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9 - Neurologic disorders Flashcards

1
Q

What is an epilepsy?

A

It is a group of neurological disorders categorized in either a chronic or recurrent seizure. It is known to be the most common chronic neurologic condition.

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2
Q

When can seizures from epilepsy occur?

A

They can occur in a convulsive (spastic) manner or occur with changes in the neurological function.

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3
Q

What are the causes of epilepsy?

A

They can occur due to abnormal and spontaneous electrical activity in the brain.

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4
Q

What are seizures?

A

They are discrete episodes in which movement, sensation, behavior, perception and consciousness are disturbed.
*Not that seizures is required to DIAGNOSE epilepsy, not that not ALL seizures imply epilepsy.
*In epilepsy, a burst of electrical activity is recurrent

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5
Q

What are the 2 major types of seizures?

A

1.) Focal (partial) seizures
2.) Generalized seizures

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6
Q

What encompasses a focal (partial) seizure?

A
  • limited in scope and manifestations e.g: simplex and complex
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7
Q

What encompasses a generalized seizure?

A
  • global in sope and manifestations e.g: tonic-clonic “grand mal”. this involves one part of the brain and spreads out
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8
Q

What does the tonic phase of a seizure imply?

A

This implies that the entire body becomes rigid. There is also muscle stiffness which may lead to loss of consciousness due to respiratory muscle spasms.

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9
Q

What does the clonic phase of a seizure imply?

A

This implies that the entire body is twitching & jerking.

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10
Q

What is implied in the aura stage of a seizure?

A

Hallucinations, confusion, dizzyness, numbness

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11
Q

What is implied in the postictal stage of a seizure?

A

Weak limbs, exhaustion, sleepiness

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12
Q

How does a diagnosis for seizure present itself?

A

It presents itself through abnormalities on the electroencephalograph (EEG)

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13
Q

What are the long-term drug therapies for epilepsy?

A

Generally an anti-convulsant medication is used.
- Valproic Acid
- Carbamazepine (Tegretol)
- Phenytoin (Dilantin)
- Medical marijuana (more recent one)

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14
Q

What are the adverse side effects of phenytoin?

A
  • **Gingival hyperplasia
  • Anemia
    -Ataxia
    -Lethargy
  • Skin rash
  • GI disturbances
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15
Q

Why is a pulse generator good for epilepsy management?

A

Because it delivers electrical signals to the left vagus nerve. It is typically implanted in the left chest wall.

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16
Q

What are the oral manifestations of epilepsy?

A
  • Broken teeth
  • tongue laceration
  • lip scares
  • Gingival hyperplasia: commonly in children & in the anterior tissue.

*Why good oral hygiene is key.

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17
Q

What is the first step to identifying and managing epilepsy?

A
  • Identify the presence of epilepsy and complete a thorough health history.
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18
Q

What is the second step to identifying and managing epilepsy?

A
  • To be aware of possible complications from anticonvulsant medications as they may increase incidence of infection, delayed healing gingival & post-op bleeding.
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19
Q

Does a VNS device require an antibiotic prophylaxis?

A

No because there are no major electrical dental equipment

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20
Q

What are some management strategies used DURING a seizure?

A
  • protect patient and prevent injury
  • Clear instruments and tray from area
  • chair should be in the supine position
  • Do not attempt to move the patient to the floor
  • Do not attempt to hod down or restrain the patient
  • maintain airway
  • Time the length of the seizure
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21
Q

What are some management strategies used AFTER a seizure?

A

100% oxygen; patient turned to the side to control airway and minimize aspirations
Discontinue treatment; arrange for patient transport.

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22
Q

What is a stroke?

A

It is a serious + fatal neurologic event caused by sudden interruption of oxygenated blood to the brain as a result of ischemia or hemorrhage

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23
Q

What is an ischemic stroke?

A

It is when the arteries are blocked. They are more common and due to a blood clot obstructing the blood vessel in the brain. It may develop on the spot (thrombosis) or travel through the blood elsewhere (embolism)

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24
Q

What is a hemorrhagic stroke?

A

It is when there is a rupture in the artery. It is far less common and may cause bleeding inside the brain that can be difficult to stop.

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25
Q

What can cause a stroke to occur?

A
  • Atherosclerosis: hardening of the artery
  • Blood clot
  • Uncontrolled BP
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26
Q

What are the risk factors associated with stroke?

A
  • Hypertension
  • Diabetes
  • Different types of heart diseases
  • Behaviours: smoking, lack of exercise, heavy alcohol use
  • Diet
  • Risk that are uncontrollable: aging, family history of strokes, gender, race
27
Q

What are symptoms of a stroke?

