Neurological disease

Question 1

multiple sclerosis caused by what?

Answer 1

demyelination of nerve axons to the brain due to inflammatory change

Question 2

what is the trigger for multiple sclerosis?

Answer 2

Unknown but seems to be genetic but may be an infective or other environmental factor

Question 3

multiple sclerosis results in?

Answer 3

loss of function of any body part where nerves are involved from cognitive to motor to sensory to autonomic function

Question 4

Question 5

investigations for multiples sclerosis

History & examination

MRI

CSF analysis
- Reduced ?
- Increased ? protein

Visual evoked potentials
- Reduced electrical activity of the visual pathways

Answer 5

lymphocytes
IgG

Question 6

outcome of multiple sclerosis

? with no effective treatment

Gradual ? - steroid treatment

? management

Answer 6

incurable

decline

symptomatic

Question 7

dental aspects of multiple sclerosis

Answer 7

limited mobility and psychological disorder

trigeminal neuralgia risk

refer pt with sudden unexplained loss of motor or sensory function

Question 8

what is motor neurone disease?

Answer 8

Degeneration of the motor nerves in the corticospinal tracts/anterior horns in the spinal cord

it can also affect the motor nuclei in the brainstem called the bulb -> bulbar motor nuclei in the cranial nerves

Question 9

is there progress into the cause and management of motor neurone disease?

Answer 9

no

Question 10

what is the outcome of motor neurone disease?

Answer 10

Progressive loss of function (ventilation, swallowing, facial expression)

Death due to
- ventilation failure -> type 2 respiratory failure
- Aspiration pneumonia -> Unable to keep material out of the lungs when eating as cough and swallowing is affected

Question 11

what is the treatment for motor neurone disease?

Answer 11

None effective

Physiotherapy and occupational therapy to maintain function for as long as possible

Riluzole

Aspiration prevention -> PEG tube feed, reduce salivation

Question 12

what are the dental aspects of motor neurone disease

Answer 12

Difficulty accepting dental care -> muscle weakness of head and kneck

Realistic treatment planning -> short life expectancy

Drooling and swallowing difficulties

Question 13

what is Parkinson’s disease caused by?

Answer 13

lack of neural transmitter dopamine in the substantia nigra (basal ganglia) of the brain

Question 14

parkinson’s disease is due to a lack of neural transmitter ? in the ?? (basal ganglia) of the brain

Shortage of dopamine in the basal ganglia results in difficulty passing ? in the cortex (thinking part of the brain) to the cerebellum and brainstem (doing part of brain) which carry out many of the instructions from the cortex. This can lead to ? in the patient ? or ? things

Answer 14

dopamine
substantia nigra

messages
delays
doing
understanding

Question 15

what is the underlying cause of parkinson’s disease?

Answer 15

unclear

Question 16

name 3 clinical features of parkinson’s disease

Answer 16

Bradykinesia -> slow movement and initiation of movement

Rigidity -> increased muscle tone so stiffer to bend down etc.

Tremor at rest often in hands and mandible

Question 17

what are the manifestations of parkinson’s disease? 4

Answer 17

Unsteady walking -> falls

Impaired use of limbs

Lack of facial expression

Swallowing problems

Question 18

what is the medical treatment for parkinson’s?

Answer 18

dopaminergic drugs -> dopamine direct replacement and agonist

Question 19

what is the purpose of physical and occupational therapy in parkinson’s disease?

Answer 19

to maintain function at as high a level for as long as possible

Question 20

what surgical procedures are used to treat parkinson’s?

Answer 20

Stereotactic surgery -> using 3D techniques to locate electrodes in part of the brain, this deep brain stimulation can help some patients return to more normal function so the medicine dose required is lower

Stem cell transplant to produce dopamine into the substantia nigra. But it is not yet a major therapy for Parkinson’s

Question 21

what is a dental affect of parkinson’s?

Answer 21

dry mouth due to anticholinergic drugs

Question 22

what is a stroke?

Answer 22

is acute focal neurological deficit resulting from cerebrovascular disease and lasting more than 24hrs or causing earlier death

It is death of brain tissue from hypoxia (Blockage of blood delivery to tissues -> no cerebral blood flow)

Question 23

what are the 2 causes of stroke?

