Common Neurological Diseases Flashcards
What are some red flags in neuro conditions?
changes in special functions (5 senses)
changes in sensation
motor functions
cerebral functions (speech, memory)
What is tone?
the resting baseline tension of a muscle at rest (is there any/how much resistance to moving a pts arm)
The inferior alveolar nerve is a ___ and so ____ recover to injury
Peripheral, may (Central nerves don’t recover)
Aetiology of Trigeminal neuralgia
Malfunction of the Schwann cells (the fat cells that form the myelin sheath), leaving the nerve hyper-excitable
Describe presentation of trigeminal neuralgia
Very sharp pain (like electric shock)
Always unilateral, associated with one of the branches of the face
stimulated by chewing, touching, wind (small stimuli)
How is trigeminal neuralgia diagnosed
Clinical presentation of symptoms, can be confirmed with MRI, also associated with multiple sclerosis
Treatment options for trigeminal neuralgia
- carbamazepine (anticonvulsant, also used for epilepsy)
- cryotherapy
- radiofrequency ablation
What is carpel tunnel syndrome
Compression of the median nerve as it passes through a small area between the carpal bones
Carpal tunnel syndrome presents as:
- both numbness and pain in area from thumb to some of the ring finger
- weak grip/thumb
How is carpal tunnel syndrome diagnosed
Clinically, can do nerve conduction tests
What are the treatment options for carpal tunnel syndrome?
NSAIDs and steroids to try and reduce inflammation
Physio: keep wrist supple with splints and exercises
Surgical decompression to expand tunnel space
Sciatica is a ___, not a ___
Symptom, not a diagnosis
(you need to go and find the underlying cause)
What is sciatica?
A pain associated with a dermatome of the legs caused by damage to the sciatic nerve
what is the difference between dermatomes and myotomes?
Dermatomes > nerve distribution in context of the skin areas
Myotomes > explaining nerve distribution by relation of the muscles
What are the symptoms of sciatica?
- 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)
What are the sciatica red flags to send them straight to A&E?
any effect around perineum, genitalia, incontinence
can deteriorate quickly, need to prevent permanent damage
What is the difference between epilepsy and a seizure
Seizure = sudden uncontrolled electrical disturbance in brain
Epilepsy = recurrent bursts of abnormal brain activity that manifests as recurrent seizures
Causes of seizures:
Genetic, trauma, stroke, tumours in the brain, meningitis infections
What are the 4 stages of seizures?
- Prodrome
- Aura
- Ictal
- Post-ictal
How do you manage a seizing patient?
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
What is the aetiology of multiple sclerosis?
Aggressive, auto-inflammatory disease of the CNS (can also affect peripheral nerves)
What are the symptoms for multiple sclerosis
Numbness, weakness, problems with thought, loss of fine motor skills, mobility issues
What is the aetiology of Parkinson’s Disease?
Degeneration of dopaminergic neurones in the basal ganglia (neural hub at the centre of the brain that use dopamine as a neurotransmitter)
Symptoms of Parkinson’s disease
loss of muscular control, tremor, emotional changes, impaired balance and coordination
What is the aetiology of Huntington’s disease?
a disease of the basal cell ganglia caused by autosomal dominant gene mutation
What are the symptoms for Huntington’s disease?
cognitive decline, uncontrollable full body movements, strong links to depression and dementia
What are the pyramidal tracts?
Tracts of efferent nerve fibres carrying motor neurone signals from the central cortex to the spinal column
Where do the pyramidal tracts run?
from the central medulla to spinal cord, through the basal ganglia (and so are affected by Parkinson’s and Huntingtons)
What are extra-pyramidal effects?
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
Why will a patient require oxygen during a tonic clonic seizure?
during the tonic phase, all their muscles contract, which means they both are using energy and not breathing
What can cause a provoked seizure?
(anything that messes with brain chemistry)
Hypoxia, hypoglycaemia, drugs, infections, tumours
What are some QoL impacts on epileptic patients?
- 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)
What are the two main types of stroke?
Ischaemic vs Haemorrhagic
What is the cause of an ischaemic stroke?
Blockage of blood flow, mostly from thombosis/embolism
What is the cause of a haemorrhagic stroke?
a bleed from one of the arteries supplying the brain
What is a transient ischaemic attack?
TIA, ‘mini stroke’
A temporary ischaemic disruption of blood flow
Which condition presents with a ‘thunderclap headache’
Subarachnoid haemorrhage
What is a subarachnoid haemorrhage
a bleed in the subarachnoid space, typically from an aneurysm
Describe the acronym used to identify a stroke
FAST
Face
Arm
Speech
Time
What is the management for an ischaemic stroke?
Thrombolysis drugs, thromboectomy
What is the management for a haemorrhagic stroke?
Lumbar puncture, angiogram, neurosurgery
What are some dental considerations for stroke patients
Can’t treat until 6 months after last stroke
accessibility issues
give information slower to allow informed consent
limit L.A and adrenaline
