Neurological + special senses Flashcards
in how many hours does a TIA take to resolve?
24 hours
usually less than 1 hour
2 types of strokes + their percentage chance
infarction = 90%
haemorrhage = 10%
what scale is used for diagnosis of strokes?
ROSIER
+1 for asymmetrical face, arm, leg weakness, speech, visual
-1 loss of consciousness, seizure activity
score 1-5 likely stoke
what scale is used to determine stroke risk after TIA?
ABCD2
score 0-3 - aspirin + investigate in 2 weeks
score 4-7 - aspirin + assessment within 24hrs
main dental relevance of strokes?
pts on antithrombotic drugs
3 stages of swallowing
mastication
pharyngal stage
oesophageal stage
4 main causes of swallowing problems
- strokes
- neurological disease
- mechanical obstruction
- oesophageal motility disorders
how to assess swallowing if suspected mechanical obstruction?
barium swallow/upper endoscopy
what is achalasia
problem with plexus of nerves that controls peristalsis + LOS doesn’t open properly
what cranial nerve is tested with tuning fork test?
8th - vestibulocochlear
what are the 2 types of deafness?
conductive - air not transported - normally wax
sensory neural - 8th cranial nerve
2 tests to distinguish conductive + sensory deafness
rinne test - if bone connectivity > air conductivity = conductive deafness
weber test - if sound on same side as problem = conductive, if contralateral = sensory
what is glue ear?
otitis media - infection of middle ear causing inflammation + fluid build up
‘blue’ ear in children
what are grommets?
tubes that help drainage from middle to outer ear
cleft pts usually fitted with grommets due to association with Eustachian tube
2 places ear infections can spread?
up to Brian
backwards to mastoid
if an elderly pt presents with an enlarged temporal artery, headache and visual problems what is presumed until proven otherwise?
temporal arteritis/giant cell arthritis
triad of symptoms for behcets disease ?
oral ulceration
genital ulceration
uveitits
how do you test for behcets?
stick needle under skin, check for over response/red mark in a couple of days
2 examples of mucous membrane disorders that can effect the eye?
Steven johnson syndrome
mucous membrane pemphigoid
histological characteristic of mucous pemphigoid?
basement membrane antibody accumulation
histological characteristic of mucous pemphigus?
intracellular antibody accumulation
difference between pemphigoid + pemphigus?
pemphigoid = basement membrane - don’t pop
pemphigus = epidermis - pop
triad of symptoms for sjogrens syndrome?
dry eyes, dry mouth, dry tissue
what are eye blow fractures associated with?
zygomatic fractures
orbital cellulitis could be caused by what dental problem
tooth ache
CN 1
olfactory
smell
CN2
optic
sight
CN3
oculomotor
movement of eye
CN4
trochlear
movement of eye
CN 5
trigeminal
sensory
motor - MOM
CN 6
abducens
eye movement
CN 7
facial
motor - facial expression, lacrimation
sensory - taste ant 2/3
CN 8
vestibulocochlear
hearing + balance
CN 9
glossopharyngeal
sensory - taste post 1/3
motor - stylopharyngeas contort - gag reflex
CN 10
vagus
sensory - throat, abdomen, aortic body
motor - muscles of pharynx, smooth muscles of glands of thorax + abdomen
CN 11
accessory
shoulder shrug
CN 12
hypoglossal
tongue
what is bells palsy?
exclusion diagnosis for facial palsy
does bells palsy effect upper or lower motor neurones of facial nerve?
lower
a lower motor neurone lesion of VII causes what sort of facial palsy?
total facial palsy on ipsilateral side
characteristic of upper motor neurone lesion of VII?
forehead spared, lower facial palsy on contralateral side
eg. from stroke/tumour
how to test trigeminal nerve?
stoke both sides of face on forehead, maxilla + mandible
look for altered sensation between sides
how to test motor facial nerve?
raise eyebrows/close eyes/smile/blow cheeks out
check same power on both sides
how to test glossopharyngeal + vagus nerve?
say ahh - look for symmetry on soft palate - would be pulled to good side + weak side floppy
how to test accessory nerve?
shoulder shrug
how to test hypoglossal nerve?
stick tongue out - will go towards weak side as strong side pushes it
what does syncope mean?
temporary loss of consciousness
why do vasovagal syncopes happen?
over-activity of sympathetic NS in response to external stimuli e.g. fear
tachycardia before, bradycardia after
why do carotid sinus syncopes happen?
