Neurology 1 Flashcards
What are the 5 things we look for in a neurological examination?
1) Tone - resistance to passive movement of a joint
2) Power - comparing your strength to patients
3) Reflex - involuntary reflexes check
4) Coordination - ask them to do voluntary purposeful movements
5) Sensation - conscious experience resulting from stimulation
What does an upper motor lesion do to the face?
Palsy of the lower part of face on the opposite side
What does a lower motor neuron affect?
The whole face on the opposite side of palsy
What test do we use to test consciousness?
A - are they alerting and reasoning to you
V - verbal commands
P - response to pressure or pain
U - unresponsive
What is a stroke?
A neurological deficit lasting longer than 24h resulting from a vascular lesion
What are the two types of strokes?
- Ischemic stroke: blood supply is blocked to a certain part of the brain
- Haemorrhagic stroke: bleeding to a particular part of the brain
How many hours is best to get to the hospital after a stroke to minimise impact?
4 hours
What are the main symptoms of stroke?
- Palsy (hemiplegia usually)
- Numbness of parts of the face
- Sudden severe headaches due to pressure build up
- Confusion, have trouble speaking or understand speech
- Aphasia (impairment of language and inability to read and write)
- Visual field defects
- Ataxia (sudden trouble walking, dizziness and loss or balance or co-ordination
In ischemic strokes, what can cause the blockage?
How do we treat ischemic strokes?
- Blockage from athlerosclerotic plaque, patient with endocarditis with vegetations coming off the heart valves, severe hypotension causing sluggish blood
- Thrombolysis (alteplase blood thinners(
- Clot retrieval
In ischemic strokes, what can cause the blockage?
How do we treat ischemic strokes?
- Blockage from athlerosclerotic plaque, patient with endocarditis with vegetations coming off the heart valves, severe hypotension causing sluggish blood
- Thrombolysis (alteplase blood thinners(
- Clot retrieval
What is the main reason for hemorrhagic stroke and how do we treat it?
Aneurysm
Clip and tie the blood vessel
What is a TIA?
It is a mini-stroke lasting less than 24h and the patient will go back to normal.
Vessels supplying the brain are narrow and cannot keep up with the blood supply.
Difference between ischemic stoke and TIA:
Stroke dont fully recover, TIA do
Stoke lasts more than 24h
Stoke is due to clot as where TIA is due to vessels narrowing
What are the risk factors for stroke?
- Diabetes
- Hypertension
- High cholesterol
- Obesity
- Cigarettes
- Alcohol intake
- Oral contraceptive pill
- Atheroma
What is a cardiac endarterectomy?
Surgery to remove the atheromatous plaque from carotid bifunction by vascular surgeons to restore blood flow
Name some of the less common types of strokes
Subarachnoid stroke - common in older women as a thunder clap headache due to arterial bleed in brain
Extra dural haemorrhage - common in young people who have had trauma from an accident
Subdural haemorrhage - caused by veins collecting blood and puts pressure on the brain
What is the dental relevance of a stroke?
- Patient often on anticoagulation
- Oral hygiene compromise due to weakness in arms when brushing
- Muscle wasting of face
- Speech may be affected which affects communication with patient
What is the definition of epilepsy?
Neurological disorder marked by recurrent episodes of sensory disturbance, loss of consciousness or convulsions association with abnormal electrical activity in the brain
Name the main types of seizures an epileptic can have?
- Tonic Clonic (muscle contractions, stiff jerking movements, inability to communicate, vomiting)
- Simple partial = sinking odd feeling in abdomen with unusual taste in mouth, patient remains awake
- Complex partial = loss of sense of awareness and random body movements occur
- Absence seizures = loss of awareness for a short period, patient may appear to be day dreaming
After how long do we ring 999 when a patient is having a seizure?
5 minutes
What triggers seizures?
Light Nicotine Caffeine Stress Fatigue Missing medication Alcohol
What investigations do we do for epileptic patients?
- CT scan
- MRI scan
- EEG
- Blood tests
How is epilepsy treated?
- Anti convulsants (phenytoin, sodium valporate, carbamazopine)
- Surgery
- Small electrical device
- Avoid any triggers
What is the pathology of multiple schlerorsis?
The pathologies are peri-vanular plaques of demyelination.
The insulation breaks down and the electrical signal does not transfer as well.
What is the dental relevance of MS?
