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Diseases Of Human Systems BDS3 > Neuroloigcal Dieases > Flashcards

Neuroloigcal Dieases Flashcards

1
Q

What is a stroke

A

A stroke is an acute focal neurological deficit resulting from cerebrovascular disease and lasting more than 24 hours or causing earlier death

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2
Q

What happens to the tissue in a stroke

A

There is death of brain tissue from hypoxia, there is no local cerebral blood flow and haemorrhage into the brain tissue

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3
Q

What is a transient ischaemic attack?

A

This is when there is rapid loss of function but rapid recovery within 24hrs.

Following this attack this raises the patients chance of having a stoke in the future

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4
Q

What does the acronym FAST stand for with regards to a stroke?

A

F- facial drooping
A- arm weakness
S- speech difficultly
T - Time ( how long has this been happening for)

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5
Q

What is thought to be the cause of a tia?

A

Thought that these happen because of platelet emboli within the vessels in the head
These platelets block blood flow causing ischaemia but are rapidly removed by the circulation and blood flow is restored before any permanent damage occurs

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6
Q

What figure diastolic blood pressure reading would puta patient 15x more at risk of a stroke than a patient with diastolic pressure of <80mm Hg

A

> 110mm Hg

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7
Q

Why is AF a risk factor for stroke

A

This is because emboli from abnormally contracting atria passing though ventricle up into the cerebral circulation causing ischamia

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8
Q

Name three other risk factors for stoke

( Not including AF and hypertension)

A

Smoking/alcohol
Ischaemic heart diease
Diabetes

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9
Q

When are three instances that an embolic stroke may occur

A

Embolism from left side of the heart
- Recent MI
- Heart valve diease
-Atrial. Fibrillation

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10
Q

What kind of aneurysm may be seen at weakpoints in an angiogram

A

Berry aneurysm

Can be a familial link

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11
Q

An infarction in a stroke is much more difficult to see, what kind of scan would you order

A

MRI
Shows more clearly than a CT the inflammatory change

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12
Q

What are three risk factors that should be reduced in order to aid in stroke prevention

A

Smoking, diabetes control and controlling hypertension

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13
Q

Surgery can be an option for prevention of stroke in which situations and what happens in the surgery?

A

Surgery can be an option when the coronary artery is heavily involved.
Carotid Endarterectomy

In these cases there is a large amount of atherosclerosis around the carotid furcation.
- in some cases complete excision happens taking the full artery away
- collateral blood supply of the head and neck is good and cope

In other occasions the surgeon will instead try to remove the plaque and make the area more patent

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14
Q

When ordering investigations for a stroke and haemorrhage why do you need to differentiate infarct, bleed or a haemorrhage

A

For a haemorrhage a CT should be ordered
Bleed - angiogram
Infarct - MRI

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15
Q

Name some complications of a stroke

A

Motor function - cranial nerve or somatic ( opposite side)
Sensory loss - ‘’. ‘’
Swallowing may be affected - can be an aspiration risk for patients, which can subsequently lead to pneumonia and death

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16
Q

There are two phases of stroke management, what are they

A

Acute phase - limit damage and reduce future risk

Chronic phase - rehab and reduce future risk

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17
Q

Why is it so important that there is normoglycaemia during the acute phase of treatment for a stroke

A

Brain is dependant on glucose for energy stores so if this is not available the patient will exaggerated damage from the stroke

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18
Q

What kind of drugs would be prescribed in the acute phase of stroke Treatment

A

Calcium channel blockers such as nimodipine are prescribed to act as anti-hypertensive medication

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19
Q

How do we prevent future risk of a stroke in the acute phase of stroke treatment

A

Aspirin 300mg daily
Anti-coagulation if indicated
- AF
- left ventricular thrombosis

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20
Q

What does the chronic phase of the stroke treatment include

A

This is about nursing and rehabilitation for the patient
Immobilty support, speech and language therapy and occupational therapy

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21
Q

What is ‘stroke pain’

A

Damage to the brain can change the way the brain understands its environment and can report pain but it is centrally herniated within the CNS and not actually due to peripheral stimulation

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22
Q

Partietns that have had a stroke may struggle with their sensory information, why may this be a problem in dentistry

A

This may mean that it is difficult for them to adapt to new oral environments e.g. dentures

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23
Q

What happens in epilespy

A

Epilespy is associated with reduced GABA levels in the brain.
This leads to abnormal cell-cell propagation
- meaning that it takes less stimulation for a neuron to fire and pass the message to another cell.

This causes an abnormal chain reaction to be set up causing an abnormal discharge of that’s of neurons either in one area or throughout the brain leading to the changes that we see.

