Neurology 1

Question 1

What are the 5 things we look for in a neurological examination?

Answer 1

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

Question 2

What does an upper motor lesion do to the face?

Answer 2

Palsy of the lower part of face on the opposite side

Question 3

What does a lower motor neuron affect?

Answer 3

The whole face on the opposite side of palsy

Question 4

What test do we use to test consciousness?

Answer 4

A - are they alerting and reasoning to you
V - verbal commands
P - response to pressure or pain
U - unresponsive

Question 5

What is a stroke?

Answer 5

A neurological deficit lasting longer than 24h resulting from a vascular lesion

Question 6

What are the two types of strokes?

Answer 6

1. Ischemic stroke: blood supply is blocked to a certain part of the brain
2. Haemorrhagic stroke: bleeding to a particular part of the brain

Question 7

How many hours is best to get to the hospital after a stroke to minimise impact?

Answer 7

4 hours

Question 8

What are the main symptoms of stroke?

Answer 8

1. Palsy (hemiplegia usually)
2. Numbness of parts of the face
3. Sudden severe headaches due to pressure build up
4. Confusion, have trouble speaking or understand speech
5. Aphasia (impairment of language and inability to read and write)
6. Visual field defects
7. Ataxia (sudden trouble walking, dizziness and loss or balance or co-ordination

Question 9

In ischemic strokes, what can cause the blockage?

How do we treat ischemic strokes?

Answer 9

• 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

Question 9

In ischemic strokes, what can cause the blockage?

How do we treat ischemic strokes?

Answer 9

• 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

Question 10

What is the main reason for hemorrhagic stroke and how do we treat it?

Answer 10

Aneurysm

Clip and tie the blood vessel

Question 11

What is a TIA?

Answer 11

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

Question 12

What are the risk factors for stroke?

Answer 12

• Diabetes
• Hypertension
• High cholesterol
• Obesity
• Cigarettes
• Alcohol intake
• Oral contraceptive pill
• Atheroma

Question 13

What is a cardiac endarterectomy?

Answer 13

Surgery to remove the atheromatous plaque from carotid bifunction by vascular surgeons to restore blood flow

Question 14

Name some of the less common types of strokes

Answer 14

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

Question 15

What is the dental relevance of a stroke?

Answer 15

• 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

Question 16

What is the definition of epilepsy?

Answer 16

Neurological disorder marked by recurrent episodes of sensory disturbance, loss of consciousness or convulsions association with abnormal electrical activity in the brain

Question 17

Name the main types of seizures an epileptic can have?

Answer 17

• 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

Question 18

After how long do we ring 999 when a patient is having a seizure?

Answer 18

5 minutes

Question 19

What triggers seizures?

Answer 19

Light
Nicotine
Caffeine 
Stress
Fatigue 
Missing medication
Alcohol

Question 20

What investigations do we do for epileptic patients?

Answer 20

1. CT scan
2. MRI scan
3. EEG
4. Blood tests

Question 21

How is epilepsy treated?

Answer 21

• Anti convulsants (phenytoin, sodium valporate, carbamazopine)
• Surgery
• Small electrical device
• Avoid any triggers

Question 22

What is the pathology of multiple schlerorsis?

Answer 22

The pathologies are peri-vanular plaques of demyelination.

The insulation breaks down and the electrical signal does not transfer as well.

Question 23

What is the dental relevance of MS?

Answer 23

• Infection and stress can make the symptoms worse

- Avoid NSAIDS if patient is on corticosteroids

Question 24

What are the investigations for MS?

Answer 24

- MRI scan | - Electrophysiology

Question 25

Types of MS?

Answer 25

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

Question 26

What are the main types of facial pain?

Answer 26

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

Question 27

What are the main types of facial pain?

Answer 27

- Dental pain - TMJ - Sensitivity - Pulpal exposure - Pulpitis - Cracked cusp - Periapical periodontitis - Periodontal abscess

Question 28

Summarise trigeminal neuralgia:

Answer 28

- 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

Question 29

What are the causes of trigeminal neuralgia?

Answer 29

Mainly due to no cause! | Some patients have vascular compression where the vessels press down on the trigeminal nerve.

Question 30

What are the treatments for trigeminal neuralgia?

Answer 30

- Anti-convulsants (phenytoin, carbamazepine) - Nerve ablation - Vascular decompression

Question 31

What is glossopharyngeal neuralgia? What is the treatment?

Answer 31

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

Question 32

What is trigeminal autonomic cephalgias?

Answer 32

The Trigeminal Autonomic Cephalalgias (TACs) are a group of headache disorders characterised 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.

Question 33

What is trigeminal neuropathic pain? What is the treatment?

Answer 33

- 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.

Question 34

What is persistent idiopathic facial pain? What is the management?

Answer 34

- 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

Question 34

What is persistent idiopathic facial pain? What is the management?

Answer 34

- 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

Question 35

What is burning mouth syndrome? What investigations do we do? How do we treat burning mouth syndrome?

Answer 35

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) ```