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Systemic Disease in Dentistry > Cranial Nerves and Epilepsy > Flashcards

Cranial Nerves and Epilepsy Flashcards

1
Q

Describe the basic principles of cranial nerves

A
  • 12 paired nerves arising from the brain
  • Connect brain to various parts of head, neck and trunk
  • Sensory, motor and parasympathetic function
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2
Q

Where do the cranial nerves arise from specifically in the brain?

A
  • CNI and CNII from the cerebrum

- CNIII to CNXII originate from brain stem

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3
Q

Where does CNI exit the skull?

A

Cribriform plate

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4
Q

Where does CNII exit the skull?

A

Optic canal

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5
Q

Where does CNIII exit the skull?

A

Superior orbital fissure

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6
Q

Where does CNIV exit the skull?

A

Superior orbital fissure

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7
Q

Where does CNV (1) exit the skull?

A

Superior orbital fissure

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8
Q

Where does CNV (2) exit the skull?

A

Foramen rotundum

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9
Q

Where does CNV (3) exit the skull?

A

Foramen ovale

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10
Q

Where does CNVI exit the skull?

A

Superior orbital fissure

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11
Q

Where does CNVII exit the skull?

A

Internal acoustic meatus

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12
Q

Where does CNVIII exit the skull?

A

Internal acoustic meatus

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13
Q

Where does CNIX exit the skull?

A

Jugular foramen

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14
Q

Where does CNX exit the skull?

A

Jugular foramen

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15
Q

Where does CNXI exit the skull?

A

Jugular foramen

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16
Q

Where does CNXII exit the skull?

A

Hypoglossal canal

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17
Q

Describe CNI

A
  • Olfactory nerve
  • Provides visceral afferent fibres for smell
  • Connects to brain (not brainstem)
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18
Q

Describe disorders of CNI

A
  • Altered / loss of sense of smell
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19
Q

Describe CNII

A
  • Optic nerve
  • Provides somatic afferent fibres for vision
  • Connects to brain (not brainstem)
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20
Q

Describe disorders of CNII

A

Optic field defects (pattern of defect determines position of lesion)

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21
Q

Describe CNIII

A
  • Oculomotor
  • Innervates extrinsic eye muscles than enables movements of the eye, raise the eyelid and constrict pupil
  • Connects to midbrain
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22
Q

Describe 3 ways in which deficits of CNIII appear clinically

A
  1. Ptosis (drooping of upper eyelid)
  2. Mydriasis (pupil dilated)
  3. Down and Out (position of the eye)
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23
Q

Describe CNIV

A
  • Trochlear
  • Provides general somatic efferent to extraocular superior oblique muscle
  • Assists in depressing and abducting the eye
  • Connects to midbrain
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24
Q

Describe the deficit of CNIV

A
  • Inferior oblique taken over so eye sits higher and mesially
  • Patient often tilts head to combat double vision
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25
Q

Describe CNV

A
  • Trigeminal
  • Emerges from the pons with 3 divisions
  • Mixed nerve with sensory and motor function
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26
Q

Name 3 divisions of the trigeminal nerve

A
  1. Ophthalmic
  2. Maxillary
  3. Mandibular
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27
Q

Describe 5 sensory functions of the ophthalmic nerve

A
  1. Cornea
  2. Skin of forehead
  3. Scalp
  4. Eyelids
  5. Mucous membranes of paranasal sinuses and nasal cavity
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28
Q

Describe 3 sensory functions of the maxillary nerve

A
  1. Skin over maxilla
  2. Upper teeth
  3. Mucous membrane of nose, maxillary sinus and palate
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29
Q

Describe the pathway of the maxillary nerve with regards to LA

A
  • Enters infraorbital canal and exits through infraorbital foramen
  • Gives of palatine nerves which can be blocked with anaesthetic
  • Posterior and anterior superior alveolar nerves supply upper teeth
30
Q

Describe 5 motor functions of the mandibular nerve

A
  1. Muscles of mastication
  2. Mylohyoid
  3. Anterior belly of digastric
  4. Tensor veli palatine
  5. Tensor tympani
31
Q

Describe 5 sensory functions of the mandibular nerve

A
  1. Skin of cheek
  2. Skin over mandible and side of head
  3. Teeth of lower jaw and TMJ
  4. Anterior 2/3 of the tongue
  5. Mucous membrane of lower jaw
32
Q

Describe the important branches of the mandibular nerve

A
  • Splits into posterior and anterior division
  • Anterior gives of buccal nerve which provides sensation to buccal mucosa
  • Posterior division gives off lingual and inferior alveolar nerve
  • Inferior alveolar nerve terminates in mental and incisive nerves
33
Q

Describe sensory trigeminal neuropathy

A
  • Progressive, painless loss of trigeminal sensation
  • Normally unilateral
  • May affect one or all trigeminal division
  • No motor weakness
34
Q

Name a common syndrome associated with sensory trigeminal neuropathy

A

Numb chin syndrome

35
Q

Describe numb chin syndrome

A
  • Sensory neuropathy presenting in numbness of chin

- Important symptom of metastatic disease (multiple reasons)

36
Q

Describe trigeminal neuralgia

A
  • Vascular compression of CNV
  • Episodic neuropathic pain
  • F>M
  • 45 to 59 years old
  • Related to pathology of idiopathic damage
37
Q

Describe CNV

A
  • Abducens
  • Provides somatic efferent fibres for eye abduction
  • Innervated lateral rectus muscle
38
Q

Describe CN VII

A
  • Facial nerve

- Mixed nerve with motor and sensory function

39
Q

Describe 4 motor functions of CN VII

A
  1. Muscles of facial expression
  2. Strapedius
  3. Posterior belly of digastric
  4. Stylohyoid
40
Q

