Neurology 1 Flashcards
what is a seizure ?
caused by a synchronous neuronal activity in the brain - all the neurones firing synchronously at the same time
*normally neurones in ur brain are firing asynchronously
what does the type of seizure depend on?
location of the brain
which part of the brain is linked to high cognitive function?
frontal lobe
which part of brain is linked to motor and sensory control?
back of the brain
which part of the brain is linked to auditory processing
lateral part of brain
what are brokers and venicas responsible for?
producing and understanding speech
which part of the brain is responsible for the vision
occipital lobe at back of brain
what are seizures divided into?
focal (part) or generalised (all over)
what happens during a focal seizure ?
pt maybe aware of what’s happening or might not be aware depending on which part of brain is affected
what happened during generalised seizure ?
lose awareness of what’s going on
what re the symptoms of focal seizures ?
depends on the part of brain affected for eg. visual changes, shaking in one part of body, deja vu or sensing an odd smell
how do describe different types of seizures ?
tonic, atonic, myclonic, tonic clonic and absence
what is tonic?
increased tone in muscle= stiff
what is atonic ?
decrease in tone of muscle = floppy
- if happens to whole body = u drop to the floor
what is myclonic?
sudden spasm
myconic jerk
what is tonic clonic ?
increase in tone
pt becomes stiff and muscles repeatedly contracting and spasming
what are absence seizures ?
- type of generalised seizure
- pt becomes vacant and doesn’t remember the seizure
if someone has a focal seizure with a loss of awareness what symptoms may they have
lip smacking - automatisms
what are the 4 phases of a seizure?
prodrome
aura
ictal
post ictal
what is prodrome?
lasts hours to days
symptoms are vague - irritable or light headed
what is Aura?
some pts may not have them
migraine or odd sensations change in vision taste smell or visions happens before seizure
what is ictal?
- seizure
- can be muscular changes or loss of awareness
what is post ictal ?
after seizure
cognitive depression
neurones In brain having fired a lot then becomes tired
pt becomes sleepy after
is it true that not all seizures are epilepsy ?
yes
how many ppl experience a seizure in their life?
1 in 20
how many ppl will experience epilepsy in their life?
1 in 100
how do the WHO define epilepsy ?
2 or more unprovoked seizures
*ppl with epilepsy may have unprovoked seizure
what is a provoked seizure ?
- an acute change
- a recent change that triggers the seizure which change the brain structure or chemistry
list the 5 types of prove seizures
metabolic
drugs
infection
structural
vascular
give eg of a metabolic cause
- hypoxia
- hypoglycaemia
give eg of a drug cause
- drugs or withdrawal of drugs
- drugs may change how excitable neurone are (increases or decrease their activity )
give eg of structural changes
trauma or tumour
eg of vascular
stroke
what are some of the causes of epilepsy
structural
genetic
metabolic
autoimmune
idiopathic
how do we diagnose a epilepsy
- if pt has had a seizure testing needs to be down to find out wether this was provoked or not this can be done by:
- blood tests can find out any metabolic causes
- brain imaging can find any structural causes
- EEG detects brain waves
- ECGS = rule things that may provoke a seizure or may not be a seizure eg. if someone has a cardiac arrhythmia leading to a cardiac syncope or if someone has a deep faint they may have muscle twitching due to reduced perfusion to brain
how do we manage a pt that has had an unprovoked seizure?
anti epileptic meds or have a device implanted that stimulate the nervous system to preen them from having the seizure or if its structural abnormality u may have neural surgery to remove
how do we manage a pt that has had a provoke seizure?
manage the cause
list some anti epileptic meds
what do pts need to think about if they have seizure/epilepsy?
DVLA - limitations on driving
safety - require safety assessments for some jobs, cant bathe alone
Drug interactions and side effects
SUDEP - 1 in 1000 Sudden and unexplained death
what questions do we ask our pt who have seizures/epilspsy ?
- ask them to describe exactly what happens
- are they in remission = controlled
- what drugs they’re taking
what is prolonged seizure ?
lasts more than 5 mins
what is a serial seizure?
