Neurologic Disorders

Question 1

epilepsy

Answer 1

disorder of brain characterized by predisposition to epileptic seizures

Question 2

epilepsy is what type of condition

Answer 2

• heterogenous condition

* multiple seizure types and syns, diverse etiologies, variable prognoses

Question 3

etiology of seizures

Answer 3

• genetic
• structural (i.e. tumor)
• metabolic
• immune
• infectious
• unknown (i.e. at end of syncopy, ppl can seize)

Question 4

what is a big component of pts having seizures?

Answer 4

alcohol withdrawal

Question 5

what are the 3 ways to classify seizure disorders

Answer 5

1. focal seizures with retained awareness
2. focal seizures with impaired awareness
3. generalized seizures

Question 6

what may pts with focal seizures with retained awareness experience?

Answer 6

an aura

Question 7

clinical presentation of focal seizures with retained awareness if occipital cortex is affected?

Answer 7

flashing lights

Question 8

clinical presentation of focal seizures with retained awareness if motor cortex is affected?

Answer 8

rhythmic jerking on body opposite affected side

Question 9

clinical presentation of focal seizures with retained awareness if parietal lobe is affected?

Answer 9

distortion of spatial perception

Question 10

clinical presentation of focal seizures with retained awareness if frontal lobe is affected?

Answer 10

sudden speech difficulties

Question 11

postical state with focal seizures with retained awareness

Answer 11

• may return to pre-event baseline

- may experience worsened neurologic fxn for a period of time

Question 12

what is the most common type of seizures in adults with epilepsy?

Answer 12

focal seizures with impaired awareness

Question 13

T/F: pts who are having a focal seizure with impaired awareness appear to be asleep

Answer 13

false, they appear to be awake

*eyes are open

Question 14

clinical presentation of person having a focal seizure with impaired awareness

Answer 14

• does not interact with others in their environment

- does not respond normally to instructions/questions

Question 15

how long does a focal seizure with impaired awareness last?

Answer 15

<3 minutes

Question 16

postical state with focal seizures with impaired awareness

Answer 16

• somnolence (state of strong desire to sleep)
• confusion
• headache

Question 17

which hemisphere does generalized seizures affect?

Answer 17

both hemispheres

Question 18

what is the most common type of generalized seizures?

Answer 18

generalized tonic-clonic

Question 19

characteristic of generalized seizure

Answer 19

abrupt loss of consciousness

Question 20

how many phases are there in a generalized seizure?

Answer 20

3

Question 21

what are the 3 phases of a generalized seizure?

Answer 21

• tonic
• clonic
• postictal

Question 22

tonic phase of generalized seizure

Answer 22

muscle stiffness

Question 23

how long does the tonic phase of a generalized seizure last?

Answer 23

~1 min

Question 24

clonic phase of generalized seizure

Answer 24

muscles jerk and twitch

Question 25

how long does the clonic phase of generalized seizure last?

Answer 25

~2 mins

Question 26

postictal phase of generalized seizure

Answer 26

- initial deep sleep followed by gradual awakening | - confusion and/or agitation

Question 27

syms of aura phase in tonic-clonic seizure

Answer 27

- light-headedness - dizziness - confusion - hallucinations - some pts say they can smell certain things

Question 28

syms of tonic phase in tonic-clonic seizure

Answer 28

- skeletal mm. tense uo | - usually lose consciousness

Question 29

syms of clonic phase in tonic-clonic seizure

Answer 29

- jerky movements - convulsions - violent shaking - uncontrollable twitching/rolling - sometimes breathing stops

Question 30

syms of postical phase in tonic-clonic seizure

Answer 30

- confusion - amnesia - nausea upon regaining consciousness

Question 31

med management of seizure disorders

Answer 31

- long-term drug therapy - reduce frequency over lifetime - slow increase in dose to avoid adverse side effects

Question 32

what are the first-line agents for pts with seizure disorders?

Answer 32

- phenytoin - carbamazepine - valproic acid

Question 33

what percent of pts gain control of seizure disorder within 5 yrs?

Answer 33

60-80%

Question 34

status epilepticus

Answer 34

repeated seizures over short period of time without a recovery period

Question 35

status epilepticus can cause the brain to be what?

Answer 35

gravely hypoxic and acidotic | *may lead to extensive brain injury and possible death

Question 36

status epilepticus is usually observed in what type of pts?

Answer 36

more frequently observes in pts who have abrupt withdrawal from anticonvulsant med or abused drug

Question 37

is routine dental care indicated for pts with controlled seizure disorders?

