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BDS3 BAMS Diseases of Human Systems > 2. Neurological Conditions > Flashcards

2. Neurological Conditions Flashcards

1
Q

Define a stroke.

A

Acute focal neurological deficit resulting from cerebrovascular disease lasting more than 24 hours or causing earlier death.

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2
Q

What causes a stroke ?

A

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.

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3
Q

What are predisposing factors to do with stroke ?

A

Men.
Ageing population.

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4
Q

Define a TIA.

A

Transient ischemic attack from temporary cerebral isechmia with full recovery within 24 hours (average - 30 mins).

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5
Q

What are risk factors for stroke ?

A

Smoking, alcohol, ischaemic heart disease, atrial fibrillation, diabetes, hypertension.

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6
Q

What are 5 preventative measures which can be put in place to reduce likelihood of stroke ?

A
  • 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.
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7
Q

What imaging can be used to investigate stroke ?

A
  • CT for non-ischaemic stroke.
  • MRA (MR angiography).
  • DSA where MRA is not available.
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8
Q

What investigative procedures can be carried out to assess risk factors for stroke ?

A

ECG.
BP.
Diabetes screening.
Thrombophilia screening (young patients).
Carotid/cardiac ultrasound.

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9
Q

What mnemonic can be used to define effects of a stroke ?

A

Facial drooping, arm weakness, speech difficulty, time - FAST.

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10
Q

What are dental aspects of stroke ?

A
  • Risk of cardiac emergency.
  • Communication difficulty.
  • Impaired mobility and dexterity.
  • Angular chelitis risk due to facial drooping.
  • Loss of protective reflexes - aspiration, saliva.
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11
Q

What prescription of aspirin is given to patients to prevent future risk of stroke ?

A

300mg daily.

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12
Q

What are predispoding factors for multiple sclerosis ?

A

Women in 40s - most severe.
Identical twins.
Younger.

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13
Q

What is multiple sclerosis ?

A

Degenerative neurological condition causing CNS lesions due to demyelination of axons - characterised by patchy distributions and progressive functional loss.

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14
Q

What are symptoms of MS ?

A

Muscle weakness.
Visual disturbance.
Paraesthesia.
Autonomic dysfunction.
Dysarthria.
Pain.
Balance and hearing loss.

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15
Q

What are signs of MS ?

A

Loss of touch.
Proprioceptive loss.
Optic atrophy.
Tremor.
Altered reflexes.
Spasticity.
Muscle weakness.

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16
Q

What changes will be seen in CSF analysis of patient with MS ?

A

Reduced lymphocytes and increased IgG protein.

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17
Q

What are the two types of MS outcomes ?

A

Relapsing and remitting type - acute exacerbations and periods of respite.
Primary progressive type - slow, steady progressive deterioration.

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18
Q

What symptomatic pharmacological management can be given to patients with MS ?

A

Antibiotics, antispasmodics, analgesia, steroids.
Disease modifying therapy - cladribine, siponimod.
Stem cell transplant.

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19
Q

What are some dental aspects of MS ?

A

Limited mobility and psychological disorders.
Treat under LA.
Orofacial motor and sensory disturbance.
Chronic orofacial pain.
Enhanced trigeminal neuralgia risk.

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20
Q

Define motor neurone disease.

A

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).

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21
Q

What is the cause of death in a patient with motor neurone disease ?

A

Ventilation failure or aspiration pneumonia.

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22
Q

What are predisposing factors for motor neurone disease ?

A

30-60 year old development.
Men.
Sporadic - not attributed with FH.

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23
Q

What is the prognosis for diagnosis of motor neurone disease ?

A

3 years.
1/3 die within a year of diagnosis.

24
Q

What are symptoms of motor neurone disease ?

A

Weakness in ankle or leg - tripping or difficulty with stairs.
Slurred speech and swallowing.
Weak grip.
Muscle cramps.
Weight loss.
Emotional lability.

25
Q

What treatment can be given for patients with motor neurone disease ?

A

Riluzole for 6-9 month life extension.
PEG tube to prevent aspiration.
No other effective treatment.

26
Q

What are dental aspects of motor neurone disease ?

A

Difficulty accepting dental care due to muscle weakness of head and neck.
Realistic treatment planning.
Drooling and swallowing difficulties.

27
Q

Define Parkinson’s disease.