3 or more in an hour - concerning
which seizure is a med emergency ?
tonic clonic
describe the tonic clonic seizure
- stiff
- breathe out with a large groan
- symmetrical rhythmical muscle contractions thru out body - lasts few minutes
- bites sides of tonnage
- urinary fecal incontinence
- risk of injuring themselves
describe how we would manage tonic clonic
STOP
safety
time
oxygen
plan
midazolam
describe the S part of managing tonic clonic
- safety
- lowering dental chair to prevent them from falling out - don’t hold pt down as u can harm yourself or them
- don’t put hands near mouth as they can be bitten
- cushion their head
describe the t part of managing tonic clonic
time
- start stopwatch
- if lasts over 5 mins - call ambulance
describe the o part of managing tonic clonic
oxygen
- thye have stopped breathing
- hypoxic
- may turn blue
- 15L non rebreather mask
describe the p part of clonic tonic
plan
- do they have a care plan
- if they don’t have a history of seizures call ambulance
- if the seizure is longer than normal
- monitor pt for another hour to check if its prolonged
- if their seizure isn’t normal according to care plan then give midazolam and call ambulance
what is important to note about midazolam?
- can cause respiratory depression so make sure ambulance is called
describe how u would manage pt in post ictal phase
- recovery position - maintains airway
- ABCDE
- wean 02 - wait until u have pulse 02 readings - if u can’t remove 02 mask without pt turning hypoxic call ambulance
- discharge
when should u call an ambulance
- first seizure
- prolonged seizure
- if midazolam given
- if injuries sustained during seizure
- ABCDE tell u to
what conditions may look like a seizure ?
psychogenic non epileptic seizure
syncope
what is a stroke ?
- an acute vascular event in which the blood supply to the brain is interrupted which causes death of the brain tissue
what are the 3 types of stroke?
ischaemic, hemorrhagic and TIA
what is ischaemic stroke?
blockage to blood flow eg. clot or thrombus
- focal - one part of brain one part of body
85%
what is a hemorrhagic stroke?
a bleed in an artery that supplies the brain - not enough blood to brain tissue starts to die
what can stokes also be cause by?
dissection - defect in artery - blood moves into wall of artery instead of lumen - so reducing blood flow in which can lead to ischamia due to clot formation
what can haemorrhagic stroke be categorised into?
small and big blood vessel
what is small haemorrhagaic stroke?
small vessel within brain tissue could bleed due to high BP or if vessels are damaged from atheroma or amyloid plaques or anatomical abnormality
what is a subarachnoid stroke?
- bleeding takes place between arachnoid membrane and the brain
why does a SS take place ?
due to anyuresym - ballooning of a blood vessel which bursts
what symptoms do ppl with SS have ?
- thunderclap headache = feels like a smack to the face
- stiff neck = blood irritates the meninges (this also are in spinal cord) so when pt bends head forwards = stercthces membranes causing stiff neck
- nausea
- photophobia
- can be Fatal
- Call 999
what are the risk factors for stroke?
- baso anything that risks a thrombus formation in vessel wall
- hypertension = damages vessel walls so easier for clot to form
- diabetes - high sugar levels damaging artery walls
- smoking and drinking = affects blood clotting
- atrial fib = LA fibrillate - causes distribution to blood flow in heart = turbulent blood flow = clot formation
- PFO= hole in heart between RA and LA should close up when ur born = clot goes from RA to LA then straight to systemic circulation and cause stroke
what is a TIA?
-transient ischaemic attack
-aka mini stroke
-symptoms last 24hrs and damage isn’t lasting
-a sign that a pt has a high risk of having a full ischaemic stroke
come ppl may have several TIAs with then leads to a big stroke
what does fast mean? and management of stroke
face - anything droopy
arm - ask to raise arm
speech - is speech affected ?slurring
time - call 999 and make a note of when symptoms started
*leg weakness, visual changes, coordination problems, neglect
*don’t give food water or meds when having a stroke, keep talking to them
* if lose consciousness - recover position
* stop breathing - CPR
how do we diagnose a stroke?
- neurological exam - CT head to identify bleeding
how is an ischeamic stroke managed?
thrombolysis - clot dissolving drugs or thrmobectomy = removal of clot
- these are done 4 hours after symptoms
how else is a stroke diagnosed ?
- Neurology exam
- CT head
- Thombolysis / thrombectomy
- Lumbar puncture / angiogram
- Neurosurgery
how do we deal with the aftermath of a stroke?
- Antiplatelets or anticoagulation
- Statin or anti hypertensives
- Blood pressure control
- Physiotherapy
- Occupational Therapy
- Speech and Language Therapy
- Psychology
- Nutrition
- incontinence care
what are some dental considerations ?
- Defer treatment for 6 months
- Accessibility
- Difficulty swallowing / chewing
- Risk of aspiration
- Drug interactions & side effects
- Potential sensitivity to sedatives / opioids
- Limit LA & avoid adrenaline in gingival retraction