turning head - pressure on carotid sinus
most common in supine position - legs higher than heart
doesn’t recover as quickly as vasovagal
treatment - jaw thrust/straighten neck
oral issues in gran Mal epilepsy? and which phase is this in?
increased salivation + bruxism
clonic phase
when does epilepsy become a medical emergency? and how is it treated?
after 5 mins
O2 15litres/min + 10mg midazolam buccal cavity
what causes stoke Adams attacks?
cardiac arrhythmias
what is PRIND?
progressive reversible ischemic neurological deficit
half way between TIA + stroke
basic cause of multiple sclerosis?
demyelination
dental relevance of multiple sclerosis?
lose control of airway - can’t cough up
what should always be suspected in a young female patient presenting with trigeminal neuralgia?
multiple sclerosis
basic MOA of Parkinson’s?
degeneration of pigmented cells of substantial migration leading to dopamine deficiency
how does Parkinson’s affect blood pressure?
hypotension
impaired autonomic function leading to postural drop in BP
medications may cause hypotension
dental relevance of motor neurone disease?
hard to cough + swallow
headache characteristic of brain tumour?
headache worse in morning
which cranial nerves are affects in bulbar palsy?
IX, X, XI, XII
what is bulbar palsy?
palsy of tongue, MOM/swallowing + facial muscles due to loss of function of motor nuclei in brain stem
2 causes of bulbar palsy?
acute - infection e.g. polio
chronic - tumour
what antipsychotic drug can cause drug induced tics?
phenothiazine therapy
what is Ramsay hunt syndrome?
facial paralysis with vesicles in pharynx + external auditory meatus of same side
geniculate ganglion of VII infected with herpes zoster
what can be a cause of bacterial meningitis?
maxillofacial injuries involving mid third of face
bacteria in through nasal/ethmoidal/frontal sinus
what is kernigs sign?
inability to straighten left when hip flexed at 90 degrees
sign for meningitis
is viral or bacteria meningitis self limiting?
viral
how to test for meningitis rash?
press with glass, doesn’t fade
upper incisor infection may cause brain abscess, which patients are most at risk?
patients with congenital heart disease
what causes cerebral palsy?
motor function disorder secondary to cerebral damage - birth injury/hypoxia
what deficiency causes spina bifida?
folic acid
what is Huntington’s chorea?
genetic dementia - progressive death of brain cells
autosomal dominant
marked involuntary movements
anticonvulsant drug dentists can prescribe to treat neuralgia?
carbamazepine
how does carbamazepine work?
blocks Na channels via a-beta fibres
what are the 2 types of neuropathic pain?
- neuralgia - rare + short lived
2. constant neuropathic pain
2 MOA of anticonvulsants?
- inhibition of ionic channels
- enhancement of GABA mediated inhibition
both inhibit rapid repetitive firing that causes seizures
how do benzodiazepines work as anticonvulsants?
increase GABA through Cl
as well as seizures what else can anticonvulsants be used for?
neuropathic pain
drug of choice for status epileptics?
BDZ - midazolam
not drug of choice for prophylactically because of dependance
NNT of carbamezapine to treat trigeminal neuralgia and reduce pain by 50%?
<2
3 common side effects of carbamezapine?
- Steven johnson syndrome
- blood dycrasias
- liver disorders
who must you be careful in prescribing carbamezapine too?
chinese/thai/malaysian race
common dental effects of the anticonvulsant phenytoin?
gingival overgrowth root shortening hypercementosis salivary gland hypertrophy cervical lymphadenopathy cleft lip + palate
common dental effects of the anticonvulsant carbamazepine ?
xerstomia glossitis ulceration cervical lymphadenopathy cleft lip + palate
how many pathways make dopamine + transport it in the brain? and which is most important to Parkinsons disease?
4
nigrostriatal system
when dopamine activity decreases what increases?
Acetylcholine actiivty - excitatory
2 classes of antiparkinsonian medication?
- dopaminergic drugs
2. anticholinergic drugs
can dopamine cross the BBB?
no - need precursor
what is levodopa?
precursor of dopamine
tyrosine –> levodopa –> dopamine
4 ways dopaminergic medications work?
- precursor of dopamine
- decrease dopamine metabolism
- direct dopamine synthetic agonists
- stimulate dopamine release
why must you avoid IV sedation in degenerative disorders?
levodopa antagonised by BDZs
oral effect of antiparkinson drugs?
xerostomia
when should dentists see PD patients?
on ‘on’ times - usually 60-90mins after meds
normally better in morning
