STROKES AND SEIZURES Flashcards
How would you describe normal brain activity
asynchronous
what type of brain activity causes seizures
synchronous/abnormal
what determines the type of seizure
location of synchronous/ abnormal activity
types of seizure
Focal
generalised
awareness
tonic
atonic
myoclonic
tonic-clonic
absence
describe a tonic seizure
increased tone, rigid, stiffness of muscles
describe atonic seizures
goes floppy
describe myotonic seizures
sudden spasms, myoclonic jerk
describe absence seizures
pt very vacant, stare blankly, can lose consciousness
causes of seizures
can be provoked or unprovoked
causes of unprovoked
- Structural
- Genetic
- Metabolic
- Autoimmune
- Idiopathic
causes of provoked
caused by acute changes eg:
- Metabolic
- Drugs/ drug withdrawal
- Infection
- Structural-tumour
- Vascular -stroke
what is epilepsy
2 or more unprovoked seizures
how is epilepsy diagnosed
clinically
brain imaging and EEG
ECG and blood test to rule out provoking causes
how is epilepsy managed
- Anti epileptic medications
- Surgery
name some anti epileptic medications
- Carbamazepine
- Clabazam
- Clonazepam
- Levetiracetam
- Lamotrigine
- Phenytoin
- Pregabalin
- Valproate
- Topiramate
- Zonisamide
living with epilepsy
DVLA-pts have to inform DVLA
Safety-advised not to take bath alone etc
Drug interactions and side effects
SUDEP- can suffer from sudden unexplanined death esp in - tonic -clonic seizures
questions to ask pts who suffer from seizures
- Type of seizure
- Frequency
- Duration
- Most recent-might want to delay procedures if having a flare up
- Care plan?
- Typical recovery-how long is post ictal phase
Prolonged seizures, or serial seizures (more than three in an hour is concerning)
how to mange tonic clonic seizure
STOP:
- Safety-lower dental chair, don’t hold pt down,protect airways, remove instruments, fingers form mouth
- Time-time seizure- if longer than 5 mins considered prolonged- call an ambulance
- Oxygen -15 L of oxygen via non rebreather mask
- Plan
Give Midazolam
Post ictal:
- Recovery position
- ABCDE
- Wean oxygen
- Discharge-monitor for an hour
Are these considered epilepsy:
Psychogenic non epileptic seizures
Syncope
No
what is a stroke
acute event, in which blood supply to brain is interrupted causes brain tissue to die, usually one sided
Strokes are either…………..
ischaemic- caused by blockage to blood flow, caused by blood clot or thrombosis 85% of stroke
OR
* haemorrhagic- caused by bleeding of arteries supplying brain, intra cerebral vessels, more elderly pts
what is a TIA
transient ischemic attack-mini stroke- same symptom as stroke, but last for 24 hrs, stroke has long lasting effects
what is a Subarachnoid haemorrhage:
bleeding on surface of brain, due to aneurysm, very severe headache, stiff neck
what are the risk factors for a stroke
- Hypertension
- High cholesterol
- Atherosclerosis
- Diabetes
- Smoking
- Drinking
- Atrial fibrillation
- PFO
what to do of you see someone having a stroke
ACT FAST:
Face, arms speech, time
how to diagnose a stroke
- Neurology exam
- CT scan of head
how to manage a stroke
- Thrombolysis/ thrombectomy
- Lumbar puncture/ angiogram
- Neurosurgery
how to manage the aftermath of a stroke
- Antiplatelets or ant coagulants
- Statins
- Blood pressure control
- Physio therapy
- Occupational therapy
- Speech and language therapy
- Psychology
- Nutrition
DENTAL CONSIDERATIONS FOR STROKE:
- Defer treatment for 6 months
- Accessibility-wheel chair etc
- Difficulty swallowing / chewing
- Risk of aspiration
- Drug interactions & side effects
- Potential sensitivity to sedatives / opioids
- Limit LA & avoid adrenaline in gingival retraction
