Neruological Pathology

Question 1

What is Bell’s palsy?

Answer 1

The most common cause of facial nerve paralysis

Question 2

What is the pathogenesis for Bell’s palsy?

Answer 2

Latent herpes virus is reactivated
Inflammation of the nerve

Question 3

What is the difference between LMN and UMN facial palsy?

Answer 3

LMN weakness - whole side of face
UMN weakness - spares forehead muscles, due to stroke or cerebral tumour

Question 4

What are some other causes of LMN facial palsy?

Answer 4

Tumours
Ear infections
Ramsay hunt syndrome
Melkerssons syndrome

Question 5

What are clinical features of Bell’s palsy?

Answer 5

Ear pain
Facial weakness and stiffness
Altered taste
Distortion of sound

Question 6

What is the treatment for Bell’s palsy?

Answer 6

Recover by yourself in 1-2 months
Prednisolone and acyclovir prevent

Question 7

What is the dental relevance of Bell’s palsy?

Answer 7

Parotid tumour facial palsy
Misdirected ID block facial palsy

Question 8

What is trigeminal neuralgia?

Answer 8

Sudden stabbing recurrent pain in trigeminal nerve
30 seconds
No facial weakness or sensory
Electric shock pain

Question 9

What causes trigeminal neuralgia?

Answer 9

Random action potentials from light touch
Blood vessels compressed trigeminal nerve
Secondary to MS, brain lesion

Question 10

What are the clinical features of trigeminal neuralgia?

Answer 10

Spasms of facial pain
Radiates from corner of mouth to ear
Light touch, chewing, shaving, cold wind
Hundreds of times a day

Question 11

What is the dental relevance of trigeminal neuralgia?

Answer 11

Confused with dental pain
Bupivacaine block gives relief

Question 12

What is the treatment for trigeminal neuralgia?

Answer 12

Carbamazepine - controls pain
Cryotherapy
Open cranial surgery

Question 13

What is a stroke?

Answer 13

Sudden neurological disturbance due to blockage or rupture of brain blood vessel
Lasts longer that 24 hours

Question 14

What are the different incidences of a stroke?

Answer 14

Minor stroke - full recovery in less than a week
Stroke in evolution - worsening symptoms
Completed stroke - neuro defecit at its worst

Question 15

What are the 3 main types of stroke?

Answer 15

Ischaemic
Haemorrhagic
Subarachnoid haemorrhage

Question 16

What is an ischaemic stroke?

Answer 16

Blockage of brain stem by embolus from atheroma

Question 17

What can an ischaemic stroke result in?

Answer 17

Horners syndrome
Pseudobulbar palsy

Question 18

What is the treatment of an ischaemic stroke?

Answer 18

Aspirin 150mg daily
Surgery for carotid artery

Question 19

What is a haemorrhagic stroke?

Answer 19

Intracerebral bleed
Less common
Visible on CT scan

Question 20

Who is at risk of a haemorrhagic stroke?

Answer 20

Hypertensives
Coagulation disorders
Genetic

Question 21

What is a subarachnoid haemorrhage?

Answer 21

Rupture of blood vessel into cerebrospinal fluid in subarachnoid space
Circle of Willis berry aneurysm

Question 22

What are signs and symptoms of a subarachnoid haemorrhage?

Answer 22

Severe headache
Pain on knee extension
Unconscious

Question 23

What is the treatment for subarachnoid haemorrhage?

Answer 23

Neuro surgery

Question 24

What are the main risk factors for a stroke?

Answer 24

Atheroma
Diabetes
Smoking alcohol
High RBC

Question 25

What are the telling symptoms for a stroke?

Answer 25

Starts with a bad headache no cause Numbness of face arm leg Confusion Slurred speech Nausea = haemorrhagic

Question 26

What is the dental relevance of a stroke?

Answer 26

Anti platelet medication Weakness of facial area Swallowing Communication Mobility

Question 27

What is epilepsy?

Answer 27

CNS disorder with seizures

Question 28

What are the 2 types of seizures in epilepsy?

Answer 28

Generalised (whole brain): Tonic-clinic Absence - children Myoclonic- jerks of limbs Focal: Simple - consciousness okay Complex - brain From tumours, infarction

Question 29

What is the treatment for epilepsy?

Answer 29

Anti epileptic drugs IV, epistatus for prolonged seizure

Question 30

What is the dental relevance of epilepsy?

Answer 30

Xerostomia Delayed healing Risk of infection Excessive bleeding Gingival hypertrophic

Question 31

How do you manage an epileptic emergency?

Answer 31

Protect airway Examine for dental trauma Do not treat Escort home

Question 32

What is dementia?

Answer 32

Deterioration of memory No disturbance of consciousness

Question 33

What is the cause of dementia?

Answer 33

Alzheimer’s Neurofibrillary tangles and plaques in brain

Question 34

What drugs can be used to treat dementia?

Answer 34

Anticholinesterases Anticonvulsants

Question 35

When is dementia reversible?

Answer 35

Tumour Intracranial lesions Depression B12, folate, thyroxine deficiency

Question 36

What is Parkinson’s?

Answer 36

Idiopathic disorder Resting tremor Rigidity

Question 37

What is the pathology of Parkinson’s?

Answer 37

Degeneration of basal ganglia Loss of dopamine Levy bodies

Question 38

What can cause Parkinson’s?

Answer 38

Drugs alcohol Stroke Trauma Ptsd

Question 39

What are the treatments for Parkinson’s?

Answer 39

Dopamine agonists Amanda dine Anticholinergics - tremor

Question 40

What is the dental relevance of Parkinson’s?

Answer 40

Do not interrupt medication Difficulty swallowing Aspiration

Question 41

What is multiple sclerosis?

Answer 41

Causes attacks of neurological disturbance Demyelination in CNS Not periphery

Question 42

What are the clinical features of MS?

Answer 42

Loss of vision Spinal cord lesions Brain stem lesions Pins and needles

Question 43

What are the 3 types of MS?

Answer 43

Relapsing remitting - attack and full recovery Primary progressive - gradual decline in function Secondary progressive - one episode, remission, reoccurance

Question 44

What is the treatment for MS?

Answer 44

IV oral steroids ACTH Muscle relaxants Anticholinergics

Question 45

What is the dental relevance of MS?

Answer 45

Avoid NSAIDs Increased risk of infection

Question 46

Wat are the 2 types of head injury?

Answer 46

Extradural - blood between skull and dura mater, defined margin on CT Subdural- blood between dural and arachnoid layer of meninges, CT widespread irregular margin