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CMS1 > STROKES AND SEIZURES > Flashcards

STROKES AND SEIZURES Flashcards

1
Q

How would you describe normal brain activity

A

asynchronous

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2
Q

what type of brain activity causes seizures

A

synchronous/abnormal

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3
Q

what determines the type of seizure

A

location of synchronous/ abnormal activity

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4
Q

types of seizure

A

Focal
generalised
awareness
tonic
atonic
myoclonic
tonic-clonic
absence

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5
Q

describe a tonic seizure

A

increased tone, rigid, stiffness of muscles

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6
Q

describe atonic seizures

A

goes floppy

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7
Q

describe myotonic seizures

A

sudden spasms, myoclonic jerk

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8
Q

describe absence seizures

A

pt very vacant, stare blankly, can lose consciousness

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9
Q

causes of seizures

A

can be provoked or unprovoked

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10
Q

causes of unprovoked

A
  • Structural
  • Genetic
  • Metabolic
  • Autoimmune
  • Idiopathic
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11
Q

causes of provoked

A

caused by acute changes eg:
- Metabolic
- Drugs/ drug withdrawal
- Infection
- Structural-tumour
- Vascular -stroke

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12
Q

what is epilepsy

A

2 or more unprovoked seizures

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13
Q

how is epilepsy diagnosed

A

clinically
brain imaging and EEG
ECG and blood test to rule out provoking causes

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14
Q

how is epilepsy managed

A
  • Anti epileptic medications
  • Surgery
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15
Q

name some anti epileptic medications

A
  • Carbamazepine
  • Clabazam
  • Clonazepam
  • Levetiracetam
  • Lamotrigine
  • Phenytoin
  • Pregabalin
  • Valproate
  • Topiramate
  • Zonisamide
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16
Q

living with epilepsy

A

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

17
Q

questions to ask pts who suffer from seizures

A
  • 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)

18
Q

how to mange tonic clonic seizure

A

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

19
Q

Are these considered epilepsy:
Psychogenic non epileptic seizures
Syncope

A

No

20
Q

what is a stroke

A

acute event, in which blood supply to brain is interrupted causes brain tissue to die, usually one sided

21
Q

Strokes are either…………..

A

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

22
Q

what is a TIA

A

transient ischemic attack-mini stroke- same symptom as stroke, but last for 24 hrs, stroke has long lasting effects

23
Q

what is a Subarachnoid haemorrhage:

A

bleeding on surface of brain, due to aneurysm, very severe headache, stiff neck

24
Q

what are the risk factors for a stroke

A
  • Hypertension
  • High cholesterol
  • Atherosclerosis
  • Diabetes
  • Smoking
  • Drinking
  • Atrial fibrillation
  • PFO
25
Q

what to do of you see someone having a stroke

A

ACT FAST:
Face, arms speech, time

26
Q

how to diagnose a stroke

A
  • Neurology exam
  • CT scan of head
27
Q

how to manage a stroke

A
  • Thrombolysis/ thrombectomy
  • Lumbar puncture/ angiogram
  • Neurosurgery
28
Q

how to manage the aftermath of a stroke

A
  • Antiplatelets or ant coagulants
  • Statins
  • Blood pressure control
  • Physio therapy
  • Occupational therapy
  • Speech and language therapy
  • Psychology
  • Nutrition
29
Q

DENTAL CONSIDERATIONS FOR STROKE:

A
  • 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

CMS1 (23 decks)

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