Traumatic lingual hematoma after generalized tonic–clonic seizure in a patient with an acquired coagulopathy
Branislav Ralić1
, Mirjana Ždraljević2, Aleksandar J Ristić2,3, Ivana Berisavac2,3
1Department of Neurology, Clinical Hospital Center Zvezdara, Serbia
2Department of Neurology, Neurology Clinic, University Clinical Center, Belgrade, Serbia
3Department of Neurology, Neurology Clinic, University Clinical Center; Department of Neurology, Neurology Clinic, University Clinical Center, Medical Faculty, University of Belgrade, Belgrade, Serbia
Keywords: Coagulopathy, lingual hematoma, provoked seizures
Abstract
Oral lacerations are common complications of seizures and account for 92% of all oral injuries. Seizures are relatively commonly associated with chronic alcohol consumption. It is already known that provoked seizures can occur after a sudden cessation of prolonged alcohol intoxication. Meanwhile, chronic alcohol consumption can disrupt the blood coagulation process on several levels. This report aims to present a case of generalized tonic–clonic seizure in a man with chronic alcoholism and acquired coagulopathy who suffered severe tongue injury during a seizure. A 45 year old man was brought to the emergency department after a first in life generalized tonic–clonic seizure. He gave information that he bit his tongue during the seizure. Shortly afterward, the patient had another generalized seizure during which he stopped breathing and was intubated. On admission, the patient was sedated, intubated, and on mechanical ventilation, with no signs of focal neurological deficit. A detailed physical examination revealed massive tongue swelling, which was significantly moved forward. Laboratory tests revealed coagulopathy (INR 2,10) severe thrombocytopenia with a platelet count of 50x109 /L. Electrolyte values were in the reference range. According to the maxillofacial surgeon’s recommendation, he was treated conservatively, and after 2 weeks, he was clinically stable with a significant reduction of lingual hematoma and without new epileptic events. In our case, decreased platelet count and probable platelet dysfunction associated with chronic alcohol consumption and tongue bite during generalized tonic–clonic seizure played a significant role in developing lingual hematoma. These fast developing lingual hematomas can lead to possible airway obstruction; therefore, careful observation and timely intubation are mandatory to prevent possible fatal complications.
How to cite this article: Ralić B, Ždraljević M, Ristić AJ, Berisavac I. Traumatic lingual hematoma after generalized tonic–clonic seizure in a patient with an acquired coagulopathy. Turk J Emerg Med 2023;23:123-6.
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BR: Writing – original draft, investigation (equal), visualization. MŽ: Investigation (equal), visualization, writing – review and editing (equal). AR: Supervision (supporting), writing – review and editing (supporting). IB: Conceptualization, supervision (lead), writing – review and editing (equal).
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