A

Degeneration of dopaminergic neurones in basal ganglia of brain. Dopamine shortage results in difficulty of message passing from thinking to doing.

28
Q

What age of patients are most commonly affected by Parkinson’s disease ?

A

Elderly.

29
Q

What are clinical signs of Parkinson’s disease ?

A

Bradykinesia - slow movement.
Rigidity - increased muscle tone.
Tremor - slow amplitude.

30
Q

What are symptoms of Parkinson’s disease ?

A

Impaired gait and falls.
Impaired use of upper limbs.
Mask-like face.
Swallowing problems.

31
Q

What is the prognosis for Parkinson’s disease ?

A

Normal-near normal life expectancy.

32
Q

What pharmacological treatment can be given for patient with Parkinson’s ?

A

Dopamine - levodopa.
Dopamine analogues -
- Promipexole tablets.
- Apomorphine injection.
- Duodopa infusion.

33
Q

What are some dental aspects of Parkinson’s disease ?

A

Tremor at rest.
Difficulty mouth opening.
Dry mouth due to anticholinergic drugs.

34
Q

What is the cause of epilepsy ?

A

Reduced GABA levels in brain leading to abnormal cell-cell message propagation.

35
Q

Define febrile seizures.

A

Seizure as a result of children >80 degrees.

36
Q

What are the symptoms of febrile seizures ?

A

Fever.
Face may turn blue or red.
Eyes rolling upwards.
Loss of consciousness.
Muscles and limbs jerk in unnatural movements.

37
Q

What are the 2 types of epilepsy ?

A

Generalised and partial.

38
Q

What are the subtypes of generalised epilepsy ?

A

Tonic/clonic.
Absence (petit mal).
Myoclonic/atonic.

39
Q

What are the subtypes of partial epilepsy ?

A

Simple partial.
Complex partial.
Simple sensory.

40
Q

What are triggers of epilepsy ?

A

Idiopathic.
Trauma - head injury.
CNS disease - tumour, stroke, CJD, meningitis, encephalitis.
Social - late nights, alcohol, hypoglycaemia, flashing lights.

41
Q

What makes generalised and partial epilepsy different ?

A

Partial - cortical focus.
Generalised - central focus.

42
Q

What are symptoms of tonic clonic epilepsy ?

A

Prodromal aura.
Loss of consciousness/continence.
Initial tonic - stiff.
Clonic - contraction/relaxation.
Post-ictal drowsiness.

43
Q

Define status epilepticus.

A

Recurrent seizures.

44
Q

Define petit mal seizures.

A

Short lived episodes - 5-15 seconds.
Loss of awareness - eyelids flutter, vacant stare, stops activity, loss of response.

45
Q

What are the two most important things to do when patient is experiencing tonic-clonic seizure ?

A

Protect from injury - remove objects from mouth if possible.
Prevent asphyxia - supplemental oxygen, Guedel airway if possible, suction secretions.

46
Q

What are common precipitators of tonic clonic seizures ?

A

Withdrawal or poor medication compliance.
Epileptogenic drugs - GA, alcohol, tricyclics, SSRIs.
Fatigue or stress.
Infection.
Menstruation.

47
Q

Define Jacksonian seizure.

A

Motor localised to one region of the brain, moves/spreads to other motor areas.

48
Q

Common medications for tonic-clonic epilepsy ?

A

Valproate.
Carbamazepine.
Phenytoin.
Gabapentin.
Phenobarbitone.
Lamotrigine.

49
Q

Common medications for absence epilepsy ?

A

Levitiracetam.

50
Q

Treatment for patient in status epilepticus ?

A

Benzodiazepines.

51
Q

What type of drug is valproate ?

A

GABA transaminase inhibitor.

52
Q

What dental condition can phenytoin cause ?

A

Gingival hyperplasia.

53
Q

What condition can valproate cause which might be significant in dentistry ?

A

Bleeding tendency.

54
Q

What are dental aspects of epilepsy ?

A

Oral soft tissue injury.
Dental injury/fracture.
Complications of treatment - including folate deficiency.
Emergency care.
Timing of appointments - treat at times of low risk.

55
Q

Patient comes into your practice who suffers from epilepsy - what are important questions to ask during medical history ?

A

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 ?

BDS3 BAMS Diseases of Human Systems (6 decks)

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