2. Neurological Conditions Flashcards
Define a stroke.
Acute focal neurological deficit resulting from cerebrovascular disease lasting more than 24 hours or causing earlier death.
What causes a stroke ?
No local cerebral blood flow i.e.
- Infarction.
- Haemorrhage - aneurysm rupture.
- Venous thrombosis.
- Embolism - from left side of heart.
- Atheroma or cerebral vessels i.e. carotid bifurcation, internal carotid artery, vertebral artery.
What are predisposing factors to do with stroke ?
Men.
Ageing population.
Define a TIA.
Transient ischemic attack from temporary cerebral isechmia with full recovery within 24 hours (average - 30 mins).
What are risk factors for stroke ?
Smoking, alcohol, ischaemic heart disease, atrial fibrillation, diabetes, hypertension.
What are 5 preventative measures which can be put in place to reduce likelihood of stroke ?
- Treatment of risk factors i.e. smoking cessation, alcohol cessation.
- Antiplatelet (secondary prevention) - aspirin, dipyridamole, clopidogrel.
- Anticoagulants where embolic risk - warfarin, apixaban.
- Carotid endarterectomy for <85 year olds - where previous TIAs.
- Preventative neurosurgery - aneurysm clips, AV malformation correction.
What imaging can be used to investigate stroke ?
- CT for non-ischaemic stroke.
- MRA (MR angiography).
- DSA where MRA is not available.
What investigative procedures can be carried out to assess risk factors for stroke ?
ECG.
BP.
Diabetes screening.
Thrombophilia screening (young patients).
Carotid/cardiac ultrasound.
What mnemonic can be used to define effects of a stroke ?
Facial drooping, arm weakness, speech difficulty, time - FAST.
What are dental aspects of stroke ?
- Risk of cardiac emergency.
- Communication difficulty.
- Impaired mobility and dexterity.
- Angular chelitis risk due to facial drooping.
- Loss of protective reflexes - aspiration, saliva.
What prescription of aspirin is given to patients to prevent future risk of stroke ?
300mg daily.
What are predispoding factors for multiple sclerosis ?
Women in 40s - most severe.
Identical twins.
Younger.
What is multiple sclerosis ?
Degenerative neurological condition causing CNS lesions due to demyelination of axons - characterised by patchy distributions and progressive functional loss.
What are symptoms of MS ?
Muscle weakness.
Visual disturbance.
Paraesthesia.
Autonomic dysfunction.
Dysarthria.
Pain.
Balance and hearing loss.
What are signs of MS ?
Loss of touch.
Proprioceptive loss.
Optic atrophy.
Tremor.
Altered reflexes.
Spasticity.
Muscle weakness.
What changes will be seen in CSF analysis of patient with MS ?
Reduced lymphocytes and increased IgG protein.
What are the two types of MS outcomes ?
Relapsing and remitting type - acute exacerbations and periods of respite.
Primary progressive type - slow, steady progressive deterioration.
What symptomatic pharmacological management can be given to patients with MS ?
Antibiotics, antispasmodics, analgesia, steroids.
Disease modifying therapy - cladribine, siponimod.
Stem cell transplant.
What are some dental aspects of MS ?
Limited mobility and psychological disorders.
Treat under LA.
Orofacial motor and sensory disturbance.
Chronic orofacial pain.
Enhanced trigeminal neuralgia risk.
Define motor neurone disease.
Degenerative of corticospinal tracts, anterior horns and bulbar motor nuclei resulting in progressive loss of motor function in limbs, intercostal, diaphragm and motor cranial nerves (CNVII-XII).
What is the cause of death in a patient with motor neurone disease ?
Ventilation failure or aspiration pneumonia.
What are predisposing factors for motor neurone disease ?
30-60 year old development.
Men.
Sporadic - not attributed with FH.
What is the prognosis for diagnosis of motor neurone disease ?
3 years.
1/3 die within a year of diagnosis.
What are symptoms of motor neurone disease ?
Weakness in ankle or leg - tripping or difficulty with stairs.
Slurred speech and swallowing.
Weak grip.
Muscle cramps.
Weight loss.
Emotional lability.
What treatment can be given for patients with motor neurone disease ?
