In an unusual case, a man’s trip to the dentist indirectly caused bleeding on his brain and led to his diagnosis of a rare genetic disorder.
Half an hour after two teeth were extracted, the man in Australia, who was in his 60s, suddenly felt dizzy and started vomiting. His vision was distorted to the point where he saw objects as if they were rotated 90 degrees counterclockwise.
Soon after, he went to the emergency room, where doctors found he had high blood pressure and his eyes were flickering to the left. He was also walking non-stop and kept falling to the right. ONE Computed Tomography (CT) scan revealed that the lower left half of his brain was bleeding – a condition known as intracerebral hemorrhage (ICH).
ICH is a common format Stroke which can be caused by many things including drug abuse such as amphetamine, brain cancer, physical trauma and extremely cold temperatures. For example, a woman with a history of high blood pressure developed it after participating in “Ice Bucket Challenge.”
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However, prior to the man’s unusual case, there had only been three other reports of people developing ICH after visiting the dentist. In the new case, published Aug. 2 in the journal BMJ Case Reportsdoctors believe the man’s ICH was likely caused by a sudden rise in blood pressure after dental surgery.
There was, however, one more piece of the puzzle to decipher.
When they reviewed the man’s medical history, doctors found that six weeks before his trip to the dentist, he had been referred for a CT scan after the GP suspected he had Parkinson’s disease, a progressive disease that kills neurons and causes movement problems. At the time, doctors found no problems with the blood vessels in the man’s brain, but they did notice signs of white matter disease — a condition in which reduced blood flow causes damage to the nerve fibers that pass information between different parts of the brain. Emergency department doctors then confirmed these signs of white matter disease with magnetic resonance imaging (MRI).
To pinpoint the cause of the white matter disease, the report’s authors analyzed the man’s DNA and found that he had a mutation in a gene called NOTCH3, which is associated with a rare, inherited disease that causes the walls of blood vessels to thicken . reducing blood flow through the brain. This condition is known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).
CADASIL is often very difficult to diagnose since it only affects severe cases 2 in every 100,000 people and the common symptoms of the disease, such as vision problems, feeling weak and difficulty walking, can often resemble other neurological conditions, such as multiple sclerosis.
ICH was initially thought to be a rare complication of CADASIL, the authors of the case report noted. However, recent survey suggests that it may be a more common complication than previously thought. Whether or not CADASIL and ICH are often associated, the authors of the case report noted that this is the first time ICH has been reported in a CADASIL patient after dental surgery.
After the man’s visit to the emergency department, his doctors prescribed medication to treat his high blood pressure, and three months later, he reported that the unsteadiness symptom had improved and his vision had returned to normal. He has since received a long-term aspirin treatment to improve blood flow to his brain and help prevent further strokes.
