Neurologic Disease (Desai) Flashcards
Why do we care about a patient’s systemic diagnoses when planning our dental treatment?
So we can give safe, modified treatment
What are 2 major types of Epilepsy?
- Epileptic syndromes
2. Seizure types
What are the 2 main types of Epilepsy seizure types?
- Partial
2. Generalized
Of the epilepsy seizure types, which one involves a problem with the entire cerebral cortex?
Generalized
Does a “simple” seizure involve a loss of consciousness?
No, complex seizures involve loss of consciousness
What is the cause of epilepsy?
Abnormal spontaneous electrical activity in the brain
Is epilepsy a one-time thing?
No. It is chronic, recurrent, paroxysmal (sudden, violent)
What are the general changes experienced in epilepsy?
- Altered neurologic function
- Altered consciousness
- Involuntary movement
What is a spontaneous uncontrollable excessive discharge of cerebral neurons that depolarize in a synchronized fashion and may result in an abrupt suspension of motor, sensory, behavioral, or body function?
Seizure
What is a physical sign of seizure activity?
Convulsion
What is the term for 3 or more recurrent seizures?
Epilepsy
What is the major etiology for greater than 50% of epilepsy?
Idiopathic
What are 6 known factors leading to epilepsy?
- Vascular abnormality
- Intracranial neoplasm
- Head trauma
- Hypoglycemia
- Drug withdrawal
- Infection or febrile (fever) illness
Grand Mal seizures are what type of seizures: partial/generalized, absence or convulsive?
Generalized tonic-clonic convulsion
What is the term for a momentary sensory alteration that produces an unusual smell or visual disturbance”, preceding convulsion?
Aura
What follows aura, caused by a spasm of diaphragmatic muscles?
Epileptic cry
What is the phase of grand mal seizure having muscle rigidity, dilated pupils, eyes roll upward or to the side, unconscious?
Tonic phase
What is the hase of grand mal seizure having uncoordinated movement, jaw clenching, head rocking, urinary incontinence?
Clonic phase
How long does the ictus (seizure) last?
Approximately 90 secs to a few minutes, then pt gradually regains consciousness being in a stupor, with a headache, confusion, and mental dullness
What other diagnostic tool besides history of seizures is used to diagnose epilepsy?
Electroencephalogram
What are the neurons doing in a seizure?
Firing all at the same time
What is key before treating a patient with epilepsy?
Determining nature, severity, control and stability of the disease
Do well-controlled seizure disorders pose any specific management problems?
No
During a seizure, should any restraint be placed on the patient?
Only passive restraint to keep the patient and others safe
Into what position should you attempt to place a seizing patient and why?
On the side to avoid aspiration
Should the operator attempt to use a padded tongue blade while the patient is seizing?
No
What should be done first after the patient stops seizing?
Examine for traumatic injuries
Should treatment be continued if the patient has a seizure?
No. Arrange for patient transport.
What position is best for the dental chair while the patient is seizing?
Supine with headrest supported by operator chair
What is the term for repeated seizures over a short period of time WITHOUT a recovery period (considered a medical emergency)?
Status epilepticus
What is the most frequent cause of status epileptics?
Abrupt withdrawal of anticonvulsant medication or an abused medication
What are three “other” causes of status epileptics (other than withdrawal from anticonvulsant medication or an abused medication)?
- Infection
- Neoplasm
- Trauma
What is the risk associated with status epileptics?
The patient becomes hypoxic or acidotic leading to brain damage or death
What are 6 things to do in an epileptic emergency?
- Airway
- Breathing
- Circulation
- Oxygen
- Monitor
- IV Line
What are 2 drugs that can be given IV to break Status Epilepticus?
- Lorazepam (ativan)
2. Diazepam (valium)
Of the benzodiazepines, Lorazepam or Diazepam, which is preferred because it is “more efficacious and lasts longer”?
Lorazepam
What is a side effect for anti-seizure medication (dilantin / phenytoin)?
Gingival hyperplasia
What is a serious and potentially fatal neurologic event caused by a sudden interruption of oxygenated blood to the brain caused by a cerebral vessel blockage or vessel rupture that results in a portion of the brain undergoing infarction, being deprived of oxygen and nutrients?
Cerebrovascular Accident (CVA)
Symptoms of a stroke depend on what?
The area of the brain affected
What are 8 risk factors for a cerebrovascular accident (CVA)?
- Hypertension
- Congestive heart failure
- Diabetes Mellitus Type I
- History of TIAs or CVAs
- More than 75 years old
- Hypercholesterolemia
- Coronary atherosclerosis
- Smoking
If the patient has a TIA in the chair, should they be free to go?
No. Get them to the hospital as they risk another TIA or full stroke.
What is the number one risk factor for stroke?
Hypertension
What are 4 events associated with stroke?
- Transient Ischemic Attack
- Reversible Ischemic Neurologic Deficit (RIND)
- Stroke-in-Evolution
- Completed Stroke
What is the term for a “mini stroke” consisting of a brief (less than 10 minutes) period of focal neurologic deficit that is rapid in onset, but resolves without permanent neurologic damage?
Transient Ischemic Attack (TIA)