Neurology For Dentists Flashcards
1
Q
Name a few types of common neurological complaints
A
Headaches/Orofacial pain Meningitis Cerebrovascular accidents Parkinsonism MS Epilepsy
2
Q
What is the most common neurological complaint
A
Headaches (often chronic)
3
Q
What are headaches usually caused by
A
- Local Disease (tumour maybe)
- Vascular Disease
- Referred Pain
- Neurological disorders
- Psychogenic disorders
4
Q
What are migraines most commonly caused by
A
Intra and extra cranial blood vessels dilatation and inflammation
5
Q
What are some triggers for migraines
A
Stress, caffeine, alcohol, weather, certain foods (choice/cheese), low blood sugar, bright light, lack of sleep
6
Q
What are the clinical features of a migraine
A
Headache usually unilateral and throbbing
Associated Sx = nausea, vomiting, photophobia and phonophobia
7
Q
What management options are there for migraines
A
Avoid the triggers
Acute attacks with triptans
Frequent attacks with B-blocker i.e. propranolol
8
Q
What are the clinical features of migrainous neuralgia/cluster headaches
A
- Unilateral pain around the eye, frontal, cheek and temporal area
- Ipsilateral lacrimation, photophobia, nasal stuffiness and rhinorrhorea
- Recurrent in separate bouts with daily or almost daily attacks for weeks/months
9
Q
What are the management options for migrainous neuralgia/ cluster headaches
A
- High flow oxygen
- Triptans
- Verapamil
10
Q
How does triptans work to reduce migraines
A
- Releases Serotonin in the brain that reduces inflammation and constricts the blood vessels
11
Q
What serious conditions can cause a headache
A
- Acute glaucoma
- Acute hypertension
- Brain tumours
- Giant cell arteritis
- Meningitis
- Subarachnoid haemorrhage
- Subdural or epidural haemorrhages
12
Q
What are the indicators of seriousness in headaches
A
- Abrupt, severe/bilateral headache
- Confusion, neck stiffness, diplopia, weakness/numbness
- Disruption of normal life and over age of 55
- Preceded head injury
13
Q
What are some of the clinical features of giant cell arteritis
A
- Fever
- Temporal headache
- Pain in the jaw and chewing
- Tenderness of the temporal artery
- Recurrence in children
- Worsening after coughing or exertion
14
Q
What does a strokes onset like
A
Rapidly developing symptoms/signs of loss of focal CNS function - like unilateral weakness in the arm
15
Q
How long do stroke symptoms last for
A
More than 24 hours or they lead to death
16
Q
What are the 2 types of stroke
A
Ischaemic
Haemorrhagic
17
Q
What causes ischaemic stroke (most common)
A
Atheroma formation in the carotid artery or intracerebral artery or an emboli that comes from the heart and travels to the brain and blocks a blood vessel
18
Q
What causes haemorrhagic stroke
A
Burst blood vessels in the brain
19
Q
What are the risk factors for a stroke
A
- Hypertension
- Diabetes Mellitus
- Hyperlipidaemia
- Heart Disease
- Atrial Fibrillation
- Excess alcohol
- Smoking
- Carotid artery occlusion
- Polycythaemia vera
20
Q
What changes in lifestyle factors can be made to reduce the risk of stroke
A
- Maintain a healthy weight
- Eat healthily
- Regular exercise
- Reduce alcohol intake
- Stop smoking
21
Q
What targets of drug treatment can be used to reduce the risk of stroke
A
- Treat hypertension
- Treat high cholesterol (diet and statins)
- Atrial fibrillation (beta blockers and anticoagulants
- Keep good glycemic control if diabetic
22
Q
What do the clinical manifestations of a stroke depend on
A
On the vascular territory affected
23
Q
What are some typical clinical features of stroke
A
- Facial weakness or numbness
- Hemiplagia (unilateral leg or arm weakness of both)
- Speech disturbance
- Sudden visual deterioration
- Dysphagia
24
Q
What investigations would be done if you suspect a stroke
A
- Assess the patients risk factors - hypertension and ECG, smoking, drinking etc.
