Neurology Flashcards
What is the dental impact on neurological illness?
Movement problems
Reduced manual dexterity
Drooling of saliva if swelling difficult
What causes a ‘blackout’ ?
Vasovagal “faint”
Postural hypotension
Aortic stenosis
Cardiomyopathy
Cardiac arrhythmia
What happens during a faint?
Nausea
Visual fields close in
Loss of consciousness
Fall to ground
Why might fainting be common in a dental practice?
It’s caused by emotion, heat and hunger
How is a patients BP and HR at the time of a faint?
Both low
How long does it take to recover from a faint?
2 minutes
How to manage a faint?
Lie flat + elevate legs
What causes postural hypotension?
Low BP reducing cerebral perfusion
Who is postural hypotension more common in?
Old people
What is the significant cause of morbidity and mortality?
Head injury
Why are sequential assessments of conscious level vital?
To recognise a deteriorating patient
What are some complication of head injury?
Extradural haemorrhage
Subdural haemorrhage
Axonal injury and coma
Maxillofacial and skull injuries
What are the 2 main ways to assess conscious level?
GCS
AVPCU Scale
In the GCS scale what 3 things are scored?
Eye opening
Motor
Verbal
What does AVPCU scale stand for?
Alert
Verbal
Pain
Confusion
Unresponsive
What are the metabolic causes of conscious level?
Hypoglycaemia
Hypoxia
Hypercapnia
Hyponatraemia
What are infection causes of conscious level?
Encephalitis
Meningitis
Cerebral abscess
Malaria
Sepsis
Drugs and alcohol affect conscious level T or F?
True
Impaired consciousness medical emergency?
ABCDE
Airway obstruction
Recovery position
Oxygen
Grade from scale
Check blood sugar level
What is epilepsy?
Excessive electrical discharge in the brain
What 2 ways can epilepsy present?
Focal (partial) seizures
Generalised seizures
How might focal seizures present?
Shaking on one side
olfactory hallucinations
odd behaviour
lip smacking
odd posture
What are the 2 phases of a seizure?
Tonic phase
Clonic phase
What happens during the tonic phase of a seizure?
Loss of consciousness
Becomes rigid
Fall
May cry
What happens during the clonic phase of a seizure?
After 30 seconds
Jerking
May bite the tongue
Frothing
Urinating
How may an absence seizure present?
Blank stare
Zoning out
Usually short lasting
What does “grand mai” mean?
Tonic-Clonic seizure
What does post ictal mean?
Headache, drowsy
How would epilepsy be investagated?
Blood tests
Brain imaging (MRI)
Electroencephalogram (EEG)
What are some medications for epilepsy?
Phenytoin
Carbamazepine
Sodium Valproate
Pregabalin
What is a side effect of phenytoin - dental aspect?
Gingival overgrowth
When would an epileptic seizure being a medical emergancy?
Lasts longer than 5 minutes or repeats
What would you do during a medical emergency of a seizure?
High flow oxygen
Midazolam oralmucoal - 10mg buccally
999 if needed
What are 2 types of headache?
Primary
Secondary
What is a primary headache disorder?
unpleasant, goes away easily
What is a secondary headache disorder?
Associated with mortality or disability
What are some red flags in regards to a headache?
Sudden onset
Severe
Worse with positional change
Present on walking
What are the primary headaches?
Tension
Migraine
Cluster
Medication overuse
Trigeminal neuralgia
What is a tension headache?
Stress related
How does a tension headache present?
“tight band”
Symmetrical
Chronic, gradual onset
What is the treatment for a tension headache?
Conventional analgesia
What is a migraine?
Prolonged reduction in cerebral blood blow following a brief spell of increased flow
What is cortical spreading depression?
A slow wave of altered brain activity
Who is more commonly affected by migraines?
Females
What are some triggers of a migraine?
Wine
Cheese
Chocolate
Anxiety
A migraine is split into 2 parts - pre headache and headache. What happens during pre headache?
first 15 mins - aura
flashing lights
dora
wavy lines
What happens during the main headache part of a migraine?
within 1 hour
one sided throbbing
What is the treatment of a migraine?
Conventional analgesia
Metoclopramide
Serotonin agonists
What is a cluster headache?
Severe pain around the eye
Who is more commonly affected by cluster headaches?
Males who smoke
How would you describe the onset of a cluster headache?
Episodic
What is the treatment of a cluster headache?
Sumatriptan
Oxygen