A

1.) Numbness or weakness of the body
2.) VIsion changes in one or both eyes
3.) Difficulty swallowing or speaking
4.) Severe headache
5.) Dizziness
6.) Confusion

28
Q

What are the four events associated with stroke? How are they defined as?

A

1.) Transient ischemic attack (TIA)
2.) Reversible ischemic neurologic deficit (RIND)
3.) Stroke-in-evolution
4.) The completed stroke.

*They are defined principally by their duration.

29
Q

What encompasses a TIA “mini stroke”?

A

It is due to a temporary disturbance in the blood supply to a localized area of the brain. It usually lasts less than 10 minutes. A major stroke can be preceded by 1-2 TIAs within several days of the first attack.

30
Q

What encompasses a RIND (reversible ischemic neurologic deficit) stroke?

A

It is like a TIA, but does not clear within 24 hours, but does eventually recover naturally.

31
Q

What encompasses a stroke-in-evolution?

A

It is a stroke caused by the occlusion or hemorrhage of a cerebral artery. It presents itself within several hours and continues to worsen during a period of observation.

32
Q

what encompasses the completed stroke?

A

When there is a prolonged deficit of about >3 weeks. The brain cells will begin to die within minutes when oxygen is deprived.
In this situation, clot-busting drugs need to be used within 3-hrs of the initial stroke symptom.

33
Q

What would occur if a cerebral infarction is to happen?

A

The associated body parts won’t work properly, which is why stroke is top cause of long-term disability. Every second = amount of brain damage.

34
Q

What does a stroke test spot?

A

1.) Face: ask for a smile, does one side droop?
2.) Arms: when raised, does one side drift down?
3.) Speech: can the person repeat a simple sentence? is the person slurring their words?
4.) Time: In need to call EMS immediately

35
Q

How is a stroke diagnosed?

A

By determining which of the TWO strokes is occuring, as they are NOT treated the same way. A CT scan is the best way to determine if a stroke is caused due to blockage or bleeding.

36
Q

What are the right-sided stroke manifestations?

A

1.) Paralyzed left side
2.) Spatial/perceptual deficits
3.) Impaired thought process
4.) Difficulty performing tasks (toothbrushing)
5.) Neglect of the left side

37
Q

What are the left-sided stroke manifestations?

A

1.) Paralyzed right side
2.) Language & speech problems
3.) Decreased auditory memory
4.) Slow & disorganized behavior
5.) Anxiety

38
Q

What are the long term problems that can occur from a stroke?

A
  • Numbness in the arms or legs
  • difficulty walking
  • vision problems
  • trouble swallowing
  • problems with speech and comprehension
39
Q

What are the medications used to prevent strokes from occurring?

A

1.) Antiplatelet medicines: aspirin to keep platelets together in the blood from sticking together and forming clots
2.) Anti-cotting drugs: warfarin: coumadin which thins the blood to make it difficult to clot & help ward off stroke
3.) High blood pressure meds.

40
Q

Describe the balloon & stent angioplasty method of preventing strokes from occurring:

A

It involves the insertion of a catheter into the artery and inflating a tiny balloon to widen the area that is married by plague.
It is a metal tube called a stent that can be inserted and left in place to keep the artery open

41
Q

What are the oral complications & manifestations of a stroke?

A

1.) Slurred or difficulty in speech
2.) Difficulty swallowing (dysphagia)
3.) Unilateral paralysis: one sided
4.) Loss of sensory stimuli of oral tissues
5.) Right-sided brain damage may neglect oral care on left side: due to the ability for motor function is lost.

42
Q

What is the first step in dental management in a patient with a previous history of a stroke?

A

Identifying the risk factors associated to a stroke:
1.) Hypertension
2.) Congestive heart failure
3.) Diabetes mellitus
4.) TIA or previous attack
*In this scenario, ensure that dental hygiene treatment is defer if a stroke has occurred under 6 months.

43
Q

What is the first step in dental management for a pt with a previous hx of a stroke?

A

Identifying the risk factors:
- hypertension
- congestive heart failure
- diabetes mellitus
- TIA or previous attack
- Increasing age (>75 years)

  • if a patient has had stroke < 6 months, defer dental treatment.
44
Q

What is the second step in dental management for a pt with a previous hx of a stroke?

A

Determine bleeding risks:
- Aspirin
- Warfarin/Coudamin (blood thinners): pre-tx INR = <3.5, if it is higher bleeding may occur
- Heparin (anticoagulant) onlus used for emergency dental care
- use measures to minimize hemorrhage (sutures, pressure, gelfoam)

45
Q

What is multiple sclerosis?