- CT head scan to distinguish ischaemic and haemorrhagic and other differentials like tumours or hematomas
25
How does a haemorrhage appear in a CT scan
Dense and white
26
How does ischaemia appear in a CT scan
Darker
27
What treatments are there for stroke
- Admission to a stroke unit for rapid clinical assessment
- Aspirin (300mg) should be given as soon as possible after the onset of stroke symptoms once a diagnosis of primary haemorrhage has been excluded
- Thrombolysis (intravenous tissue plasminogen activator) - eligible for ischaemic stroke and ineligible for haemorrhagic stroke - risk of haemorrhage
28
How fast should treatment be given after the onset of stroke symptoms
4 hours
29
What are the dental aspects of treating someone who has had a stroke in the past
- Impaired mobility and communication - speak slower and simply
- Oral hygiene deterioration on paralysed side - suggest electric toothbrush or manual with adapted holder
- Modifications during dental treatment- treatment in upright position and good suction to prevent foreign objects from entering the pharynx
- Monitor BP and anticoagulation status
30
What is a Transient Ischaemic Attack (TIAs)
Mini strokes commonly caused by thromboembolism from an atheroma in the carotid vessels
31
What symptoms of Transient Ischaemic Attacks (TIAs) are there
Sudden loss of focal CNS function
Speeh disturbance
Weakness and numbness in limbs
32
How long do the clinical manifestations of Transient Ischaemic Attacks last for
Minutes/hours that fully resolve within 24 hours
33
What are some risk factors for Transient Ischaemic Attacks (TIAs)
- Smoking/alcohol
- Hypercholesterolaemia
- Atrial fibrillation/valvular disease
- Hypertension
- Diabetes Mellitus
34
What are some preventative measures for Transient Ischaemic Attacks (TIAs)
- Stop drinking/smoking
- Reduce cholesterol by diet or drugs (statins)
- Anticoagulant (warfarin, NOAC)
- Antiplatelet (aspirin, clopidogrel)
- Treat hypertension
- Keep blood sugar under control
35
What does Parkinson's disease affect the most
The substantia nigra of the basal ganglia where dopamine is the neurotransmitter
36
What is Parkinson's caused by
Gradual and progressive death of neutrons in the substantial nigra - loss of dopamine leads to less stimulation of the motor cortex and slower onset of movements
37
When do symptoms for Parkinson's appear
When 60-80% of dopaminergic neurones are lost
38
What does the substantia nigra normally do
Sends dopamine releasing signals to the cordic nucleus? basal ganglia and this sends signals to the motor cortex and neurones to do movement
39
What are the clinical features of Parkinson's
```
Akinesia:
- Bradykinesia
- Poverty of facial expression
- Difficulty changing position
- Quiet monotonous speech
Gait:
- Flexed or stooped posture
- Reduced arm swing on walking
- Postural instability
Tremor/Rigidity
```
40
How does dopamine replacement therapy work for Parkinson's
L-Dopa + Carbidopa = Co-careldopa
L-Dopa is broken down into Dopamine and travels in a vesicle to the synapse where dopamine is released and will bind to receptors and stimulate motor cortex to move
41
How does dopamine agonist therapy work for Parkinson's, include named examples
Bromocriptine, Pergolide, Ropinirole
| These binds directly to the dopamine receptors
42
What does selegiline do to treat parkinson's
Inhibits dopamine metabolism by inhibiting monoamine oxidase type B
43
What does entacapone do to treat parkinson's
Inhibits Dopamine and L-dopa breakdown by inhibiting Cathechol-O-methyl transferase
44
Name some anticholinergic drugs and how they help to treat Parkinson's
Procyclidine and benzotropine
| These reduce tremors at rest but have side effects like dry mouth
45
Why can't L-dopa be given alone
As 97%+ will only be present in the peripheral circulation and can't enter the brain and this will cause a lot of side effects like nausea, vomiting, arrhythmia and postural hypertension
46
Why do we give carbidopa along with L-dopa for dopamine replacement
It inhibits the DOPA decarboxylase enzyme so less Dopamine is released into the peripheral circulation so less side effects
47
What are the dental aspects relating to Parkinson's disease
- Lack of expression doesn't mean lack of reaction or intelligence
- Minimise anxiety as it increases tremor that may affect the tongue/lip
- Avoid LA with epinephrine that can interact with L-dopa + Dopa decarboxylase inhibitor and COMT inhibitors
- Anticholinergic drugs - dry mouth and hallucinations
48
What can be caused by the interaction between epinephrine and L-Dopa + Dopa decarboxylase inhibitor and COMT inhibitors
Tachycardia
Arrhythmias
Hypertension
49
Why might you need to protect the airways of a patient with Parkinson's
