Case Report: Botulinum Toxin Type A Injection for Bruxism Following Left Basal Ganglia Hemorrhage

BACKGROUND Post‑stroke bruxism is an underrecognized complication that may impair oral function, cause orofacial pain, and negatively impact rehabilitation outcomes. Botulinum toxin type A (BoNT‑A) has been reported for bruxism, but its application in post‑stroke populations remains sparsely documented. This case describes the assessment and treatment of bruxism following cerebral hemorrhage, utilizing the Standardized Tool for the Assessment of Bruxism (STAB) as a structured multidimensional framework. CASE REPORT A 40-year-old man developed bruxism during recovery from a massive left hemispheric intracerebral hemorrhage after decompressive craniectomy and hematoma evacuation. About 3 months after admission, he began to exhibit bilateral masseter muscle hypertrophy with marked tenderness, temporomandibular joint pain, and drooling from the right mouth corner, with no prior history of bruxism. STAB-based evaluation yielded the following Axis A findings: Subject-based assessment revealed nocturnal grinding reported by caregivers. Clinically based assessment revealed bilateral masseter hypertrophy, tenderness on palpation, and dental wear. Instrument-based assessment (surface electromyography used for injection guidance) confirmed increased masseter muscle activity at rest and during clenching. Symptoms were refractory to occlusal splint therapy combined with hot compresses. At 48 hours after electromyography-guided injection into the bilateral masseter muscles (50 U per side, divided into 3 sites per side), muscle tension and tenderness were markedly reduced, and clinical improvement persisted at 6-month follow-up. CONCLUSIONS In this single case, BoNT‑A injection was temporally associated with symptom relief in post-stroke bruxism. STAB provided a structured multidimensional assessment framework. These descriptive findings have limited generalizability. Controlled studies are needed to establish the efficacy and safety of this intervention in the post‑stroke population.