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Abstract Background Transcranial motor-evoked potential (Tc-MEP) monitoring is usually performed during surgeries involving a risk of damaging brain motor areas. However, it involves a risk of bite injuries. We report a case of severe tongue laceration from Tc-MEP stimulation during carotid endarterectomy (CEA) in a patient taking antiplatelet agents. Case presentation A 74-year-old man on antiplatelet therapy was scheduled for CEA under general anesthesia with intraoperative Tc-MEP monitoring. Bite blocks were not inserted. Postoperatively, we observed a tongue laceration with severe bleeding, which was sutured. The difficulties in tongue movement persisted for ≥ 1 month postoperatively. Conclusions Bite injuries during Tc-MEP may induce severe bleeding in patients on antiplatelets. The complications of tongue bite injuries may persist, decreasing the patients’ quality of life. Hence, during Tc-MEP monitoring, it is important to use soft bite blocks and to check the patient’s face and the position of the tracheal tube intraoperatively.