Severe bruxism following basal ganglia infarcts: insights into pathophysiology.
Bruxism characterized by clenching and grinding of teeth can lead to toothwear, headaches and depression. While bruxism has been associated with a number of neurological diseases, it has not been highlighted following cerebral infarction. An elderly man presented with an acute onset of tooth grinding and jaw clenching associated with dysarthria. His bruxism was worse during the day and resolved during sleep. He had frequent jaw aches, headaches and swallowing difficulty. Examination demonstrated the presence of dysarthria with jaw clenching and tooth grinding, producing persistent high pitch and loud squeaky sounds. A magnetic resonance imaging and angiography examination revealed a recent infarct in the right thalamus. In addition, chronic lacunar infarcts were present in the bilateral caudate nuclei with severe basilar artery stenosis. He was successfully treated with botulinum toxin. We discuss the pathophysiologic mechanisms of bruxism associated with basal ganglia infarcts. Dysfunction of the efferent and/or afferent thalamic or striatopallidal tracts may play a role in bruxism. Early recognition of bruxism following stroke could reduce unnecessary suffering since the condition can be effectively treated.
Tan
Eng-King
EK
Department of Neurology, Singapore General Hospital, Outram Road, 169608, Singapore, Singapore. gnrtek@sgh.com.sg
Chan
Ling-Ling
LL
Chang
Hui-Meng
HM
D020144:Basal Ganglia Cerebrovascular Disease / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D001905:Botulinum Toxins / Q000627:therapeutic use; D002012:Bruxism / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D002421:Caudate Nucleus / Q000473:pathology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013788:Thalamus / Q000473:pathology / Q000503:physiopathology; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000473:pathology / Q000503:physiopathology
D001905:Botulinum Toxins