Answer 37

ye,s can do surgery and any elective dental care

Question 38

should pts with seizure disorders discontinue taking their anticonvulsant meds before their appt?

Answer 38

no

Question 39

dental mods for pts with controlled seizure disorders

Answer 39

good stress/pain control

Question 40

what should you do if the pt in your chair is having a seizure?

Answer 40

- stop procedure and remove everything from mouth - passively support pt to prevent injury - should have return of consciousness within few minutes - escort home

Question 41

should you hold down a pt who is having a seizure in your chair?

Answer 41

no, don't try to hold pt down

Question 42

why should you check a pt's blood sugar after they have a seizure?

Answer 42

low blood sugar can induce seizure

Question 43

should you send the pt who was having a seizure in your chair to the ER?

Answer 43

no

Question 44

stroke

Answer 44

sudden interruption of oxygenated blood to brain

Question 45

what determines the morbidity/mortality of stroke pts?

Answer 45

- length and severity of ischemia | - amount of brain that has necroses

Question 46

T/F: having a stroke is not fatal

Answer 46

false, can be

Question 47

a stroke can debilitate what?

Answer 47

- motor - speech - cognition

Question 48

additive risk factors for developing a stroke

Answer 48

- history of stroke or transient ischemic attack (TIA) - age >75 yrs - smoking - hypertension - coronary atherosclerosis - congestive HF - diabetes mellitus - hyperchlesterolemia

Question 49

what are the 2 types of stroke?

Answer 49

- ischemic | - hemorrhagic

Question 50

what percent of stokes are ischemic?

Answer 50

60-80%

Question 51

what can lead to someone having an ischemic stroke?

Answer 51

- atherosclerosis - emboli - hypotension

Question 52

ischemic stroke

Answer 52

clot stops blood supply to area of brain

Question 53

hemorrhagic stroke

Answer 53

bleeding into brain from ruptured vessel

Question 54

what can cause microaneurysms?

Answer 54

hypertension

Question 55

transient ischemic attack (TIA) | *mini stroke

Answer 55

transient episode of neurologic dysfunction caused by focal ischemia without acute infarction

Question 56

T/F: TIA can cause permanent injury

Answer 56

true

Question 57

T/F: TIA is considered a neurologic emergency

Answer 57

true

Question 58

why is TIA a bad sign?

Answer 58

something pending is about to happen... i.e. MI or bigger stroke

Question 59

if pts syms resolve before medics arrive, do pts still need to go to the ED?

Answer 59

yes, need to be evaluated (i.e. determine what type of stroke it was)

Question 60

outcomes of cerebrovascular accident (CVA) aka another name for stroke

Answer 60

- death | - disability

Question 61

what percent of CVA deaths are hemorrhagic?

Answer 61

38-47%

Question 62

what percent of CVA deaths are ischemic?

Answer 62

8%

Question 63

disability due to CVA depends on what?

Answer 63

size and location of injury

Question 64

T/F: return of fxn of CVA pts are predictable

Answer 64

false, return of fxn is unpredictable and slow

Question 65

med management of individuals at risk for CVA

Answer 65

- reduce/eliminate risk factors | - drug therapy

Question 66

drug therapy for individuals at risk for CVA

Answer 66

- antihypertensive drugs - antiplatelet drugs - statis

Question 67

acute med management of CVA

Answer 67

1. sustain life immediately after stroke 2. emergency effort to prevent further thrombosis or hemorrhage or to lyse the clot 3. rehabilitation and prevention of future events

Question 68

T/F: once pts have stoke, they're always going to be at risk for having another stroke

Answer 68

true

Question 69

individuals with history of CVA/TIA are at an elevated risk for stroke for how long after the event

Answer 69

6 months

Question 70

during the first 6 months after a pt has a stroke, can they have invasive dental work done?

Answer 70

no, just preventative like prophys

Question 71

T/F: pts with recent TIA are considered unstable

Answer 71

true

Question 72

should you txt pts who has a recent TIA?

Answer 72

no, no elective care

Question 73

dental management of individuals with history of CVA/TIA

Answer 73

- timing important | - stress reduction

Question 74

analgesia for individuals with history of CVA/TIA

Answer 74

Tylenol

Question 75

why can't individuals with history of CVA/TIA take NSAIDs?

Answer 75

pt on anti-platelet drugs after stroke so can affect platelets

Question 76

should you give a pt Aspirin when they're having a stroke?

Answer 76

NO, don't know what type of stroke they're having

Question 77

what will happen if you give Aspirin to a a pt who is having a hemorrhagic stroke?

Answer 77

will thin them out even more