Name 5 branches of CN VII

A
  1. Temporal
  2. Zygomatic
  3. Buccal
  4. Mandibular
  5. Cervical
41
Q

Name 4 common facial nerve palsys

A
  1. Bell’s palsy
  2. Tumour
  3. Ramsay Hunt Syndrome
  4. Frey Syndrome
42
Q

Describe Bell’s syndrome

A
  • Drooping of eye, mouth and nasolabial fold
  • Suspected viral irritation of CN VII
  • High dose steroid management
43
Q

Describe a facial nerve palsy caused by tumours

A
  • When a tumour is either compressing facial nerve or invading nerve it may cause weakness
  • Acoustic or facial neruoma in region of parotid gland are common
  • May be accompanied by other symptoms
43
Q

What is the best way to differentiate an UMNL and a LMNL?

A
  • Frontalis muscle is spared in UMNL

- If patient can wrinkle their forehead, UMNL, and if they cannot, LMNL

44
Q

What is Ramsay Hunt syndrome?

A
  • Reactivation of latent herpes zoster virus within vesicles within auditory canal
  • Otalgia and varying levels of hearing loss occur
  • Management with course of antivirals
45
Q

Describe Frey Syndrome

A
  • Most often occurs as a result of surgery in area of parotid gland
  • Undesirable sweating and flushing after eating certain food
  • Damage to sympathetic and parasympathetic nerves
46
Q

Describe CN VIII

A
  • Vestibulocochlear

- Provides special somatic afferent fibres for hearing and balance

47
Q

Describe CN IX

A
  • Glossopharyngeal nerve

- Mixed nerve with motor, sensory and secretomotor functions

48
Q

Describe the 5 sensory functions of CN IX

A
  1. Tonsils
  2. Soft palate
  3. Pharynx
  4. Middle ear
  5. Posterior 1/3 of tongue
49
Q

Describe the motor function of CN IX

A

Innervated stylopharyngeal muscle

50
Q

Describe the secretomotor functions of CN IX

A

Parasympathetic to parotid gland

51
Q

Describe CN X

A
  • Vagus nerve

- Parasympathetic innervation of viscera

52
Q

Describe CN XI

A
  • Accessory nerve
  • Reference to spinal part of nerve
  • Motor control to trapezius and sternocleidomastoid muscles
53
Q

Describe CN XII

A
  • Hypoglossal

- Innervates muscles of tongue except palatoglossal

54
Q

Describe hypoglossal palsy

A
  • Rare in isolation
  • Deviation and fasciculation to affected side
  • Can be idiopathic, medical, trauma or metastatic disease
55
Q

What is epilepsy?

A

A chronic disorder which causes unprovoked and recurrent seizures

56
Q

Describe what is necessary for an epilepsy diagnosis

A

a) Over 2 unprovoked seizures more than 24 hours apart

b) A single unprovoked seizure with 60% change of having another within 10 years

57
Q

Describe seizure aetiology

A
  • Idiopathic
  • Trauma
  • CNS disease (tumour, stroke, CVD)
  • Infection (meningitis, malaria)
  • Hyperthermia
58
Q

Name 5 possible triggers for a seizure

A
  1. Lack of sleep
  2. Illness / Stress
  3. Bright lights
  4. Caffeine, alcohol or medicine
  5. Menstruation
59
Q

What is the difference between focal and generalized seizures?

A

Focal seizures occur in one hemisphere of the brain and generalized occur in both simultaneously

60
Q

Describe the main symptoms of a sensory focal stroke

A

Disturbances in vision, hearing, taste and smell

61
Q

Describe the main symptoms of a motor focal seizure

A

Reduction in motion in one limb but can spread

62
Q

Describe a febrile seizure

A
  • Related to infection and higher temperature
  • Occurs in children between 6 months and 3 years
  • May occur in subsequent illness
  • Slight increase in risk of developing epilepsy
63
Q

Describe a tonic clonic seizure

A
  • Prodromal aura
  • Loss of consciousness
  • Initial tonic (stiff) then clonic (relaxation / contraction)
  • Seen in stratus epilepticus
64
Q

What is stratus epilepticus?

A

Seizures with no gain of consciousness in between or a single seizure lasting over 30 minutes

65
Q

Describe a generalized absence seizure

A
  • Much harder to spot than tonic clonic
  • Sudden stop in motion without falling
  • Chewing movements
  • Cognitive problems
  • Stopping speech midway
66
Q

Name 4 complications of epilepsy

A
  1. Injury
  2. Drug reactions
  3. Death (asphyxiation / aspiration)
  4. Social (driving / employment)
67
Q

Describe 4 ways a dentist should assess the risk of an epileptic fit occurring in the practice

A
  1. Up to date medical history
  2. Up to date social history
  3. Pattern of fits
  4. Treat during low risk phase
68
Q

Describe 4 complications of epilepsy related to dentistry

A
  1. Injury
  2. Gingival hyperplasia with phenytoin
  3. Bleeding tendency with valproate
  4. Drug interactions
69
Q

Describe the management of a patient who suffers a seizure in a dental surgery

A
  • Safe surrounding and shout for help
  • ABC (airway, breathing and circulation)
  • Time the seizure
  • Buccal midazolam 10mg if status epilepticus
  • Do not move or restrain patient
  • Ring 999
70
Q

Describe post-ictal management of a patient

A
  • Place in recovery position
  • Do not allow patient to leave until sure they have made a full recovery and contact family if they are alone
  • Do brief examination for sustained injuries but do not carry out further treatment

Systemic Disease in Dentistry (22 decks)

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