Neurologic Disease (Desai) Flashcards
(112 cards)
1
Q
Why do we care about a patient’s systemic diagnoses when planning our dental treatment?
A
So we can give safe, modified treatment
2
Q
What are 2 major types of Epilepsy?
A
- Epileptic syndromes
2. Seizure types
3
Q
What are the 2 main types of Epilepsy seizure types?
A
- Partial
2. Generalized
4
Q
Of the epilepsy seizure types, which one involves a problem with the entire cerebral cortex?
A
Generalized
5
Q
Does a “simple” seizure involve a loss of consciousness?
A
No, complex seizures involve loss of consciousness
6
Q
What is the cause of epilepsy?
A
Abnormal spontaneous electrical activity in the brain
7
Q
Is epilepsy a one-time thing?
A
No. It is chronic, recurrent, paroxysmal (sudden, violent)
8
Q
What are the general changes experienced in epilepsy?
A
- Altered neurologic function
- Altered consciousness
- Involuntary movement
9
Q
What is a spontaneous uncontrollable excessive discharge of cerebral neurons that depolarize in a synchronized fashion and may result in an abrupt suspension of motor, sensory, behavioral, or body function?
A
Seizure
10
Q
What is a physical sign of seizure activity?
A
Convulsion
11
Q
What is the term for 3 or more recurrent seizures?
A
Epilepsy
12
Q
What is the major etiology for greater than 50% of epilepsy?
A
Idiopathic
13
Q
What are 6 known factors leading to epilepsy?
A
- Vascular abnormality
- Intracranial neoplasm
- Head trauma
- Hypoglycemia
- Drug withdrawal
- Infection or febrile (fever) illness
14
Q
Grand Mal seizures are what type of seizures: partial/generalized, absence or convulsive?
A
Generalized tonic-clonic convulsion
15
Q
What is the term for a momentary sensory alteration that produces an unusual smell or visual disturbance”, preceding convulsion?
A
Aura
16
Q
What follows aura, caused by a spasm of diaphragmatic muscles?
A
Epileptic cry
17
Q
What is the phase of grand mal seizure having muscle rigidity, dilated pupils, eyes roll upward or to the side, unconscious?
A
Tonic phase
18
Q
What is the hase of grand mal seizure having uncoordinated movement, jaw clenching, head rocking, urinary incontinence?
A
Clonic phase
19
Q
How long does the ictus (seizure) last?
A
Approximately 90 secs to a few minutes, then pt gradually regains consciousness being in a stupor, with a headache, confusion, and mental dullness
20
Q
What other diagnostic tool besides history of seizures is used to diagnose epilepsy?
A
Electroencephalogram
21
Q
What are the neurons doing in a seizure?
A
Firing all at the same time
22
Q
What is key before treating a patient with epilepsy?
A
Determining nature, severity, control and stability of the disease
23
Q
Do well-controlled seizure disorders pose any specific management problems?
A
No
24
Q
During a seizure, should any restraint be placed on the patient?
A
Only passive restraint to keep the patient and others safe
25
Into what position should you attempt to place a seizing patient and why?
On the side to avoid aspiration
26
Should the operator attempt to use a padded tongue blade while the patient is seizing?
No
27
What should be done first after the patient stops seizing?
Examine for traumatic injuries
28
Should treatment be continued if the patient has a seizure?
No. Arrange for patient transport.
29
What position is best for the dental chair while the patient is seizing?
Supine with headrest supported by operator chair
30
What is the term for repeated seizures over a short period of time WITHOUT a recovery period (considered a medical emergency)?
Status epilepticus
31
What is the most frequent cause of status epileptics?
Abrupt withdrawal of anticonvulsant medication or an abused medication
32
What are three "other" causes of status epileptics (other than withdrawal from anticonvulsant medication or an abused medication)?
1. Infection
2. Neoplasm
3. Trauma
33
What is the risk associated with status epileptics?
The patient becomes hypoxic or acidotic leading to brain damage or death
34
What are 6 things to do in an epileptic emergency?
1. Airway
2. Breathing
3. Circulation
4. Oxygen
5. Monitor
6. IV Line
35
What are 2 drugs that can be given IV to break Status Epilepticus?
1. Lorazepam (ativan)
| 2. Diazepam (valium)
36
Of the benzodiazepines, Lorazepam or Diazepam, which is preferred because it is “more efficacious and lasts longer”?
Lorazepam
37
What is a side effect for anti-seizure medication (dilantin / phenytoin)?
Gingival hyperplasia
38
What is a serious and potentially fatal neurologic event caused by a sudden interruption of oxygenated blood to the brain caused by a cerebral vessel blockage or vessel rupture that results in a portion of the brain undergoing infarction, being deprived of oxygen and nutrients?
Cerebrovascular Accident (CVA)
39
Symptoms of a stroke depend on what?
The area of the brain affected
40
What are 8 risk factors for a cerebrovascular accident (CVA)?
