title: Acute cervical artery dissection after a dental procedure due to a second inferior molar infection.
abstract: Periodontal infections might represent one of the causative factors for cervical artery dissection. We present a case of a 49-year-old woman admitted due to headache. The patient had been suffering from a right second inferior molar infection with a cervical phlegmon for 1 week prior to admission. On 2 October 2014, the patient went to the dentist and a molar extraction was performed in the morning. In the afternoon, the patient began to experience right hemifacial pain that progressed towards an intense and bilateral headache. Neurological status at the time of admission revealed right miosis, ptosis and conjuntival hyperaemia. A CT angiography showed a right internal carotid artery dissection provoking a high-degree stenosis. The relationship between periodontal infection and vascular disease has been previously presented. Microbial agents may directly, and inflammatory and immunological host response indirectly, influence inflammatory changes in cervical arteries favouring dissections with minor traumas.
authors.affiliation: Neurology Service, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Montserrat G
authors.initials: MG
authors.lastname: Delgado
authors.affiliation: Neurology Service, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Riesco
authors.affiliation: Radiology Service, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Murias
authors.affiliation: Neurology Service, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Calleja
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D020215:Carotid Artery, Internal, Dissection / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D002481:Cellulitis / Q000382:microbiology / Q000473:pathology; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D008963:Molar / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D014076:Tooth Diseases / Q000382:microbiology / Q000601:surgery*; D014081:Tooth Extraction / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight