Neurologic Disorders Flashcards
epilepsy
disorder of brain characterized by predisposition to epileptic seizures
epilepsy is what type of condition
- heterogenous condition
* multiple seizure types and syns, diverse etiologies, variable prognoses
etiology of seizures
- genetic
- structural (i.e. tumor)
- metabolic
- immune
- infectious
- unknown (i.e. at end of syncopy, ppl can seize)
what is a big component of pts having seizures?
alcohol withdrawal
what are the 3 ways to classify seizure disorders
- focal seizures with retained awareness
- focal seizures with impaired awareness
- generalized seizures
what may pts with focal seizures with retained awareness experience?
an aura
clinical presentation of focal seizures with retained awareness if occipital cortex is affected?
flashing lights
clinical presentation of focal seizures with retained awareness if motor cortex is affected?
rhythmic jerking on body opposite affected side
clinical presentation of focal seizures with retained awareness if parietal lobe is affected?
distortion of spatial perception
clinical presentation of focal seizures with retained awareness if frontal lobe is affected?
sudden speech difficulties
postical state with focal seizures with retained awareness
- may return to pre-event baseline
- may experience worsened neurologic fxn for a period of time
what is the most common type of seizures in adults with epilepsy?
focal seizures with impaired awareness
T/F: pts who are having a focal seizure with impaired awareness appear to be asleep
false, they appear to be awake
*eyes are open
clinical presentation of person having a focal seizure with impaired awareness
- does not interact with others in their environment
- does not respond normally to instructions/questions
how long does a focal seizure with impaired awareness last?
<3 minutes
postical state with focal seizures with impaired awareness
- somnolence (state of strong desire to sleep)
- confusion
- headache
which hemisphere does generalized seizures affect?
both hemispheres
what is the most common type of generalized seizures?
generalized tonic-clonic
characteristic of generalized seizure
abrupt loss of consciousness
how many phases are there in a generalized seizure?
3
what are the 3 phases of a generalized seizure?
- tonic
- clonic
- postictal
tonic phase of generalized seizure
muscle stiffness
how long does the tonic phase of a generalized seizure last?
~1 min
clonic phase of generalized seizure
muscles jerk and twitch
how long does the clonic phase of generalized seizure last?
~2 mins
postictal phase of generalized seizure
- initial deep sleep followed by gradual awakening
- confusion and/or agitation
syms of aura phase in tonic-clonic seizure
- light-headedness
- dizziness
- confusion
- hallucinations
- some pts say they can smell certain things
syms of tonic phase in tonic-clonic seizure
- skeletal mm. tense uo
- usually lose consciousness
syms of clonic phase in tonic-clonic seizure
- jerky movements
- convulsions
- violent shaking
- uncontrollable twitching/rolling
- sometimes breathing stops
syms of postical phase in tonic-clonic seizure
- confusion
- amnesia
- nausea upon regaining consciousness
med management of seizure disorders
- long-term drug therapy
- reduce frequency over lifetime
- slow increase in dose to avoid adverse side effects
what are the first-line agents for pts with seizure disorders?
- phenytoin
- carbamazepine
- valproic acid
what percent of pts gain control of seizure disorder within 5 yrs?
60-80%
status epilepticus
repeated seizures over short period of time without a recovery period
status epilepticus can cause the brain to be what?
gravely hypoxic and acidotic
*may lead to extensive brain injury and possible death
status epilepticus is usually observed in what type of pts?
more frequently observes in pts who have abrupt withdrawal from anticonvulsant med or abused drug
is routine dental care indicated for pts with controlled seizure disorders?
ye,s can do surgery and any elective dental care
should pts with seizure disorders discontinue taking their anticonvulsant meds before their appt?
no
dental mods for pts with controlled seizure disorders
good stress/pain control
what should you do if the pt in your chair is having a seizure?
- stop procedure and remove everything from mouth
- passively support pt to prevent injury
- should have return of consciousness within few minutes
- escort home
should you hold down a pt who is having a seizure in your chair?
no, don’t try to hold pt down
why should you check a pt’s blood sugar after they have a seizure?
low blood sugar can induce seizure
should you send the pt who was having a seizure in your chair to the ER?
no
stroke
sudden interruption of oxygenated blood to brain
what determines the morbidity/mortality of stroke pts?
- length and severity of ischemia
- amount of brain that has necroses
T/F: having a stroke is not fatal
false, can be
a stroke can debilitate what?
- motor
- speech
- cognition
additive risk factors for developing a stroke
- history of stroke or transient ischemic attack (TIA)
- age >75 yrs
- smoking
- hypertension
- coronary atherosclerosis
- congestive HF
- diabetes mellitus
- hyperchlesterolemia
what are the 2 types of stroke?
- ischemic
- hemorrhagic
what percent of stokes are ischemic?
60-80%
what can lead to someone having an ischemic stroke?
- atherosclerosis
- emboli
- hypotension
ischemic stroke
clot stops blood supply to area of brain
hemorrhagic stroke
bleeding into brain from ruptured vessel
what can cause microaneurysms?
hypertension
transient ischemic attack (TIA)
*mini stroke
transient episode of neurologic dysfunction caused by focal ischemia without acute infarction
T/F: TIA can cause permanent injury
true
T/F: TIA is considered a neurologic emergency
true
why is TIA a bad sign?
something pending is about to happen… i.e. MI or bigger stroke
if pts syms resolve before medics arrive, do pts still need to go to the ED?
yes, need to be evaluated (i.e. determine what type of stroke it was)
outcomes of cerebrovascular accident (CVA) aka another name for stroke
- death
- disability
what percent of CVA deaths are hemorrhagic?
38-47%
what percent of CVA deaths are ischemic?
8%
disability due to CVA depends on what?
size and location of injury
T/F: return of fxn of CVA pts are predictable
false, return of fxn is unpredictable and slow
med management of individuals at risk for CVA
- reduce/eliminate risk factors
- drug therapy
drug therapy for individuals at risk for CVA
- antihypertensive drugs
- antiplatelet drugs
- statis
acute med management of CVA
- sustain life immediately after stroke
- emergency effort to prevent further thrombosis or hemorrhage or to lyse the clot
- rehabilitation and prevention of future events
T/F: once pts have stoke, they’re always going to be at risk for having another stroke
true
individuals with history of CVA/TIA are at an elevated risk for stroke for how long after the event
6 months
during the first 6 months after a pt has a stroke, can they have invasive dental work done?
no, just preventative like prophys
T/F: pts with recent TIA are considered unstable
true
should you txt pts who has a recent TIA?
no, no elective care
dental management of individuals with history of CVA/TIA
- timing important
- stress reduction
analgesia for individuals with history of CVA/TIA
Tylenol
why can’t individuals with history of CVA/TIA take NSAIDs?
pt on anti-platelet drugs after stroke so can affect platelets
should you give a pt Aspirin when they’re having a stroke?
NO, don’t know what type of stroke they’re having
what will happen if you give Aspirin to a a pt who is having a hemorrhagic stroke?
will thin them out even more
