Neruological Pathology Flashcards
What is Bell’s palsy?
The most common cause of facial nerve paralysis
What is the pathogenesis for Bell’s palsy?
Latent herpes virus is reactivated
Inflammation of the nerve
What is the difference between LMN and UMN facial palsy?
LMN weakness - whole side of face
UMN weakness - spares forehead muscles, due to stroke or cerebral tumour
What are some other causes of LMN facial palsy?
Tumours
Ear infections
Ramsay hunt syndrome
Melkerssons syndrome
What are clinical features of Bell’s palsy?
Ear pain
Facial weakness and stiffness
Altered taste
Distortion of sound
What is the treatment for Bell’s palsy?
Recover by yourself in 1-2 months
Prednisolone and acyclovir prevent
What is the dental relevance of Bell’s palsy?
Parotid tumour facial palsy
Misdirected ID block facial palsy
What is trigeminal neuralgia?
Sudden stabbing recurrent pain in trigeminal nerve
30 seconds
No facial weakness or sensory
Electric shock pain
What causes trigeminal neuralgia?
Random action potentials from light touch
Blood vessels compressed trigeminal nerve
Secondary to MS, brain lesion
What are the clinical features of trigeminal neuralgia?
Spasms of facial pain
Radiates from corner of mouth to ear
Light touch, chewing, shaving, cold wind
Hundreds of times a day
What is the dental relevance of trigeminal neuralgia?
Confused with dental pain
Bupivacaine block gives relief
What is the treatment for trigeminal neuralgia?
Carbamazepine - controls pain
Cryotherapy
Open cranial surgery
What is a stroke?
Sudden neurological disturbance due to blockage or rupture of brain blood vessel
Lasts longer that 24 hours
What are the different incidences of a stroke?
Minor stroke - full recovery in less than a week
Stroke in evolution - worsening symptoms
Completed stroke - neuro defecit at its worst
What are the 3 main types of stroke?
Ischaemic
Haemorrhagic
Subarachnoid haemorrhage
What is an ischaemic stroke?
Blockage of brain stem by embolus from atheroma
What can an ischaemic stroke result in?
Horners syndrome
Pseudobulbar palsy
What is the treatment of an ischaemic stroke?
Aspirin 150mg daily
Surgery for carotid artery
What is a haemorrhagic stroke?
Intracerebral bleed
Less common
Visible on CT scan
Who is at risk of a haemorrhagic stroke?
Hypertensives
Coagulation disorders
Genetic
What is a subarachnoid haemorrhage?
Rupture of blood vessel into cerebrospinal fluid in subarachnoid space
Circle of Willis berry aneurysm
What are signs and symptoms of a subarachnoid haemorrhage?
Severe headache
Pain on knee extension
Unconscious
What is the treatment for subarachnoid haemorrhage?
Neuro surgery
What are the main risk factors for a stroke?
Atheroma
Diabetes
Smoking alcohol
High RBC
What are the telling symptoms for a stroke?
Starts with a bad headache no cause
Numbness of face arm leg
Confusion
Slurred speech
Nausea = haemorrhagic
What is the dental relevance of a stroke?
Anti platelet medication
Weakness of facial area
Swallowing
Communication
Mobility
What is epilepsy?
CNS disorder with seizures
What are the 2 types of seizures in epilepsy?
Generalised (whole brain):
Tonic-clinic
Absence - children
Myoclonic- jerks of limbs
Focal:
Simple - consciousness okay
Complex - brain
From tumours, infarction
What is the treatment for epilepsy?
Anti epileptic drugs
IV, epistatus for prolonged seizure
What is the dental relevance of epilepsy?
Xerostomia
Delayed healing
Risk of infection
Excessive bleeding
Gingival hypertrophic
How do you manage an epileptic emergency?
Protect airway
Examine for dental trauma
Do not treat
Escort home
What is dementia?
Deterioration of memory
No disturbance of consciousness
What is the cause of dementia?
Alzheimer’s
Neurofibrillary tangles and plaques in brain
What drugs can be used to treat dementia?
Anticholinesterases
Anticonvulsants
When is dementia reversible?
Tumour
Intracranial lesions
Depression
B12, folate, thyroxine deficiency
What is Parkinson’s?
Idiopathic disorder
Resting tremor
Rigidity
What is the pathology of Parkinson’s?
Degeneration of basal ganglia
Loss of dopamine
Levy bodies
What can cause Parkinson’s?
Drugs alcohol
Stroke
Trauma
Ptsd
What are the treatments for Parkinson’s?
Dopamine agonists
Amanda dine
Anticholinergics - tremor
What is the dental relevance of Parkinson’s?
Do not interrupt medication
Difficulty swallowing
Aspiration
What is multiple sclerosis?
Causes attacks of neurological disturbance
Demyelination in CNS
Not periphery
What are the clinical features of MS?
Loss of vision
Spinal cord lesions
Brain stem lesions
Pins and needles
What are the 3 types of MS?
Relapsing remitting - attack and full recovery
Primary progressive - gradual decline in function
Secondary progressive - one episode, remission, reoccurance
What is the treatment for MS?
IV oral steroids
ACTH
Muscle relaxants
Anticholinergics
What is the dental relevance of MS?
Avoid NSAIDs
Increased risk of infection
Wat are the 2 types of head injury?
Extradural - blood between skull and dura mater, defined margin on CT
Subdural- blood between dural and arachnoid layer of meninges, CT widespread irregular margin
