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5 Human Diseases > Neurological disease > Flashcards

Neurological disease Flashcards

1
Q

multiple sclerosis caused by what?

A

demyelination of nerve axons to the brain due to inflammatory change

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2
Q

what is the trigger for multiple sclerosis?

A

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

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3
Q

multiple sclerosis results in?

A

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

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4
Q
A
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5
Q

investigations for multiples sclerosis

History & examination

MRI

CSF analysis
- Reduced ?
- Increased ? protein

Visual evoked potentials
- Reduced electrical activity of the visual pathways

A

lymphocytes
IgG

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6
Q

outcome of multiple sclerosis

? with no effective treatment

Gradual ? - steroid treatment

? management

A

incurable

decline

symptomatic

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7
Q

dental aspects of multiple sclerosis

A

limited mobility and psychological disorder

trigeminal neuralgia risk

refer pt with sudden unexplained loss of motor or sensory function

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8
Q

what is motor neurone disease caused by?

A

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

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9
Q

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

A

no

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10
Q

what is the outcome of motor neurone disease?

A

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

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11
Q

what is the treatment for motor neurone disease?

A

None effective

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

Riluzole

Aspiration prevention -> PEG tube feed, reduce salivation

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12
Q

what are the dental aspects of motor neurone disease

A

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

Realistic treatment planning -> short life expectancy

Drooling and swallowing difficulties

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13
Q

what is Parkinson’s disease caused by?

A

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

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14
Q

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

A

dopamine
substantia nigra

messages
delays
doing
understanding

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15
Q

what is the underlying cause of parkinson’s disease?

A

unclear

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16
Q

name 3 clinical features of parkinson’s disease

A

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

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17
Q

what are the manifestations of parkinson’s disease? 4

A

Unsteady walking -> falls

Impaired use of limbs

Lack of facial expression

Swallowing problems

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18
Q

what is the medical treatment for parkinson’s?

A

dopaminergic drugs -> dopamine direct replacement and agonist

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19
Q

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

A

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

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20
Q

what surgical procedures are used to treat parkinson’s?

A

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

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21
Q

what is a dental affect of parkinson’s?

A

dry mouth due to anticholinergic drugs

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22
Q

what is a stroke?

A

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)

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23
Q

what are the 2 causes of stroke?

A

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

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24
Q

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

A

FAST

facial drooping
arm weakness
speach difficulty
time

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25
Q

what are the 2 types of stroke?

A

ischaemic stroke

haemorrhaging stroke

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26
Q

define ischaemic?

A

inadequate blood flow to an organ or part of the body

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27
Q

what is a transient ischaemic attack?

A

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

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28
Q

what causes transient ischaemic attacks?

A

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

29
Q

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

A

blood vessels

stroke

30
Q

what are the risks for stroke?

A

Hypertension (130/80)

Smoking

Alcohol

Ischaemic heart disease

31
Q

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

A

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

32
Q

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

A

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)

33
Q

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

A
34
Q

how is stroke prevented?

A

reduce risk factors
anticoagulants
antiplatelets
surgery

35
Q

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

A
36
Q

what are the effects of stroke?

A

loss of functional brain tissue

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

37
Q

what are the 2 phases in stroke management?

A

acute and chronic

38
Q

what is the general acute management for stroke? 2

A

limit the damage

limit future risk

39
Q

how is damage limited in the acute management of stroke?

A

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

40
Q

how is future risk limited in acute management of stroke?

A

Aspirin

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

41
Q

what does the chronic management of stroke involve generally?

A

rehabilitation
reduce future risk

42
Q

what does rehabilitation involve in the chronic management of stroke?

A

Immobility support

Speech and language therapy
- Communication, swallowing, eating

Occupational therapy

43
Q

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

A

cardiac
MI

aspiration
anticholinergic

dentures

44
Q

Epilepsy is a group of conditions that happen due to what?

Reduced ? level -> abnormal cell-cell message ? -> ? stimulation for the neurone to fire

A

abnormal discharge of neurones within the brain

GABA
proprogation
less

45
Q

how do febrile seizures differ from epilepsy?

A

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

46
Q

what is the management of febrile seizures?

A

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

47
Q

what are the 2 classifications of epilepsy?

A

generalised seizure
partial seizure

48
Q

how does a generalised seizure work?

A

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

49
Q

are tonic clonic seizures generalised or partial?

A

generalised

50
Q

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

A

pt becomes tonic - all muscles contract

then clonic - muscles relax

this repeats for 1-2 minutes

post-ictal drowsiness follows

51
Q

what is post-ictal drowsiness

A

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

52
Q

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

A

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

53
Q

absence seizures are generalised or partial seizures?

A

generalised seizure

54
Q

absence seizures are more common in what people?

A

children

55
Q

what are absence seizures commonly mistaken for?

A

daydreaming

56
Q

what happens to an ECG during a generalised seizure?

A

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

57
Q

how does a partial seizure work?

A

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

58
Q

what is a jacksonian seizure?

A

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

59
Q

what is a complex partial seizure?

A

different areas of the brain are affected which produce connected movement

60
Q

epilepsy triggers? 4

A

Idiopathic -> mostly unknown

Trauma -> head injury

Degenerative CNS disease -> tumour, stroke, meningitis

Environmental -> late nights, alcohol, hypoglycaemia, flashing lights

61
Q

what is the preventative treatment for epilepsy?

A

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

62
Q

what is the emergency management of epilepsy?

A

Supportive if unconscious -> airway and oxygen

Status epilepticus requires benzodiazepines

63
Q

Epilepsy drugs

Most drugs work on ?? (valproate, benzodiazepines)

Recently developed medicines work on ?? (carbamazepine, phenytoin)

Can be used in combination

A

GABA receptors

sodium channels

64
Q

what is the surgery for epilepsy?

A

Removal of focal neurological lesions

65
Q

what are the dental complications of epileptic fits? 2

A

soft tissue injury

dental injury

66
Q

what are the complications of epilepsy treatment? 3

A

Gingival hyperplasia (drug phenytoin)

Bleeding tendency (drug valproate)

Folate deficiency (Rare)

67
Q

how is the risk of an epileptic fit assessed?

A

Type of seizure

Treatment and compliance and changes in medication

When did the last 3 seizures take place (tells likelihood of seizure that day)

68
Q

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)

A

5 Human Diseases (16 decks)

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