Common Neurological Diseases

Question 1

What are some red flags in neuro conditions?

Answer 1

changes in special functions (5 senses)
changes in sensation
motor functions
cerebral functions (speech, memory)

Question 2

What is tone?

Answer 2

the resting baseline tension of a muscle at rest (is there any/how much resistance to moving a pts arm)

Question 3

The inferior alveolar nerve is a ___ and so ____ recover to injury

Answer 3

Peripheral, may (Central nerves don’t recover)

Question 4

Aetiology of Trigeminal neuralgia

Answer 4

Malfunction of the Schwann cells (the fat cells that form the myelin sheath), leaving the nerve hyper-excitable

Question 5

Describe presentation of trigeminal neuralgia

Answer 5

Very sharp pain (like electric shock)
Always unilateral, associated with one of the branches of the face
stimulated by chewing, touching, wind (small stimuli)

Question 6

How is trigeminal neuralgia diagnosed

Answer 6

Clinical presentation of symptoms, can be confirmed with MRI, also associated with multiple sclerosis

Question 7

Treatment options for trigeminal neuralgia

Answer 7

• carbamazepine (anticonvulsant, also used for epilepsy)
• cryotherapy
• radiofrequency ablation

Question 8

What is carpel tunnel syndrome

Answer 8

Compression of the median nerve as it passes through a small area between the carpal bones

Question 9

Carpal tunnel syndrome presents as:

Answer 9

• both numbness and pain in area from thumb to some of the ring finger
• weak grip/thumb

Question 10

How is carpal tunnel syndrome diagnosed

Answer 10

Clinically, can do nerve conduction tests

Question 11

What are the treatment options for carpal tunnel syndrome?

Answer 11

NSAIDs and steroids to try and reduce inflammation
Physio: keep wrist supple with splints and exercises
Surgical decompression to expand tunnel space

Question 12

Sciatica is a ___, not a ___

Answer 12

Symptom, not a diagnosis
(you need to go and find the underlying cause)

Question 13

What is sciatica?

Answer 13

A pain associated with a dermatome of the legs caused by damage to the sciatic nerve

Question 14

what is the difference between dermatomes and myotomes?

Answer 14

Dermatomes > nerve distribution in context of the skin areas
Myotomes > explaining nerve distribution by relation of the muscles

Question 15

What are the symptoms of sciatica?

Answer 15

• mild to serve pain in legs, normally in L4 or L% dermatomes
• a droopy foot (L5 also controls raising of the foot, this is reduced)

Question 16

What are the sciatica red flags to send them straight to A&E?

Answer 16

any effect around perineum, genitalia, incontinence
can deteriorate quickly, need to prevent permanent damage

Question 17

What is the difference between epilepsy and a seizure

Answer 17

Seizure = sudden uncontrolled electrical disturbance in brain
Epilepsy = recurrent bursts of abnormal brain activity that manifests as recurrent seizures

Question 18

Causes of seizures:

Answer 18

Genetic, trauma, stroke, tumours in the brain, meningitis infections

Question 19

What are the 4 stages of seizures?

Answer 19

• Prodrome
• Aura
• Ictal
• Post-ictal

Question 20

How do you manage a seizing patient?

Answer 20

Make sure there are no sharps/equipment they could damage themselves with, do not attempt to restrain, time the seizure (if +5 min, 999)
long term > carbamazepine

Question 21

What is the aetiology of multiple sclerosis?

Answer 21

Aggressive, auto-inflammatory disease of the CNS (can also affect peripheral nerves)

Question 22

What are the symptoms for multiple sclerosis

Answer 22

Numbness, weakness, problems with thought, loss of fine motor skills, mobility issues

Question 23

What is the aetiology of Parkinson’s Disease?

Answer 23

Degeneration of dopaminergic neurones in the basal ganglia (neural hub at the centre of the brain that use dopamine as a neurotransmitter)

Question 24

Symptoms of Parkinson’s disease

Answer 24

loss of muscular control, tremor, emotional changes, impaired balance and coordination

Question 25

What is the aetiology of Huntington’s disease?

Answer 25

a disease of the basal cell ganglia caused by autosomal dominant gene mutation

Question 26

What are the symptoms for Huntington’s disease?

Answer 26

cognitive decline, uncontrollable full body movements, strong links to depression and dementia

Question 27

What are the pyramidal tracts?

Answer 27

Tracts of efferent nerve fibres carrying motor neurone signals from the central cortex to the spinal column

Question 28

Where do the pyramidal tracts run?

Answer 28

from the central medulla to spinal cord, through the basal ganglia (and so are affected by Parkinson’s and Huntingtons)

Question 29

What are extra-pyramidal effects?

Answer 29

side effects caused by drugs that push the neurones too far from the basal ganglia trying to treat other conditions
Tremor, lack of movement, posture instability

Question 30

Why will a patient require oxygen during a tonic clonic seizure?

Answer 30

during the tonic phase, all their muscles contract, which means they both are using energy and not breathing

Question 31

What can cause a provoked seizure?

Answer 31

(anything that messes with brain chemistry)
Hypoxia, hypoglycaemia, drugs, infections, tumours

Question 32

What are some QoL impacts on epileptic patients?

Answer 32

• must inform DVLA, may not be able to drive
• safety assessments for certain jobs
• advised not to have a bath alone (home alone)
• SUDEP (sudden unexpected death in epilepsy)

Question 33

What are the two main types of stroke?

Answer 33

Ischaemic vs Haemorrhagic

Question 34

What is the cause of an ischaemic stroke?

Answer 34

Blockage of blood flow, mostly from thombosis/embolism

Question 35

What is the cause of a haemorrhagic stroke?

Answer 35

a bleed from one of the arteries supplying the brain

Question 36

What is a transient ischaemic attack?

Answer 36

TIA, ‘mini stroke’
A temporary ischaemic disruption of blood flow

Question 37

Which condition presents with a ‘thunderclap headache’

Answer 37

Subarachnoid haemorrhage

Question 38

What is a subarachnoid haemorrhage

Answer 38

a bleed in the subarachnoid space, typically from an aneurysm

Question 39

Describe the acronym used to identify a stroke

Answer 39

FAST
Face
Arm
Speech
Time

Question 40

What is the management for an ischaemic stroke?

Answer 40

Thrombolysis drugs, thromboectomy

Question 41

What is the management for a haemorrhagic stroke?

Answer 41

Lumbar puncture, angiogram, neurosurgery

Question 42

What are some dental considerations for stroke patients

Answer 42

Can’t treat until 6 months after last stroke
accessibility issues
give information slower to allow informed consent
limit L.A and adrenaline