12. Neurology I: demyelination, facial pain & cerebrovascular disease

Question 1

LOs

Answer 1

– Understand the normal functioning of the nervous system
– Understand common pathologies relating to the nervous system
– Consider the implications on dentistry for patients with neurological pathologies

Question 2

what is neurology?

Answer 2

The branch of medicine or biology that deals with the anatomy,
functions, and organic disorders of nerves and the nervous
system.

Question 3

Yr 1 recap

Answer 3

NS = CNS + PNS

Central NS = brain + spinal cord
peripheral NS = everything else

autonomic and parasympathetic NS
- responses to things
EG fight + flight response, salivary produc, etc

• need to be aware of what diff parts of NS does + what area of path is being effected

Question 4

Yr 1 recap

Answer 4

NEURON

• most basic unit of structure of NS
• axon terminals usual in peripheral
• know structure (diagram)
• node of ranvier is where Na is taken in to allow propagation

Question 5

Yr 1 recap

Answer 5

Question 6

Yr 1 recap - decussate

Answer 6

Cranial and Spinal nerves all decussate

• Right side is controlled
  by the left side of brain

Question 7

Why do a neurological examination?

Answer 7

The aim of examination is to discover in what anatomical region a pathology may have occurred

Tone – (resistance to passive movement of a joint)
Power – (power is tested by comparing the patient’s strength against your own.)
Reflex – (involuntary and nearly instantaneous movement in response to a stimulus)
Co-ordination – (voluntary / purposeful movements)
Sensation – (conscious experience resulting from stimulation

• upper motor neuron - brain
• lower motor neurone = peripheral nerves

eg upper motor neurone lesion = some type of problem in brain, that can present in peripheral demonstration of symptom

(facial palsy’s will be the most relevant in dent)

Question 8

Yr 1 recap

Answer 8

• as part of neurological examination - need to think about consciousness level of patient

AVPU
(know ones on left)

Question 9

Yr 1 recap
consciousness level Q’s and point system

Answer 9

Question 10

1. what is a stroke?
2. types?
3. what is FAST?

Answer 10

1
- A focal neurological deficit which lasts longer than 24 hours resulting from a
vascular lesion

2
- can be 1 of 2 types
- ISCHAEMIC
~ blood supply is cut off to part of brain
- HEMORRHAGIC
~ bleed out into part of bran

3
Face – Asymmetry of the face – Unilateral palsy
Arms – Weakness in the arms
Speech - Slurring of speech - (Dysarthria)
Time – Phone for help

FAST

• important to take action within first 4 hours for better outcomes/ to be more effective
  ~ improve chance of survival
  ~ minimise impact

Question 11

Stroke Symptoms

Answer 11

• Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
• Sudden severe headache with no known cause. (Haemorrhagic - due to pressure build up from bleed)
• Confusion, trouble speaking, or difficulty understanding speech
  ~ Aphasia is an impairment of
  language, affecting the production or
  comprehension of speech and the
  ability to read or write
• Sudden trouble seeing in one or both eyes. (Visual Field Defects) (variable - depends on where stroke is)
• Ataxia - Sudden trouble walking (gait disturbance), dizziness, loss
  of balance, or lack of coordination

Question 12

1. what does palsy mean?
2. types of paralysis?

Answer 12

1
paralysis

2
- hemiplegia
- paraplegia
- quadriplegia
- monoplegia

Question 13

Ischaemic Vs Haemorrhagic stroke

Answer 13

ISCHAEMIA
- Area of the brain deprived of blood
- Obstruction blocks the flow to part of the brain
- Thrombus (Atheroma, Vegetations – IE)
Atheroma / atherosclerotic plaques
- Severe hypotension (have thicker blood)
- 80% of all stroke events
- Treatment with thrombolysis in acute phase (blood thinners) (EG. Alteplase)
- longer blood flow is restricted = more necrosis

HAEMORRHAGIC
- Area of bleeding
- Weakened vessel walls rupturing causing
bleeding into the brain (aneurysm)
- 20% of all stroke events

Question 14

What is a TIA?

Answer 14

Transient Ischemic Attack

• A focal neurological deficit which lasts less than 24 hours resulting from a vascular lesion. The deficit fully resolves
• Temporary in nature
• Requires active preventative treatment and investigation

Question 15

Risk Factors of Stroke

Answer 15

• Diabetes
• Cigarettes
• Obesity
• Oestrogen OCP
• Excess EtOH
• Polycythaemia (Raised haemaglobin)
• Atheroma (hypercholesterol / lipid aemia)
• Hereditable nature
• Hypertension

Answer 16