- Infection and stress can make the symptoms worse
- Avoid NSAIDS if patient is on corticosteroids
What are the investigations for MS?
- MRI scan
- Electrophysiology
Types of MS?
Primary progressive = progressives causing accumulation of neurological deficits
Secondary progressive = one episode every now and again causing symptoms
Benign = one episode followed by a full recovery
What are the main types of facial pain?
Allodymia = pain from normally non-painful stimulus
Hyperalgesia = increases responses to normally painful stimulus
Dysasthesia = unpleasant sensation spontaneous or evoked
Paraethesia = abnormal sensation
Hypoalgesia = diminished pain response to painful stimulus
Anaesthesia = no pain from painful stimulus
Neuralgia = nerve distribution pain
Neuropathic = nerve pathology
Neuropathy = never function / damage / pathology pain
What are the main types of facial pain?
- Dental pain
- TMJ
- Sensitivity
- Pulpal exposure
- Pulpitis
- Cracked cusp
- Periapical periodontitis
- Periodontal abscess
Summarise trigeminal neuralgia:
- Brief recurrent pain that comes in waves
- Sharp shooting pain
- Typically affects one side of the face
- V2 and V3 affected
- Pain is triggered by touch, chewing, shaving and cold wind
What are the causes of trigeminal neuralgia?
Mainly due to no cause!
Some patients have vascular compression where the vessels press down on the trigeminal nerve.
What are the treatments for trigeminal neuralgia?
- Anti-convulsants (phenytoin, carbamazepine)
- Nerve ablation
- Vascular decompression
What is glossopharyngeal neuralgia?
What is the treatment?
Sudden onset of pain in the tongue, ear, throat, angle of jaw and tonsils.
Trigged by chewing, swallowing, talking, yawning and coughing.
GN can be caused by compression of the glossopharyngeal nerve, but in some cases
No cause is evident like trigeminal neuralgia.
It is associated with multiple sclerosis.
GN primarily affects the elderly.
TREATMENT - same as trigeminal neuralgia
We give them anti-convulsants such as carbamezepine
Surgical options such as nerve resection or microvascular decompressions
What is trigeminal autonomic cephalgias?
The Trigeminal Autonomic Cephalalgias (TACs) are agroup of headache disorderscharacterised by attacks of moderate to severe unilateral pain in the head or face.
They have a face onset typically affecting males age 20-50 years.
It leads to mainly peri-orbital pain.
What is trigeminal neuropathic pain?
What is the treatment?
- This is caused by trauma to peripheral nerves of trigeminal nerve.
- The pain still persists after the treatment is done.
- Caused by a constant insult to a peripheral nerve after DENTAL TREATMENT.
- Patients get altered taste of metal.
Managed with anti-depressants in low doses such as nortriptyline as it dampens down the nerve signals (not cause the patient is depressed but to dampen down nerve signals).
- Psychology - to help the patient to deal with the pain.
What is persistent idiopathic facial pain?
What is the management?
- The unexplained pain along the territory of the trigeminal nerve that does not fit the classic presentation of other cranial neuralgias
- Dull throbbing pain that keeps a patient awake.
- Typically moves around the face across the midline e.c.t
- Relieved by rest and relaxation.
Management:
We give anti-depressants (nortryptyline, amitryptiline), psychology and self-management.
- Rest and relaxation relieves it
What is persistent idiopathic facial pain?
What is the management?
- The unexplained pain along the territory of the trigeminal nerve that does not fit the classic presentation of other cranial neuralgias
- Dull throbbing pain that keeps a patient awake.
- Typically moves around the face across the midline e.c.t
- Relieved by rest and relaxation.
Management:
We give anti-depressants (nortryptyline, amitryptiline), psychology and self-management.
- Rest and relaxation relieves it
What is burning mouth syndrome?
What investigations do we do?
How do we treat burning mouth syndrome?
Sensations with burning sensations on the tongue.
Idiopathic
Lingual nerve affected
Common in females
Can cause unusual tastes
Often stress and anxiety are big impact
They often feel that their mouth is dry when its not.
INVESTIGATIONS:
Test for low iron, B12 and folic acid as these are responsible for nerve health
Candida count may be raised which causes burning
MRI scan in young person to check anything in the brain causing a problem typically on one side (stroke)
Management: Psychology Anti-depressants (nortryptyline) Self-management Symptomatic relief - mouthwash that are numbing (fiddle and lidocaine)
