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12 Sep, 12 tweets, 2 min read
🟒 Mini Neuro Tweetorial #1
🧠 Cortex (Grey cells/axons. Processes. Coms to/from other neurones. Some Higher functions are lateralised).
🧠 LT cortex dom in RT hander
🧠 LT cortex dom in 50% LT handers
What happens if cortical destructive lesion bullet/tumour/bleed/infarct ??
R cortical 🧠 damage causes a clinical subset of 4 things.
πŸ‘‰L Sided Weakness FACE|ARM|TRUNK|LEG ALL same side
πŸ‘‰L Hemisensory reduction/Loss
πŸ‘‰L Homonymous Hemianopia (No vision to LT. Pt looks RT)
πŸ‘‰Right Higher function loss: Extinction/Anosognosia
L cortical 🧠 damage causes a clinical subset of
πŸ‘‰R Sided Weakness FACE|ARM|TRUNK|LEG all same side
πŸ‘‰R Hemisensory reduction/Loss
πŸ‘‰R Homonymous Hemianopia (No vision to RT. Pt looks LT)
πŸ‘‰Left Higher function loss: Language(Dysphasia)
Subcortical 🧠 Damage (Nuclei and Myelinated axons)
πŸ‘‰Contralateral sensory/motor/ataxia
πŸ‘‰No Higher functional loss or hemianopia.
πŸ‘‰Usually due to white matter pathologies
Brainstem: Midbrain Pons Medulla MPM
πŸ‘‰V shaped MR/CT. Limbs of V cerebral peduncles which hold C/spinal fibres.
πŸ‘‰Substantia nigra and red nucleus [Think Colors !].
πŸ‘‰3rd/EW nucleus and below this 4th CN.
πŸ‘‰3rd exits ant btwn V limbs.
πŸ‘‰4th exits pstrly to C/L SO.
Lesion in Midbrain: subset of
πŸ‘‰ Ipsilateral III and C/L hemiparesis (Weber syn)
πŸ‘‰ Ipsilateral rubral tremor
πŸ‘‰ Ipsilateral IV
Pons: looks swollen on CT/MR as axons++ to and from cerebellum traverse. A bridge "pons" over CSF in IVth ventricles behind. Separates it from cerebellum behind. Contains
πŸ‘‰ Corticospinal fibres
πŸ‘‰ CN 5,6,7,8. 6/7 lie close
πŸ‘‰ Axons to/from cerebellum
πŸ‘‰ Sensory fibres
πŸ‘‰ MLF
A lesion will cause a subset of
πŸ‘‰ Contralateral Hemiparesis arm/leg/trunk
πŸ‘‰ Ipsilateral 5/6/7/8 nerve lesion - especially ipsilateral facial weakness and LR palsy
πŸ‘‰ Internuclear ophthalmoplegia
πŸ‘‰ Ipsilateral cerebellar symp/signs
Small oval. Corticospinal fibres cross anteriorly. CN 9,10,11,12. Symp trct. Nclus ambig. sensory fibres
Classic Lat med PICA occlusion. Get DWI
πŸ‘‰ Vertigo Hiccups, Dysphagia, Dysarthria
πŸ‘‰ I/L Horner's syn
πŸ‘‰ Ataxia
πŸ‘‰ Pain altered I/L face
πŸ‘‰ Loss pain/temp C/L arm/leg
Basically for Brainstem remember its basically
Cranial nerve palsy + C/L weakness so neuro on both sides. This was all done at one sitting without books so basically a brain dump so please forgive any omissions but generally hope its ok. I will do more later.
WRT Cortex the simple concept point I neglected to state is that the right brain receives sensory input (touch/vision) from left side of your world and outputs all motor to the left side of your world and vice versa.

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12 Sep
Mini Neuro Tweetorial #2 : Cord and Cauda
Spinal Cord
πŸ‘‰ Starts at Foramen magnum.
πŸ‘‰ Ends at lower edge of L1 vertebra
πŸ‘‰ So can LP below L1.
πŸ‘‰ Whole cord C8/T12/L5/S5/C1 31 nerves.
πŸ‘‰ 7 Cervical vert but 8 nerves. C1 goes over the top.
πŸ‘‰ Cord much shorter than the canal.
πŸ‘‰ Cord has corticospinal tract (CST)
πŸ‘‰ CST is Upper motor neuron (UMN).
πŸ‘‰ CST Synapses at anterior horn cell to form
πŸ‘‰ Motor Roots which are Lower motor neuron (LMN)
πŸ‘‰ These exit cord anterior. Forms root.
πŸ‘‰ Exits canal at foramina
πŸ‘‰ In cord we correlate clinical findings primarily with dermatomal and myotomal level. Secondarily with side.
πŸ‘‰We need to know our myotomal /dermatomal landmarks
πŸ‘‰ Highest dermatome ? C2 back of head
πŸ‘‰ Lowest dermatome ? S5 Perianal
Read 12 tweets
16 May
NHS management 101
If u are not complaining then u are overstaffed. You will lose assets
If you are complaining then you are at peak efficiency and assets sweated
If u r complaining + metrics worsening + adverse event. you might need help but first will be told to get a move on
If there are patients in corridors during surge then you have enough beds. Ride it out
If there are never patients in corridors during surge then you have too many beds
If there are patients in corridors frequently then sweat your discharge process. Might need more beds.
The weakness is that over staffed departments with staff learned in the art of complaining don't get touched as too much work to analyse the metrics and redeploy assets. Managers only around for 1-2 years so pass the parcel.
Read 8 tweets

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