• Chikanori Inenaga, Kazuya Hokamura, Kazuhiko Nakano, Ryota Nomura, Shuhei Naka, Toshihiko Ohashi, Takashi Ooshima, Nagato Kuriyama, Toshimitsu Hamasaki, Koichiro Wada, Kazuo Umemura, and Tokutaro Tanaka.
• Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
• World Neurosurg. 2018 May 1; 113: e77-e81.

BackgroundAmong human oral bacteria, particular kinds of Streptococcus mutans (SM) known as dental caries pathogens contain a collagen-binding protein, Cnm, and show platelet aggregation inhibition and matrix metalloproteinase-9 activation. We have previously reported that these strains may be a risk factor for intracerebral hemorrhage. As a major sample-providing hospital, we report the clinical details, including intracranial aneurysms and ischemic stroke.MethodsAfter the study received approval from the Ethical Committee, 429 samples of whole saliva were obtained from patients who were admitted to or visited our hospital between February 16, 2010, and February 28, 2011. The study cohort comprised 48 patients with cardioembolic stroke (CES), 151 with non-CES infarct, 54 with intracerebral hemorrhage (ICH), 43 with ruptured intracranial aneurysm (RIA), and 97 with unruptured intracranial aneurysm (UIA). Cultured SM was identified as Cnm-positive when the corresponding gene was positive. The results were compared with those from 79 healthy volunteers. Relationships between Cnm-positive SM and known risk factors, including hypertension, diabetes, hyperlipidemia, smoking, and alcohol consumption, were analyzed.ResultsA statistically significant high Cnm-positive rate was observed in patients with CES, non-CES infarct, ICH, and RIA (P = 0.002, 0.039, 0.013, and 0.009, respectively). There were no relationships between Cnm-positive SM and known risk factors.ConclusionsSpecific types of oral SM can be a risk factor for cardioembolic infarct, intracerebral hemorrhage, and intracranial aneurysm rupture. Further study is needed.Copyright © 2018 Elsevier Inc. All rights reserved.

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