Neurology Flashcards
Name some common neurological complaints (9)
- Cerebrovascular accidents - Epilepsy
- Headaches / orofacial pain
- Meningitis
- Trigeminal neuralgia
- Herpes Zoster
- Multiple sclerosis
- Parkinsonism
- Tumours
What is the most common neurological complaint?
Headaches / Orofacial pain
What can cause Headaches / Orofacial pain? (5)
- Local disease
- Vascular disease
- Referred pain
- Neurological disorders
- Psychogenic disorders
What is the most likely cause of a migraine?
Likely caused by intra and extracranial blood vessels dilatation and inflammation
Name some common triggers of a migraine
- Stress
- Caffeine
- Alcohol
- Weather
- Certain foods
- Low blood sugar
- Bright light
- Lack of sleep
How would you manage acute migraine attacks?
With use of Triptans
How would you manage recurrent frequent migraine attacks?
With use of a B-blocker
E.g. Propanolol
What are some associated signs/symptoms of a migraine? (4)
- Nausea
- Vomiting
- Photophobia (light sensitivity)
- Phonophobia (sound sensitivity)
Who are mainly affected by Migrainous neuralgia?
Middle aged men
What is Migrainous neuralgia commonly know as?
Cluster headaches
Migrainous neuralgia causes unilateral pain where? (4)
Unilateral pain around the;
- Eye
- Frontal area
- Cheek
- Temporal area
Besides unilateral pain name some symptoms of Migrainous neuralgia (4)
- Ipsilateral lacrimation
- Photophobia
- Nasal stuffiness
- Rhinorrhorea (runny nose)
Name 3 ways in which Migrainous neuralgia is managed
- High flow oxygen
- Triptans
- Verapamil
Name some serious causes of headache (7)
- Acute glaucoma
- Acute hypertension
- Brain tumours
- Giant cell arteritis
- Meningitis
- Subarachnoid haemorrhage
- Subdural or epidural haemorrhage
Define a stroke
Syndrome consisting of rapidly developing symptoms/signs of loss of focal CNS function
What are the 2 vascular mechanisms that cause stroke
- Ischaemic
- Haemorrhagic
What directly causes a stroke?
Atherosclerosis in carotid or intracerebral arteries
Name some risk factors of a stroke
- Hypertension
- Diabetes mellitus
- Hyperlipidaemia
- Heart disease
- Atrial Fibrillation
- Excess alcohol
- Smoking
- Carotid artery occlusion
- Polycythaemia vera
What is the acronym to see if someone is suffering from a stroke
- FAST
- Face drooping
- Arms weakness
- Speech slurred
- Time to call 999
How do you investigate a stoke?
- Assess patients risk factors
- CT Scan
How would you treat a stroke?
300mg Aspirin to be administered within 48 hours of onset
What are things you may need to recognise a patient with a stroke may have? (3)
- Impaired mobility and communication (speak slowly and clearly)
- Likelihood of oral hygiene deterioration on the paralysed side (recommend electric toothbrush)
- Need for modifications during dental treatment (upright position with extra care)
As a dentists what should you monitor for a patient with a history of stroke? (2)
- Blood pressure
- Anticoagulation status
What are Transient Ischaemic Attacks most commonly caused by?
Thromboembolism from an atheroma in the carotid vessels
What occurs during a Transient Ischaemic Attack?
Manifest as sudden loss of focal CNS function
How long does a Transient Ischaemic Attack typically last?
A few minutes
What are some risk factors of a Transient Ischaemic Attack? (5)
- Smoking/Alcohol
- Hypercholesterolaemia
- Atrial fibrillation/Valvular disease
- Hypertension
- Diabetes Mellitus
What is Parkinson’s disease?
Degenerative conditions primarily affecting the substantia nigra of the basal ganglia where dopamine is the neurotransmitter
Parkinson’s depletes dopamine levels, what does this cause?