Answer 23

infarction of tissue - > blockage of artery due to thrombus or embolus

Haemorrhage into the brain tissue -> Bleeding into the brain tissue can occur causing pressure effects and stop blood flow to areas of the brain and cause damage

Question 24

what acryonym is used to to tell people the signs of a stroke?

Answer 24

FAST

facial drooping
arm weakness
speach difficulty
time

Question 25

what are the 2 types of stroke?

Answer 25

ischaemic stroke haemorrhaging stroke

Question 26

define ischaemic?

Answer 26

inadequate blood flow to an organ or part of the body

Question 27

what is a transient ischaemic attack?

Answer 27

rapid loss of function then a rapid recovery of function so patient recovered all neurological functions which were lost in 24hrs.

Question 28

what causes transient ischaemic attacks?

Answer 28

platelet emboli vessels in the neck that block the blood flow to the brain tissue (ischaemia) but then are rapidly removed so blood flow is restored before permanent damage has occurred

Question 29

transient ischaemic attacks suggest a problem with the ?? and the patient is at higher risk of ? in the future.

Answer 29

blood vessels stroke

Question 30

what are the risks for stroke?

Answer 30

Hypertension (130/80) Smoking Alcohol Ischaemic heart disease

Question 31

Causes of stroke Unclear why ischaemic stroked happen Most of the time it will be due what? 3

Answer 31

narrowing of the vessels, plaques forming ischaemia - inadequate blood flow

Question 32

causes of stroke Haemorrhagic strokes can happen as a result of what? 3

Answer 32

Intracranial brain bleed -> usually an aneurism of a small blood vessel which eventually fails Embolic stroke can happen from changes in the left side of the heart such as atrial fibrillation Atheroma of the cerebral vessels can lead to changes in particular to TIA but sometimes to full strokes (degeneration of vessel walls and fatty deposit collects)

Question 33

less common causes of stroke Venous thrombosis - oral contraception, polycythaemia (high haemoglobin level), thrombophilia (blood clot tendency) Borderzone infarction - Cardiac event that has damaged the brain -> severe hypertension, cardiac arrest Vasculitis - Narrow the blood vessels into the brain causing limitation of oxygen delivery -> stroke

Question 34

how is stroke prevented?

Answer 34

reduce risk factors anticoagulants antiplatelets surgery

Question 35

Investigation of stroke Treatment needs to happen as quick as possible to minimise the amount of tissue lost Depends on what kind of stroke -> Infarction, bleed, subarachnoid haemorrhage Imaging - CT scan (not good for ischaemic strokes) - MRI scan -> MR angiography is the best investigation for visualising brain circulation - Digital subtraction angiography -> if MRA not available Assess risk factors - Carotid ultrasounds -> look for atherosclerosis in carotid artery - Cardiac ultrasound -> see if there's a thrombus forming in the left ventricle - ECG -> arrhythmias, atrial fibrillation - Blood pressure -> hypertension - Diabetes screen -> controlled? - Thrombophilia screen -> patients have higher tendency to form clots than normal

Question 36

what are the effects of stroke?

Answer 36

loss of functional brain tissue loss of function - motor, sensory cognitive (speech, language, memory)

Question 37

what are the 2 phases in stroke management?

Answer 37

acute and chronic

Question 38

what is the general acute management for stroke? 2

Answer 38

limit the damage limit future risk

Question 39

how is damage limited in the acute management of stroke?

Answer 39

Reduce the penumbra regions damage - Calcium channel blockers and other medicines Improve blood flow Control glucose levels as brain is solely dependant on glucose for its energy stores Remove haematoma -> subarachnoid haemorrhages only

Question 40

how is future risk limited in acute management of stroke?

Answer 40

Aspirin Anticoagulant (if history of atrial fibrillation or left ventricular thrombus)

Question 41

what does the chronic management of stroke involve generally?

Answer 41

rehabilitation reduce future risk

Question 42

what does rehabilitation involve in the chronic management of stroke?