1. Hypertension
2. Congestive heart failure
3. Diabetes Mellitus Type I
4. History of TIAs or CVAs
5. More than 75 years old
6. Hypercholesterolemia
7. Coronary atherosclerosis
8. Smoking
41
If the patient has a TIA in the chair, should they be free to go?
No. Get them to the hospital as they risk another TIA or full stroke.
42
What is the number one risk factor for stroke?
Hypertension
43
What are 4 events associated with stroke?
1. Transient Ischemic Attack
2. Reversible Ischemic Neurologic Deficit (RIND)
3. Stroke-in-Evolution
4. Completed Stroke
44
What is the term for a "mini stroke" consisting of a brief (less than 10 minutes) period of focal neurologic deficit that is rapid in onset, but resolves without permanent neurologic damage?
Transient Ischemic Attack (TIA)
45
A transient ischemia of a TIA be a prodome of what?
Impending stroke
46
What is similar to a TIA, but does not clear in 24 hours, though the patient eventually recovers with no neurologic deficits?
Reversible Ischemic Neurologic Deficit (RIND)
47
What is the term for when deficits are present for several hours and continue to worsen and lead to a completed stroke?
Stroke-in-evolution
48
What are 2 general classes of strokes?
1. Ischemic
| 2. Hemorrhagic
49
What are 3 types of ischemic stroke?
1. Thrombotic
2. Embolic
3. Lacunar
50
What type of stroke makes up 60-80% of ischemic strokes and are caused by plaques and thrombi blocking a vessel in the brain?
Thrombotic Ischemic Stroke
51
What is an ischemic stroke caused by a clot somewhere else in the body getting into the brain via the internal carotid artery?
Embolic ischemic stroke
52
What is an ischemic stroke caused by small cerebral vessels?
Lacunar Ischemic Stroke
53
What cardiac problem is prone to having a stroke?
Atrial fibrillation (they are on blood thinners to decrease likelihood of clot in the atrium)
54
What is the term for a stroke resulting from the rupture of a vascular malformation or aneurysm, blood everywhere in the head?
Hemorrhagic stroke
55
If the patient is a stroke risk and is taking anticoagulation coumarin, what is the desired INR to treat without physician consultation to reduce dose?
Less than or equal to 3.5
56
Should surgery be done on a stroke risk patient who takes IV Heparin as an anticoagulant?
No. Only do palliative emergency dental care. If surgery is required, 6-12 hours prior, go off heparin, switch to coumadin for surgery. Let clot form. 6 hours later, go back on IV Heparin
57
Are any changes required for surgery if the patient is taking subcutaneous Low Molecular Weight Heparin?
No
58
What post-surgery measures can be taken for a stroke risk patient on anti-coagulation therapy?
1. Atraumatic surgery
2. Pressure
3. Gelfoam
4. Sutures
59
What dental treatments can be done within the first 6 months after a TIA, RIND, or stroke?
Only emergency treatment
60
What is indicated throughout the procedure for a person who has recently had a stroke or TIA and requires emergency dental work (e.g. emergency full mouth periodontal probings)?
Monitor BP and oxygen saturation
61
What anesthesia supplementation is indicated for dental procedure on a patient within 6 months of TIA or stroke?
Nitrous oxide-osygen mix
62
What radiograph can show atherosclerotic plaques in the interal carotid artery, which supplies blood to the brain?
Panoramic
63
What is a disease caused by the death and depletion of dopaminergic neurons resulting in characteristic motor disturbances: resting tremor, muscle rigidity, bradykinesia, postural instability?
Parkinson's Disease
64
What is the clinical presentation of a patient with Parkinson's?
1. Pill-dolling resting tumor
2. Cogwheel muscle rigidity
3. Bradykinesia (slow movement)
4. Shuffling gait
5. Mask-like face
65
What is a risk for a patient with Parkinson's taking Dopamine?
Hypotension, so caution with sitting or standing
66
What are the side effects of the Anticholinergic drugs and Dopamine agonists a patient with Parkinson's takes?
1. Sedation
2. Drowsiness
3. Slow mentation
4. Fatigue
5. Confusion
6. Dizziness
67
This disease, at the gross level, has progressive destruction of the neurons leading to atrophy of the cerebral cortex and enlargement of the ventricles, while on the micro level, beta-amyloid plaques and neuroinflammation result in neurofibrillary tangles and loss of cortical neurons.
Alzheimer's disease
68
What neurotransmitter is deficient in Alzheimer's disease?
Acetylcholine and its enzymes
69
Though there are cognitive defects and associated short-term memory loss, what portions of the cerebral cortex are typically spared in a patient with Alzheimer's Disease?
1. Motor
2. Visual
3. Somatosensory
70
What is the only way to diagnose Alzheimer's Disease?
Brain biopsy
71
Due to the lack of acetylcholine in a patient with alzheimer's, what is the drug type used to increase acetylcholine?
Anticholinesterase drugs
72
What is a treatment consideration with Alzheimer's patients?