Riluzole for 6-9 month life extension.
PEG tube to prevent aspiration.
No other effective treatment.
What are dental aspects of motor neurone disease ?
Difficulty accepting dental care due to muscle weakness of head and neck.
Realistic treatment planning.
Drooling and swallowing difficulties.
Define Parkinson’s disease.
Degeneration of dopaminergic neurones in basal ganglia of brain. Dopamine shortage results in difficulty of message passing from thinking to doing.
What age of patients are most commonly affected by Parkinson’s disease ?
Elderly.
What are clinical signs of Parkinson’s disease ?
Bradykinesia - slow movement.
Rigidity - increased muscle tone.
Tremor - slow amplitude.
What are symptoms of Parkinson’s disease ?
Impaired gait and falls.
Impaired use of upper limbs.
Mask-like face.
Swallowing problems.
What is the prognosis for Parkinson’s disease ?
Normal-near normal life expectancy.
What pharmacological treatment can be given for patient with Parkinson’s ?
Dopamine - levodopa.
Dopamine analogues -
- Promipexole tablets.
- Apomorphine injection.
- Duodopa infusion.
What are some dental aspects of Parkinson’s disease ?
Tremor at rest.
Difficulty mouth opening.
Dry mouth due to anticholinergic drugs.
What is the cause of epilepsy ?
Reduced GABA levels in brain leading to abnormal cell-cell message propagation.
Define febrile seizures.
Seizure as a result of children >80 degrees.
What are the symptoms of febrile seizures ?
Fever.
Face may turn blue or red.
Eyes rolling upwards.
Loss of consciousness.
Muscles and limbs jerk in unnatural movements.
What are the 2 types of epilepsy ?
Generalised and partial.
What are the subtypes of generalised epilepsy ?
Tonic/clonic.
Absence (petit mal).
Myoclonic/atonic.
What are the subtypes of partial epilepsy ?
Simple partial.
Complex partial.
Simple sensory.
What are triggers of epilepsy ?
Idiopathic.
Trauma - head injury.
CNS disease - tumour, stroke, CJD, meningitis, encephalitis.
Social - late nights, alcohol, hypoglycaemia, flashing lights.
What makes generalised and partial epilepsy different ?
Partial - cortical focus.
Generalised - central focus.
What are symptoms of tonic clonic epilepsy ?
Prodromal aura.
Loss of consciousness/continence.
Initial tonic - stiff.
Clonic - contraction/relaxation.
Post-ictal drowsiness.
Define status epilepticus.
Recurrent seizures.
Define petit mal seizures.
Short lived episodes - 5-15 seconds.
Loss of awareness - eyelids flutter, vacant stare, stops activity, loss of response.
What are the two most important things to do when patient is experiencing tonic-clonic seizure ?
Protect from injury - remove objects from mouth if possible.
Prevent asphyxia - supplemental oxygen, Guedel airway if possible, suction secretions.
What are common precipitators of tonic clonic seizures ?
Withdrawal or poor medication compliance.
Epileptogenic drugs - GA, alcohol, tricyclics, SSRIs.
Fatigue or stress.
Infection.
Menstruation.
Define Jacksonian seizure.
Motor localised to one region of the brain, moves/spreads to other motor areas.
Common medications for tonic-clonic epilepsy ?
Valproate.
Carbamazepine.
Phenytoin.
Gabapentin.
Phenobarbitone.
Lamotrigine.
Common medications for absence epilepsy ?
Levitiracetam.
Treatment for patient in status epilepticus ?
Benzodiazepines.
What type of drug is valproate ?
GABA transaminase inhibitor.
What dental condition can phenytoin cause ?
Gingival hyperplasia.
What condition can valproate cause which might be significant in dentistry ?
Bleeding tendency.
What are dental aspects of epilepsy ?
Oral soft tissue injury.
Dental injury/fracture.
Complications of treatment - including folate deficiency.
Emergency care.
Timing of appointments - treat at times of low risk.
Patient comes into your practice who suffers from epilepsy - what are important questions to ask during medical history ?
When are good and bad phases ?
What brings on a seizure ?
When did the last 3 fits take place ?
Compliance with medication ?
Changes in medication ?
What do their symptoms look like ?