A

It is a autoimmune disease of the nervous system which can either be chronic and continuous demyelination of the neurons in two or more regions of the brain and spinal cord.

46
Q

What can cause multiple sclerosis to occur?

A

1.) The autoimmune-mediated inflammation (leading to demyelination and axonal injury).
2.) The triggering of an infectious agent.

47
Q

Who is more prone to acquiring multiple sclerosis?

A
  • young adults between ages 15 and 50
  • Women twice as often as men
48
Q

What are signs and symptoms of multiple sclerosis?

A

1.) Visual disturbances
2.) Loss of sensation
3.) Limb weakness
4.) Bladder and bowel dysfunction
5.) Mental changes
6.) Depression Paranoia
7.) Muscle spasms

49
Q

What are some clinical presentations of multiple sclerosis?

A
  • Motor disturbances affecting hands (loss of balance, incoordination etc)
  • Blindness and nystagmus (abnormal eye movement)
  • Fatigue
  • Problem with concentrations

*Symptoms exacerbated by Heat and dehydration

50
Q

How is multiple sclerosis diagnosed?

A

1.) Patient history
2.) Clinical examination
3.) Cerebrospinal fluid analysis: signs of low grade inflammation/detect antibodies & protein immune response
4.) MRI

51
Q

What are the medical managements used for MS?

A

1.) For acute attacks: corticosteroids
2.) For spasticity: anti-spastic drugs; a GABA agonist
3.) For depression accompanying MS; SSRIs

52
Q

What are some oral complications & manifestations of MS?

A

1.) Dysarthria: Slurred speech
2.) Paresthesia
3.) Numbness of orofacial structures
4.) Trigeminal neuralgia: chronic pain in the trigeminal nerve; sensations to your face

53
Q

What are the dental management symptoms of MS?

A
  • Reports of abnormal facial pain (mimicking trigeminal neuralgia)
  • Afternoon fatigue
  • Xerostomia or burning mouth from medications
  • Immunosuppressant meds putting patient at risk for opportunistic infection.
54
Q

What are some treatment planning modifications made for MS?

A

If it is more advanced:
- require help to transfer to and from the dental chair
- Have difficulty maintaining oral hygiene
- poor candidates for reconstructive and prosthetic procedures.

55
Q

What is Parkinson’s disease?

A

It is the chronic and progressive neurodegenerative disorder of neurons that produces dopamine. Less production of dopamine. They are a gradual loss of these neurons due to characteristic motor disturbances.

56
Q

What causes Parkinson’s Disease to occur?

A
  • Death and depletion of dopaminergic neurons in the substantia nigra. Etiology is still yet unknown but is likely due to genetic and environmental factors.
57
Q

In which type of individual is Parkinson’s Disease most prevalent in ?

A
  • People around the age of 62 years.
  • Family memebrs with PD will increase the risk
  • Men > Women are 1.5x times likely
58
Q

What are the early signs of Parkinson’s?

A
  • Slight shaking of a finger, hand, leg or lip
  • stiffness or difficulty walking
  • Small, crowded handwriting
  • Stooped posture
  • “masked”/frozen/serious facial expression.
59
Q

What are the movement symptoms of Parkinson’s disease?

A

1.) Tremor: “pill-rolling” manner
2.) Bradykinesia: slowness of movement, shuffle walking
3.) Impaired balance: stooped posture; drooping shoulders; head jutted forward; increased risk of falling.
4.) Rigidity: Occurs when muscles stay stiff and don’t relax

60
Q

What are some other symptoms of Parkinson’s Disease that do NOT involve movement?

A
  • Restless sleep or daytime fatigue
  • soft voice or slurred speech
  • Difficulty swallowing
  • Memory problems, dementia
  • Oily skin and dandruff
  • Bladder dysfunction or constipation
61
Q

What is the main characteristic of Parkinson’s disease?

A
  • It is progressive, meaning it changes within the brain over time.
62
Q

What is a drug that helps replace/mimic dopamine for Parkinson’s disease?

A

L-dopa
- An amino acid that the brain converts into dopamine.
- helps reduce bradykinesia + rigidity
- wear off quickly
- should NOT be taken with a high-protein diet.

63
Q

Why is a direct mimic or replacement of dopamine not really useful over time?

A

Because they can become less effective over time. They have side effects including nausea, vomiting, drowsiness.

64
Q

What is the dental management used for Parkinson’s disease?

A
  • Frequent hygiene recalls
  • Salivry substitutes
  • Topical fluoride
  • Specialized toothbrushes
  • Personal care provides should be educated on their roles

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