They get scared and anxious quickly
73
Though a patient can be on cholinesterase inhibitors, a patient with alzheimer's or other dementia could be treated with anticholinergic which has what side effect we are concerned with in the dental setting?
Sedation
74
What is a chronic and continuous demyelination of the corticospinal tract neurons in two or more regions of the brain and spinal cord?
Multiple Sclerosis
75
Demyelinated regions of multiple sclerosis are limited to which matter of the brain? Are they predictably located or random? Are they single or multiple?
White matter
Random
Multiple
76
Demyelinated areas called "plaques" have what type of conduction?
Impaired axonal conduction
77
What are the 3 most commonly affected regions by multiple sclerosis?
1. Optic nerve
2. Periventricular cerebral white matter
3. Cervical spinal cord
78
Is the peripheral nervous system affected by multiple sclerosis?
No
79
What condition associated with CNV is 400 times more likely among persons with multiple sclerosis than among the general population?
Trigeminal Neuralgia
80
Dr Lui likened the patient with multiple sclerosis to what?
A drained battery
81
What are 4 types of multiple sclerosis?
1. Relapsing-remitting
2. Primary progressive
3. Secondary progressive
4. Progressive-relapsing
82
What is a multiple sclerosis that has a steady decline (steadily increasing disability) with superimposed attacks?
Relapsing-remitting
83
The majority of multiple sclerosis cases (85%) are what type?
Relapsing-remitting
84
What is the term for an initial relapsing-remitting multiple sclerosis that suddenly begins to have decline (increasing disability) without period of remission?
Secondary progressive multiple sclerosis
85
What is a multiple sclerosis type that has a steady increase in disability without attacks?
Primary progressive multiple sclerosis
86
What is a multiple sclerosis type with unpredictable attacks which may or may not leave permanent deficits followed by periods of remission?
Relapsing-remitting multiple sclerosis
87
What is the main theme of multiple sclerosis?
A progressive disease where the patient never gets any better, only worse
88
What is a key symptom / presentation of a patient with multiple sclerosis?
They get worse in the afternoon
89
When should an appointment be schedule for a patient with multiple sclerosis?
In the morning because symptoms are worse in the afternoon
90
What head and neck problems should be considered for a patient with multiple sclerosis?
1. Dysphagia (swallowing)
| 2. Dysarthria (speaking)
91
Why must the operator be conscious of hot instruments around the mouth of a patient with multiple sclerosis?
Because of facial hypoesthesia. You could burn the patient and they would not know it or give you feedback to remove the instrument
92
What is the term for an increasing accumulation of cerebrospinal fluid (CSF) within the cerebral ventricles?
Hydrocephaly
93
What is the treatment for hydrocephalus?
A shunt placed within cerebral ventricles and peripheral cavities to reduce increased CSF pressure
94
What are 3 common CSF shunts?
1. Ventriculoperitoneal
2. Ventriculoatrial
3. Lumboperitoneal
95
What is a consideration when manipulating the head of a patient with a CSF shunt?
Careful not to kink the shunt tubing
96
Is antibiotic prophylaxis indicated for patients with a CSF shunt who will undergo dental (e.g. an extraction), respiratory, gastrointestinal or genitourinary procedures?
No
97
When is antibiotic prophylaxis indicated for a patient with a CSF shunt?
If the patient requires incision and drainage of infection at other sites or require replacement of an infected device
98
Many neurological disorders are associated with what else?
Mood disorder, commonly depression
99
A dopaminergic agent (carbidopa or levodopa for example) used to treat Parkinson's can cause what side effect?
Hallucinations
100
Schizophrenia is caused by excessive dopamine reaction in which pathway?
Mesolimbic pathway
101
What is the #1 risk factor for someone to have a successful suidice?
Prior suicidal attempt
102
If the patient drove down to your office by himself or herself and then admitted suicidal thoughts, do you allow him or her to leave?
No
103
What are 3 types of medications that can cause gingival hyperplasia?
1. Dilantin / phenytoin
2. Calcium channel blockers
3. Cyclosporin
104
If a patient describes his seizure as eyes roll upward or to the side, they become unconscious, they have uncoordinated movement, their jaws clench, their head rocks and they have urinary incontinence, what type of seizure do they have?
Generalized grand mal
105
Do you call EMS if your patient, who has a family history of seizures, seizes in your chair?
No, unless the seizure is different than their normal one or becomes status epileptics (more than 5 minutes long and they do not regain consciousness)
106
What is the most common cause of status epilepticus?
Abrupt discontinuation of anti-seizure meds
107
What is the difference between a TIA and a stroke?
TIA is fast (minutes) while stroke is progressive (e.g. TIA would just have facial droop, while stroke would have facial droop then arm numbness)
108
A patient having an ischemic stroke will have what blood pressure: high or low?
High because the body is trying to compensate for lack of brain profusion
109
What is a more common stroke in the US?
Ischemic
110
A patient recovering from ischemic stroke would be on what therapy?
Anticoagulation
111
How long after a stroke do you wait to treat?
6 months
112
What is the most important thing to stop bleeding?
Pressure
