A case of cerebral infarction following impression taking

R. Wakita, M. Sato, H. Suzuki, N. Iwatsuki

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Abstract

This is a case of cerebral infarction that occurred in a patient following impression taking at our outpatient clinic. She was a 53-year-old female with the past history of hysterectomy for myoma uteri. Her past histories of hypertension and myocardial infarction were only recognized after this episode. When the impression taking was completed, she complained of nausea and trembling of her right hand. We anesthesiologists called for a consultation, noticing elevated blood pressure (190/90 mmHg) and a numbness of the right hand. We speculated that transient hypertension may be the cause of these symptoms, and ordered the patient to remain at rest for a few hours with close observation. Two hours later, a light level of disorientation, speech disorder, and right side paresis became obvious. Moreover, her conscious level gradually decreased to Japan Coma Scale of 2-3. We suspected a development of a cerebrovascular accident and asked a neurologist to consult. The immediately taken brain CT revealed a low density area in the left putamen (arrow), but no high density area suggesting cerebral bleeding (Fig. 1). Since a cerebral infarction was strongly suggested, she was transferred to a special hospital for brain disease. MRI and MRA taken there showed a fresh infarction (arrows) in the left putamen and caudate nucleus (Fig. 2) and a severe stenosis of the left MCA (arrow) (Fig. 3). She was treated with antithrombal drugs and for brain edema. MRI and MRA taken a month later demonstrated an obsolete infarction (arrow) in left putamen (Fig. 4) and the moderate narrowing (arrow) of MCA (Fig. 5), respectively. She was discharged after one month's rehabilitation and currently has been visiting the outpatient clinic of our hospital for the farther dental treatment with no troubles. Several etiologies could explain this development of brain infarction. Perhaps hypertension induced by stress of the impression taking might trigger emboli to move from the heart or cervical vessels to the brain, or the extended neck position might reduce brain blood flow to accelerate thrombus formation in the brain. One of the important points to be mentioned in this case is that the dentist in charge did not know the patient's complete past history and general condition when she was treated. Dentists should have sufficient knowledge about the in patients before each treatment in order to avoid peri-treatment complications.

Original languageEnglish
Pages (from-to)232-236
Number of pages5
JournalJournal of Japanese Dental Society of Anesthesiology
Volume28
Issue number2
Publication statusPublished - 2000 Jan 1

Keywords

  • Cerebral infarction
  • Hypertension
  • Impression taking
  • Past-history

ASJC Scopus subject areas

  • Dentistry(all)
  • Anesthesiology and Pain Medicine

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