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24
Q

What is reduced in epilespy

A

Epilepsy is associated with reduced GABA levels in the brain

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25
Q

What is GABA

A

It it an inhibitory neurotransmitter

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26
Q

If a patient is having a febrile seizure, they demonstrate the same symptoms as a tonic clonic seizure, how can you tell the difference

A

Febrile seizures are largely in children and they are only when a child has a FEVER.

This does not mean that the child is epileptic - just that they are prone to febrile seizures

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27
Q

Children above 38 degrees are at risk of febrile seizure, how can you cool hot children down?

A

Paracetamol and ibuprofen should be given
Remove the child’s clothing
Cool sponging and bath

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28
Q

There are two types of epileptic focus what are they

A

Central and partial

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29
Q

What is central focus in epilepsy

A

This sends signals out to all parts of the Cortex so are parts of the body are involved in the seizure

30
Q

What is partial focus in epilepsy

A

The primary area will be affected by the seizure and this can be any modality in the body.
this can affect motor or perception/sensation
hear, smell,see, taste something that is generated in the brain by epileptic focus not present in their environment.
Must be wary of this when patients are presenting with symptoms with no obvious cause

31
Q

What is a tonic clonic seizure?

A

In these seizures the patient is aware of the change in their brain function.
They experince an initial TONIC (stiff) - where all the joints contract together putting a huge strain on the spine.
there is then the CLONIC (contraction/relaxation) - intermittent contraction, patient seeming to jerk/spasm

32
Q

A patient experiencing a tonic clonic seizure will experince, prodromal aura. What is this?

A

The patient has an awareness in the change in their brain function, they may not be able to report it to you but they have a change in the awareness of their actions

33
Q

What is status epilepticus?

A

A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes is called status epilepticus. This is a medical emergency that may lead to permanent brain damage or death.

If this continues to happen it can be vary dangerous a normal breathing muscles cannot operate and the patient will become hypoxic

34
Q

What is a petit mal( absence) seizure?

A

These are short levied episodes - sometimes only lasting 5-15 seconds, there can be multiple attacks in a single day

It is a loss of awareness.
It usually happens in childhood

35
Q

What are some symptoms of someone having a petit mal seizure?

A

Loss of awareness
- eyelids flutter
- vacant stare
-stops activity
- loss of response

36
Q

Medically how can you help someone having a tonic clonic seizure?

A

Protect them from INJURY
- help to guide fall if possible
- remove things from mouth if possible

Asphyxia
- use supplemental 02
-suction any secretions

37
Q

How may aspiration lead to sudden death in epilepsy patients

A

Ther can be aspiration of the gastric contents which have refluxed leading to acute lung damage

38
Q

Sodium valproate can often be used to treat tonic clonic seizures, in what situation should we be careful with this medication as it can be harmful

A

This drug can be harmful in pregnancy

39
Q

Tonic clonic seizures are most often idiopathic - however what are some precipitating factors?

A

Poor compliance or withdrawn of medication - patients often do not like the side affects or stop medicine before staring on a new one

Mentrustion
Fatigue/stres
Infection
Antidepressants and some GA agents

40
Q

What is a Jacksonian seizure?

A

This happens in a partial focus seizure

The paietnt will start with a small tremor at extremity of upper limb and it will aggressively move up towards the neck

41
Q

What symptoms might a patient get during a partial seizure?

A

Tends to be sensory
- visual or auditory hallucinations
- can have a taste in thier mouth
- strong smell

42
Q

What happens during a complex partial seizure?

A

This is when different areas of the brai are affected which produce connected Movements.
This leads to repeated purposeless movement

E.g.lip smacking, grimacing - both which require a variety of muscles

43
Q

Name some common preventative anticonvulsant medications prescribed for epileptic patients. With tonic clonic seizures

A

Valproate, carbamazepine and phenytoin
Gabapentin

44
Q

What may levitiracetam be used to treat

A

Absence seizures

45
Q

How does valproate work

A

This drug is a gaba transaminase inhibitor

46
Q

When would surgery be used in epilepsy treatment

A

This can be used to removal focal neurological lesions - such as a brain tumour ( begin)

It can also be used when there is an identifiable point of origin within the brain that isn’t well controlled by medication - focal seizures

47
Q

When treating an epileptic patient what are some questions you might ask to determine the patients risk level

A

When did the last three fits take place?
- this gives a good indication of how likely they are to have one in the chair
- ask about compliance with medication
- ask about changes in medication

48
Q

How may complications of fits affect the patients dental care

A

When they fall they may cause a dental injury/fracture or may cause an oral soft tissue injury

The medication can have dentally related side affects such as phenytoin - gingival hyperplasia
Valproate can lead to bleeding tendency

49
Q

Multiple sclerosis, motor neurone disease and Parkinson’s diease

What do these three diseases ask have in common

A

They are slowly progressive diease which stop proper neurological function.