Loss of dopamine leads to less stimulation of the motor cortex and slower
onset of movements
When to Parkinson’s disease symptoms appear?
When 60-80% of dopaminergic neurons are lost
What is Akinesia?
Loss or impairment of the power of voluntary movement
What is Gait?
Flexed or stooped ape-like posture, reduced arm swing, postural instability
What are some clinical features of someone with Parkinson’s?
- Akinesia
- Gait
- Tremor/Rigidity
Parkinson’s disease is treated by enhancing dopaminergic pathways. What are the ways in which it is done? (5)
- Dopamine replacement
- Dopamine agonist
- Blocks Dopamine metabolism
- Inhibitors of Dopamine and L-Dopa breakdown
- Anticholinergics
What as a dentist should you consider when treating a patient with Parkinson’s?
- Blankness of expression and apparent unresponsiveness not mistaken for
lack of reaction or intelligence - Minimise anxiety as it increases tremor which may affect tongue/lip
- Avoid LA
What is multiple sclerosis?
Chronic relapsing neurological disorder affecting young adults
(Demyelination disease)
What is the Female:Male in multiple sclerosis?
3:1 (more common in females)
When can Multiple sclerosis develop?
At any age
Rare in children/elderly
What climate has the highest incidence of multiple sclerosis?
Tropical climates
What type of disease is Multiple sclerosis thought to be?
Autoimmune disease in genetically susceptible individuals
What does multiple sclerosis affect? (3)
- White matter of the brain
- Spinal cord
- Optic nerves
What are the consequences of multiple sclerosis? (2)
- Reduction in conduction velocity
- Loss of information conveyed
What are the 3 aspects of multiple sclerosis treatment?
- Management of an acute relapse
- Modification of the disease course
- Control of symptoms
As a dentist what should be considered when treating a patient with multiple sclerosis?
- Short appointments (unable to open mouth for long time)
- Treat in morning so less fatigue
- Treat upright
What are some oral manifestations suggestive of advanced multiple sclerosis?
- Trigeminal neuralgia
- Facial palsy
- Facial pain
- Difficulty swallowing
- Higher incidence of dental diseases
What is Epilepsy?
Recurrent occasional, sudden, excessive, rapid and local discharges of the nerve cells in the grey matter
What is status epilepticus?
Uncontrolled series of seizures with no regain of consciousness in between attacks
What are some causes of epilepsy in neonates? (5)
- Birth trauma
- Intracranial haemorrhage
- Hypoxia
- Hypoglycaemia
- Hypocalcaemia
What are some causes of epilepsy in children? (2)
- Congenital abnormalities
- Metabolic storage disease (Phenylketonuria)
What are some causes of epilepsy in young adults? (2)
- Head injuries
- Drugs and alcohol
What precautions should be taken during dental treatment of a patient with epilepsy? (3)
- Use strong mouth props
- Keep mouth as free as possible from debris
- Ensure minimal equipment around patient area
What are some dental relevant side-effects of the anticonvulsant Phenytoin? (2)
- Gingival hypertrophy
- Folic acid deficiency
What are some dental relevant side-effects of the anticonvulsant Sodium valproate? (2)
- Thrombocytopenia (low platelets)
- Inhibits platelet aggregation
If a patient has just had a seizure and is in the flaccid phase what should you do?
- Place in recovery position and suction to remove secretions blocking airways
- Administer oxygen (15L/min)
- Administer midazolam
What is Bell’s palsy?
Bilateral or Unilateral?
Acute paralysis of CN VII near stylomastoid foramen
usually unilateral
What is the aetiology of Bell’s palsy?
Inflammation
of the facial nerves at stylomastoid canal
What are some clinical features of Bell’s palsy? (3)
- Pain around jaw/ear
- Unilateral facial paralysis
- Hyperacusis (noise sensitivity)
What is Trigeminal neuralgia?
Characterised by brief electric-shock, lighting-like (lancinating) pain limited to the distribution of one or more divisions