They may have dysphagia and trouble swallowing so might need rubber dam or some shit
50
What is multiple sclerosis and who is it common in
- Chronic relapsing neurological disorder affecting young adults, thought to be autoimmune
- More common in females than males
- Can develop at any age
- Usually presents between 20 and 40 years
- More common in temperate areas than tropical climate
51
What parts of the body are affected by multiple sclerosis
Affects the white matter of the brain, spinal cord and optic nerves
- Forms multiple foci of inflammatory demyelination (plaques) and scarring (sclerosis)
52
What are the consequences of multiple sclerosis
Reduction in conduction velocity, loss of information conveyed by impulse traffic along various pathways
53
What is the most common form of multiple sclerosis and how does the level of disability develop over time
Relapsing-remitting MS
| Unpredictable attack that may or may not leave permanent deficits followed by periods of remission
54
What is the 2nd most common form (10-20%) of MS and how does the level of disability develop over time
Primary progressive MS
| Steady increase in disability without attacks
55
What is the 3rd most common form of MS and how does the level of disability develop over time
Secondary progressive MS
| Initial relapsing-remitting MS that suddenly begins to have decline without periods of remission
56
What is the least common form of MS and how does the level of disability develop over time
Progressive relapsing MS
| Steady decline since onset with super-imposed attacks
57
What are some clinical features of MS
Central - Fatigue, depression, unstable mood
Visual - optic nerve inflammation, diplopia
Musculoskeletal - weakness, spasms, ataxia
Bowel - incontinence, diarrhoea or constipation
58
What is done to manage acute relapses of MS
High dose corticosteroids e.g. methylprednisolone
59
What drugs can be given to modify the number of relapses
Immunosuppressants - azathioprine, methotrexate and cyclophosphamide
Disease Modifying Therapies 0 Beta-interferons, glatiramer, natalizumab and mitoxantrone
60
What can be done to treat the depression, spasms and bladder dysfunction of MS
Depression - SSRIs, tricyclics
Spasms - Muscle relaxants - benzodiazepine
Bladder dysfunction - anticholinergic drugs
61
What symptoms are likely manifestations suggestive of advanced MS
Trigeminal neuralgia - often bilateral
Facial para/anaesthesia - numbest of lower lip and chin
- Facial Palsy
Abnormal facial or intraoral pain and discomfort
Difficulty swallowing
Lhermitte phenomenon - tingling sensation (arms or legs) on neck flexion
62
What are the dental aspects to consider of MS
- Shorter appointments - unable to keep mouth open for long
- Treat in morning - fatigue is less pronounced
- Treat in semi-supine position - respiratory problems
- Emphasis on preventative care
63
What does motor neurone disease do
Leads to progressive paralysis and eventual death, gradually muscles under voluntary control are affected
64
What are the clinical features of Motor neurone disease
Limb weakness - usually affects the upper limbs and/or lower limbs
Bulbar onset - Slurred speech, dysphagia, accompanying emotional liability
Respiratory onset - dyspnoea and orthopnoea
65
What's done to diagnose motor neurone disease
Clinical examinations
EMG/nerve conduction studies
CT/MRI brain and spinal cord - excludes other pathologies
66
What can be done to manage motor neurone disease
- No cure
- Supportive care, MDT + management of symptoms
- Drug: riluzole - disease modifying efficacy
67
What dental aspects are there relating to motor neurone disease
- Impaired oral hygiene
- Poor mobility and co-ordination
- Protection of airway may be impaired
68
What happens to the grey matter in epilepsy
Recurrent occasional, sudden, excessive, rapid and local discharges of the nerve cells in grey matter
69
What kind of disorder is epilepsy and what characterises it
It is a paroxysmal disorder characterised by intermittent, stereotyped attacks of altered consciousness, motor or sensory function, behaviour or emotion
70
What happens in a grand-mal/tonic clonic seizure and who is this most common in
Aura - becomes irritable and loses consciousness
Tonic phase - rigidity
Clonic phase - jerking movements, lots of salivation
Recovery phase - confused and stuff
Common in adults
71
What happens in a petit-mal/absence seizure and who is this most common in
Common in children
Presents with repetitive rapid blinking, child stares into space
72
What is status epilepticus
Medical emergency where the seizure lasts more than 5 minutes or patient gets 2 or more seizures within 5 minutes with no regain of consciousness