Answer 42

Immobility support Speech and language therapy - Communication, swallowing, eating Occupational therapy

Question 43

Dental aspects of stroke Impaired mobility -> attendance and OH Communication difficulties Risk of ? emergencies - ? and further stroke Loss of protective reflexes - ? and managing saliva (? drugs can decrease secretions) Loss of sensory information - Difficulty adapting to new oral environment e.g. ? Stroke pain CNS generated pain perception

Answer 43

cardiac MI aspiration anticholinergic dentures

Question 44

Epilepsy is a group of conditions that happen due to what? Reduced ? level -> abnormal cell-cell message ? -> ? stimulation for the neurone to fire

Answer 44

abnormal discharge of neurones within the brain GABA proprogation less

Question 45

how do febrile seizures differ from epilepsy?

Answer 45

same symptoms as epilepsy but only happens in children when they have a fever >38*c

Question 46

what is the management of febrile seizures?

Answer 46

reducing fever using antipyretic medication e.g. paracetemol, ibuprofen

Question 47

what are the 2 classifications of epilepsy?

Answer 47

generalised seizure partial seizure

Question 48

how does a generalised seizure work?

Answer 48

central focus which spreads the signal out to all parts of the cortex meaning that all parts of the body are involved in the seizure

Question 49

are tonic clonic seizures generalised or partial?

Answer 49

generalised

Question 50

what is the main symptoms of a tonic clonic generalised seizure?

Answer 50

pt becomes tonic - all muscles contract then clonic - muscles relax this repeats for 1-2 minutes post-ictal drowsiness follows

Question 51

what is status epilepticus

Answer 51

after going tonic then clinic then having post-ictal drowsiness the whole process happens again -> another tonic/clonic seizure

Question 52

what medical problem is associated with tonic/clonic generalised seizure?

Answer 52

asphyxia no normal breathing occurs ◊ Supplemental oxygen using a Guedel airway and suction secretions

Question 53

absence seizures are generalised or partial seizures?

Answer 53

generalised seizure

Question 54

absence seizures are more common in what people?

Answer 54

children

Question 55

what are absence seizures commonly mistaken for?

Answer 55

daydreaming

Question 56

what happens to an ECG during a generalised seizure?

Answer 56

Electrical changes become larger and have a more erratic pattern at different parts of the brain

Question 57

how does a partial seizure work?

Answer 57

focus is closer to one part of the cortex which will primarily be the area that is affected by the seizure

Question 58

what is a jacksonian seizure?

Answer 58

motor region of the brain is affected so patient will start with a small tremor which will spread

Question 59

what is a complex partial seizure?

Answer 59

different areas of the brain are affected which produce connected movement

Question 60

epilepsy triggers? 4

Answer 60

Idiopathic -> mostly unknown Trauma -> head injury Degenerative CNS disease -> tumour, stroke, meningitis Environmental -> late nights, alcohol, hypoglycaemia, flashing lights

Question 61

what is the preventative treatment for epilepsy?

Answer 61

Anticonvulsant drugs (tonic-clonic = gabapentin) (absence = levitiracetum)

Question 62

what is the emergency management of epilepsy?

Answer 62

Supportive if unconscious -> airway and oxygen Status epilepticus requires benzodiazepines

Question 63

Epilepsy drugs Most drugs work on ?? (valproate, benzodiazepines) Recently developed medicines work on ?? (carbamazepine, phenytoin) Can be used in combination

Answer 63

GABA receptors sodium channels

Question 64

what is the surgery for epilepsy?

Answer 64

Removal of focal neurological lesions

Question 65

what are the dental complications of epileptic fits? 2

Answer 65

soft tissue injury dental injury

Question 66

what are the complications of epilepsy treatment? 3

Answer 66

Gingival hyperplasia (drug phenytoin) Bleeding tendency (drug valproate) Folate deficiency (Rare)

Question 67

how is the risk of an epileptic fit assessed?

Answer 67

Type of seizure Treatment and compliance and changes in medication When did the last 3 seizures take place (tells likelihood of seizure that day)

Question 68

remember Dental aspects of epilepsy Complications of fits -> soft tissue injury, dental injury Complications of treatment - Gingival hyperplasia (drug phenytoin) - Bleeding tendency (drug valproate) - Folate deficiency (Rare) Know emergency care for epilepsy Assess risk of fit - Type of seizure - Treatment and compliance and changes in medication - When did the last 3 seizures take place (tells likelihood of seizure that day)