They can be quicker in some, slower in others but decline will occur

50
Q

Why does multiple sclerosis happen

A

It happens due to the DEMYLINATION of axons, it happens due to inflammatory change

Progressive functional loss which leads to permanent neurological deficit causing loss of function

51
Q

What symptoms may a patient complain of when suffering from multiple sclerosis

A

Muscle weakness
Visual disturbance
Paraesthesia - may present to dentist with sudden loss of facial feeling
Dysarthria - muscles weakness so cant talk properly

52
Q

What signs might a clinician report in a patient with multiple sclerosis

A

Muscle weakness
Spasticity- happens in UMN lesion
Tremor
Optic atrophy - condution speed of nerve will be slower
Proprioception loss and loss of touch

53
Q

In a CSF analysis of a patient of Multiple sclerosis, what might be the findings?

A

Reduced lymphocytes
Increased IgG proteins

54
Q

Why does patient with multiple sclerosis unfortunately eventually end up disabled?

A

The damage to the CNS builds up with each episode and many will eventually develop progressive form ( secondary progressive)

55
Q

What is the difference between the primary and secondary progressive types of MS

A

Primary - slow steady progress, cumulative damage. There is no exacerbation and remission just a slow detioration.

Relapsing and remitting type. - damage builds with each episode and this collective damage will eventually develop secondary progressive form

56
Q

What are physiotherapy and occupational therapy aiming to do. While treating MS patients?

A

They are aiming to reduce function loss but they cannot reduced Madge

57
Q

If a patient presents to you with sdden loss of facial motor function, what should you suspect and what investigation should be ordered

A

Suspect MS
Investigation should be an MRI

58
Q

What happens in motor neurone disease?

A

There is degeneration in the spinal cord of the motor nerves in the anteior horns
The corticospinal tract

59
Q

Why may patients with motor neurone disease experience hypoxia

A

Because there is progressive loss of motor function in this diease and this can affect the intercostal muscles and the diaphragm - impairing ventilation - leading to hypoxia

60
Q

What are two main causes of death in motor neurone disease

A

Ventilation failure - type 2 respiratory failure
Aspiration pneumonia - patient is no longer able to use protective relflexes in pharynx to keep material out of lungs when eating

61
Q

What might the patient notice, when they have motor neurone disease?

A

They may find that they have weakness in thier ankle/leg - which can cause them to trip and can eventually lead to them tripping.

They may experience slurred speech- eventually leading to swallowing difficulties.

A weak grip - droppping things, or finding it hard to open jars or do up buttons

62
Q

What is the treatment for motor neurone dieSEASE?

A

There are no effective
Physiotherapy and occupational therapy
Aspiration prevention - PEG fed and reduce salivation

63
Q

Why might someone with motor neurone diease have thier saliva reduced?

A

This is to prevent saliva containing oral bacteria being aspirated back into the lungs

64
Q

What happens to the brain in Parkinson’s dieseae

A

Degeneration of dopaminergic neurones in the basal ganglia of the brain ( substantia nigra)

The underlying cause is unknown

65
Q

In Parkinson’s one of the clinical signs can be bradykinesia, what is this

A

Slow movement and slow initiation of movement

66
Q

A resting tremor is a key feature in which degenerative brain disease?

A

Parkinson’s

67
Q

How may Parkinson’s manifest clinically

A

The. Patient may have impaired gait and falls
Impaired use of upper limbs
Swallowing issues

68
Q

What is the aim of physical support in Parkinson’s

A

Physio and occupational therapy work to maintain function at a high level for as long as possible.
They try to Maximise living ability with that function

69
Q

What is levodopa used to treat
and what is the problem with it

A

This is used to treat patients hat have Parkinson’s diease

It is a effective at the beginning however the dose needs to be continually increased to keep that benefit so then the side affect eventually become intolerable

70
Q

Dopamine analogues can b used in patients with Parkinson’s to mimic the affect of dopamine ( promipexole and apomorphine ), however what can these drugs lead to

A

These medications can lead to compulsions and issues with gambling so the patients family must be made aware of this.

71
Q

Why must a dentist be patient with someone who has Parkinson’s

A

These patients can often have difficulty accepting treatment due to access, movement and cooperation. The dentist must be aware that they may take some time to be compliant

Diseases Of Human Systems BDS3 (5 decks)

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