condition disrupts the flow of blood through small vessels, particularly in the brain. It is estimated to affect as few as 2 out of every 100,000 people, with many cases going undetected or misdiagnosed. A mutated gene coding for receptor proteins leads to premature death of the surrounding muscle, weakening the capillaries and causing blockages. The result is often leukoencephalopathy, the death of the brain’s white matter. A DNA test confirmed the broken NOTCH3 gene, solidifying the patient’s diagnosis.
While blockages are common in patients with CADASIL, hemorrhages are not, especially compared to other stroke-causing abnormalities. This case study represents the first documented instance of a dental patient with CADASIL experiencing a brain bleed. The medical literature references only three other cases of intracerebral hemorrhages occurring during dental procedures. One tragic case from over 30 years ago involved a 52-year-old woman with a painful abscess who did not survive the intracerebral hemorrhage. These rare examples underscore the importance of dental care in maintaining overall health.
The Importance of Dental Health
It is crucial not to use rare neurological traumas as an excuse to avoid necessary dental check-ups. In fact, regular dental visits can have positive implications for brain health. Prolonged gum disease increases the risk of Alzheimer’s disease by up to 70 percent, while poor oral hygiene can lead to shrinkage in brain regions associated with memory. By ensuring proper dental care and maintenance, individuals can prioritize their overall health for years to come.
The case study of the Australian man’s tooth extraction gone wrong sheds light on the potential risks involved in dental procedures. While the link between the dental procedure and the subsequent intracerebral hemorrhage cannot be definitively established, it underscores the importance of monitoring blood pressure during such medical interventions. Furthermore, this case study provides valuable insights into the rare disorder, CADASIL, and highlights the need for accurate diagnosis and treatment. Ultimately, maintaining oral health remains crucial not just for a healthy smile but also for overall well-being, including brain health.