Please cite this article in press as: Naganawa T, et al. Intracranial hemorrhage after tooth extraction in a patient with chronic disseminated intravascular coagulation. J Oral Maxillofac Surg Med Pathol (2015), http://dx.doi.org/10.1016/j.ajoms.2015.01.014 ARTICLE IN PRESS G Model JOMSMP-374; No. of Pages 4 Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (2015) xxx–xxx Contents lists available at ScienceDirect Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology j o ur nal ho me pa ge: www.elsevier.com/locate/jomsmp Case Report Intracranial hemorrhage after tooth extraction in a patient with chronic disseminated intravascular coagulation Takuya Naganawa a,∗ , Kosuke Sakuma a , Abhishek Kumar b,c , Satoshi Fukuzawa a , Toshihiro Okamoto a , Tomohiro Ando a a Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, School of Medicine, Tokyo, Japan b Section of Clinical Oral Physiology, Department of Dentistry, Aarhus University, Aarhus C, Denmark c Scandinavian Center for Orofacial Neuroscience (SCON) a r t i c l e i n f o Article history: Received 20 October 2014 Received in revised form 1 December 2014 Accepted 28 January 2015 Available online xxx Keywords: Disseminated intravascular coagulation Tooth extraction Bleeding Intracranial hemorrhage a b s t r a c t Disseminated intravascular coagulation (DIC) is a condition causing severe bleeding, which requires hemostatic measures be taken after surgical treatment. However, there is no clear method to assess coagulation and bleeding after surgical treatment. Here, we describe a rare case of intracranial hemor- rhage after tooth extraction in a patient with chronic DIC associated with aortic dissection. A 76-year-old Japanese male reported spontaneous pain in the upper front teeth region. Tooth extraction was performed based on a diagnosis of severe periodontitis. Four hours after the extraction, re-bleeding from the tooth socket was reported. Moreover, 10 and 20 h after extraction, bleeding occurred from the tooth socket again. In both situations, the bleeding was successfully controlled by pressure hemostasis. Three and 5 days after the extraction, the patient reported to the emergency outpatient care with post-extraction hemorrhage. Twelve days after the extraction, the patient complained of spontaneous severe headache. Computed tomography (CT) of the head was taken and hemorrhage was observed in his left frontal lobe. Thirty-eight days after tooth extraction, brain hemorrhage was spontaneously evoked again. It must be noted that bleeding may occur in any part of the body in patients with DIC and not only at the surgical site. © 2015 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.  1. Introduction Intraoral bleeding from the gingiva or socket commonly occurs in dental and oral surgery patients post-tooth extraction. The bleed- ing is relatively easy to control professionally by the application of extreme external pressure to the mucosa, or ligation using artery forceps, because it is almost always from a local cause such as inflammation [1]. Occasionally, persistent or intermittent hem- orrhage refractory to treatment indicates a general hemostatic disturbance, including coagulation factor deficiencies, fibrinolysis defect, platelet or vascular disorders and effects of anticoagulant medication [2]. Disseminated intravascular coagulation (DIC) is  AsianAOMS: Asian Association of Oral and Maxillofacial Surgeons; ASOMP: Asian Society of Oral and Maxillofacial Pathology; JSOP: Japanese Society of Oral Pathol- ogy; JSOMS: Japanese Society of Oral and Maxillofacial Surgeons; JSOM: Japanese Society of Oral Medicine; JAMI: Japanese Academy of Maxillofacial Implants. ∗ Corresponding author at: Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Tel.: +81 333538111; fax: +81 52692367. E-mail address: tanaganawa@gmail.com (T. Naganawa). one of the well-known risks of bleeding which requires postop- erative bleeding management [1,3]. DIC is a clinicopathological syndrome that complicates a range of illnesses. It is characterized by systemic activation of the pathways that lead to and regu- late coagulation, which can result in the generation of fibrin clots that can cause organ failure with concomitant consumption of platelets and coagulation factors that can result in clinical bleeding [4]. Previous reports have shown that persistent intraoral bleed- ing was the initial sign of DIC [3,5–8]. However, there are few reports on the association between DIC and oral surgery [1,3,5–8]. Here, we describe an unusual case of intracranial hemorrhage after tooth extraction in a patient with aortic dissection associated with chronic DIC. 2. Case report 2.1. Medical history A 76-year-old Japanese male patient (subject) was referred to the Department of Oral and Maxillofacial Surgery with spontaneous http://dx.doi.org/10.1016/j.ajoms.2015.01.014 2212-5558/© 2015 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved. 