Neurology

Question 1

What are the 3 different types of stroke?

Answer 1

Ischaemic
Haemorrhagic
TIA

Question 2

What are the risk factors for stroke?

Answer 2

Hypertension
Smoking
Atherosclerosis
Ischaemic heart disease

Question 3

How can you prevent stroke?

Answer 3

Reduce the risk factors - smoking, control hypertension, diabetic control
Antiplatelet, anti-coagulant action.

Question 4

What are the effects of stroke in brain?

Answer 4

Loss of functional brain tissue - immediate nerve cell death
Nerve cell ischaemia in surrounding tissues.

Gradual or rapid loss of function depending on location/ extent.

Question 5

What are some complications of stroke?

Answer 5

Motor function loss
Swallowing - aspiration of food and saliva

Sensory loss
Body perception - feeling that one of their limbs is not theirs, phantom limbs

Cognitive impairment - understanding/ processing information, speech

Question 6

What is multiple sclerosis?

Answer 6

A disorder that affects the brain and spinal cord.
De-myelination of axons in CNS lesions.
Has varied symptoms including tiredness, vision problems and problems with walking or balance.

Question 7

What are symptoms of multiple sclerosis?

Answer 7

Muscle weakness
Visual disturbance
Paraesthesia
Autonomic dysfunction
Dysarthria
Pain
Balance/ hearing loss

Question 8

What are some dental aspects of MS?

Answer 8

Limited mobility and psychological disorders
Chronic orofacial pain possible
Orofacial motor and sensory disturbance - suspect younger patients
Enhanced TIRGEMINAL NEURALGIA risk - suspect in younger patients

Question 9

Describe relapsing and remitting type of MS

Answer 9

Acute exacerbation and periods of respite
Damage builds up with each episode

Question 10

Describe primary progressive type of MS

Answer 10

Slow, steady progressive deterioration - cumulative neurological damage

Question 11

What causes motor neurone disease?

Answer 11

Degeneration of the motor nerves in the anterior horns of the corticospinal tracts in spinal cord.
Can also affect bulbar motor nuclei in brain.

Question 12

Why does death typically occur in motor neurone disease?

Answer 12

Ventilation failure
Aspiration pneumonia (unable to use protective function of larynx to keep food/ drink out of lungs when eating - swallowing/ cough)

Question 13

What may patient initially notice in MND?

Answer 13

Weakness in ankle or leg
Slurred speech
Weak grip
Muscle cramps and twitches
Weight loss - as muscles may become thinner over time
Emotional lability - crying or laughing in inappropriate situations.

Question 14

What is treatment of motor neurone disease?

Answer 14

NO treatment
Physiotherapy and occupational therapy
PEG fed

Question 15

MND dental aspects

Answer 15

Difficulty in acceptance of dental care
Realistic treatment planning
Drooling and swallowing difficulties
OH maintenance difficult

Question 16

What is Parkinson’s disease?

Answer 16

Progressive brain disorder that causes unintended or uncontrollable movements such as shaking, stiffness and difficulty with balance and co-ordination

Question 17

What causes Parkinson’s disease?

Answer 17

Degeneration of nerve cells in the basal ganglia (area of brain that controls movement).
Nerve cells in BG produce dopamine, and when these produce less dopamine due to disease, movement is impaired.
It is unknown why the neurons die.

Question 18

What are some clinical signs of Parkinson’s disease?

Answer 18

Bradykinesia - slow movement and slow initiation of movement
Rigidity - increased muscle tone
Tremor AT REST - slow amplitude. Typically in hands and arms and sometimes mandible.
Impairment of gait and falls
Difficulty swallowing
Can progress to on/off (not being able to move at all) movement disorder - often after treatment.

Question 19

Parkinson’s treatment

Answer 19

Physiotherapy and occupational therapy - work to maintain function at as high a level for as long as possible.

Anti-cholinergics - very effectively initially but dose needs to be gradually increased over time to retain effectiveness. Side-effects eventually become un-tolerable.

Surgery

Question 20

What are the dental aspects of Parkinson’s?

Answer 20

Difficulty accepting treatment
- Tremor of body at rest
- Often facial tremor reduces on purposeful movement - mouth opening. Do not be put off by mandibular tremor.

Dry mouth - anticholinergic effects of the drugs.

Drug interactions??