W16 61 neurological disease Flashcards
What diseases classify as neurological diseases?
Epilepsy
Stroke
Multiple sclerosis (MS) and motor neurone disease (MND)
Headache, neuralgia
What is a seizure?
A rapid and uncoordinated electrical firing in the brain
What are the types of seizures?
Provokes - cause for the seizure, eg high fevers, alcohol, drug withdrawal, low blood sugar
Unprovoked - spontaneous, or more than 7 days after an acute injury or insult such as stroke or brain haemorrhage
What is epilepsy?
Disease of the brain defined by either:
- at least 2 unprovoked (or reflex) seizures occurring more than 24hrs apart
- 1 unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after 2 unprovoked seizures occurring over the next 10 years
What are the different types of epileptic seizure?
Focal, generalised, unknown onset
What is a focal onset seizure?
Seizures start in, and affect, one part of the brain
Can be aware or unaware, motor onset or non-motor onset (with or without physical movement)
What is a generalised onset seizure?
Seizures start in, affect both sides of the brain at once and happen without warning.
Can be motor or non-motor.
Can be unknown onset in the brain or unclassified.
What are some features of specific seizures?
Tonic seizure - short-lived (<1min), abrupt, generalised muscle stiffening with rapid recovery
Generalised tonic-clonic seizure - generalised stiffening and subsequent rhythmic jerking of the limbs, urinary incontinence, tongue biting
Absence seizure - more common in children, brief, sudden lapses of consciousness (look like daydreaming)
Atonic seizure - sudden onset of loss of muscle tone
Myoclonic seizure - brief, ‘shock-like’ involuntary single or multiple jerks
What things are needed to diagnose epilepsy?
Blood glucose - first test
Blood test
CT head - to rule out intracranial pathologies eg brain haemorrhage or space occupying lesions like trauma
Electroencephalogram (EEG)
What is the blood test done for epilepsy?
Sodium imbalance, uraemia, or other metabolic abnormalities
Evaluate for evidence of systemic or central nervous system (CNS)
Toxicology screen
What does an EEG show for epilepsy results?
Done last. Picks up uncoordinated signals in the brain.
Indicated after unprovoked seizure event
Can support diagnoses of generalised or focal onset epilepsy
Negative result does not mean pt does not have the disease
What medical history in dental practice should you take for epilepsy?
Frequency of seizures and how they are controlled
Ask about triggers
Know the emergency drug box
Protect the airways
Take alcohol intake and drug intake
Alcohol increases risks of attack
Check post-seizure - check airway for tongue swelling, sublingual haematoma etc
What should you do (less than 5 mins) for people having a tonic-clonic seizure?
Protect them from injury
Do not restrain them or put anything in their mouth
Monitor for 5 mins
If seizure stops, check their airway and place them in the recovery position
Observe them until they have recovered
Send them to A&E if this is their first seizure or there is breathing difficulty or altered consciousness level
What should you do for people having a tonic-clonic seizure lasting more than 5min, or who have more than 3 seizures in 1 hour?
Buccal midazolam - first line
Rectal diazepam if this not available
Intravenous lorazepam if intravenous access is already established and resuscitation facilities are available - if your practice has the facilities or you are in a hospital setting
Call an ambulance for urgent hospital admission if seizures do not respond properly to treatment
What anti-epileptic drugs are there?
Valproic acid - gingival hyperplasia
Lamotrigine
Topiramate
Carbamazepine
Levetiracetam
What is stroke?
A clinical syndrome of presumed vascular origin characterised by rapidly developing signs of focal or global disturbance of cerebral functions.
Lasts longer than 24hrs or leads to death.
What causes strokes?
85% - ischaemic (caused by thrombus)
15% - haemorrhagic (caused by blood vessel damage)
(Stroke increases the risk of more neurological events)
What is a transient ischaemic attack (TIA)?
A transient (less than 24hrs) neurological dysfunction.
Caused by focal brain, spinal cord or retinal ischaemia, without evidence of acute infarction.
How do you recognise a TIA?
Focal neurological deficit (resolves within 1hr but can persist for upto 24)
Unilateral weakness or sensory loss
Dysphasia - problems with speech
Ataxia, vertigo or loss of balance
Syncope
Sudden transient loss of vision in one eye, aplopia or homonymous hermianopia (loss of visual fields)
Cranial nerve defects
How do you recognise stroke?
Focal neurological deficit
Confusion
Headache - intracranial haemorrhage and subarachnoid haemorrhage. Usually sudden to set, gradual increase in intensity and failure to respond to pain relief.
Visual disturbances
Gaze paresis - often horizontal and unidirectional
Photophobia
Dizziness, vertigo or loss of balance
Nausea and/or vomitting - usually associated with intracranial pressure and haemorrhagic stroke
Specific cranial nerve deficits such as unilateral tongue weakness or Horner’s syndrome (miosis, ptosis, and facial anhidrosis)
Difficulty with fine motor coordination and gait
Neck or facial pain
How do you manage stroke in dental practice?
A-E approach - oxygen, check glucose, reassurance, CPR if needed
Call an ambulance - tell them time of onset: FAST:
Facial weakness - can person smile, has their mouth or eye dropped
Arm weakness - can the person raise both arms
Speech problems - can the person speak clearly and understand what you say?
Time to call 999 - stroke is a medical emergency
How do you manage stroke/TIA (specialists)?
Stroke team review immediately upon arrival
Offer aspirin (300mg daily), unless contraindicated, to people who have had a suspected TIA, to be started immediately
Perform brain imaging immediately with a non-enhanced CT
Thrombolysis with alter place for people with acute ischaemic stroke - within 4.5hrs of onset of stroke symptoms
Thrombectomy - aspirin and anticoagulant treatment
What do patients who have had a stroke take in the long term?
Long-term anticoagulant and anti-platelets
(Increases risks of bleeding)
When should you call an ambulance if you suspect a stroke?
Immediately
What are the issues for dentists with post-stroke patients?
Communication
Manual dexterity and mobility - oral hygiene and access of dental care
What is multiple sclerosis (MS)?
An acquired immune-mediated inflammatory condition of the central nervous system. Causes demyelination, gliosis and secondary neural damage throughout the CNS.
Can affect nearly any part of the CNS.
What are the 3 main patterns of MS?
Relapsing-remitting MS (RRMS) - most common
Secondary progressive MS (SPMS)
Primary progressive MS (PPMS)
What is relapsing remitting MS?
Episodes of exacerbations of symptoms (relapses) are followed by recovery (remissions) and periods of stability
