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12 Sep, 12 tweets, 3 min read
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
See Derm maps. Some think it is head to foot - it is not
Back of head: C2
Shoulders: C4
Lateral arm: C5/6
Fingers: C7 Middle finger
Medial arm: C8/T1
Chest: T4 nipple
Abdomen: T10 umbilicus L1 inguinal
Front legs: L2/3/4/5
Sole feet: S1
Back legs: S2/3
Perianal /Genital: S4/5
Myotomal maps: I won't do details here but generally
πŸ‘‰C5-T1 Upper limb
πŸ‘‰L1-S2 Lower Limb
πŸ‘‰S3-5 Anal sphincter, Bowels/Bladder
Cord Injury at T4. No motor or sensory below T4 MOTOR LEVEL
πŸ‘‰ Bilateral weak legs but normal arms
πŸ‘‰ Increased tone both legs and clonus
πŸ‘‰ Upgoing plantars
πŸ‘‰ Increased ankle and knee reflexes

In some cases acute spinal shock can cause initial pattern to be flaccid areflexia
πŸ‘‰ Loss of sensation everywhere below the nipple both sides chest, abdomen, legs, buttocks
πŸ‘‰ Loss of sensation bowels/bladder
πŸ‘‰ Labile Blood pressure, tachycardia, hypotension
πŸ‘‰ Urinary retention. Bowel and bladder dysfunction
A Cord lesion at or above T1 will cause UMN upper limb signs in both arms and legs. The higher it goes will lead to a quadriplegia. A high cervical cord lesion can cause difficulty with breathing in addition.
Cauda Equina
This is the bundle of nerve roots which have exited the cord which has ended at L1 and sit in the lumbar cistern awaiting their foramina through which to exit. Contains sensory/motor nerve roots to L2-5, S1-5 and C1. These are Lower motor neurons.
What if there is a knife/bullet/disc/tumour/clot at L3 which compresses this bundle of nerve what will we find
πŸ‘‰ Flaccid bilateral weak legs
πŸ‘‰ Reduced tone areflexia, absent plantars
πŸ‘‰ Weak anal bladder sphincters with incontinence
πŸ‘‰ Lack sensation saddle area anus genitals
PS Brown Sequard: hemisection of cord - 1 motor pathway 2 sensory: Cord lesion
πŸ‘‰I/L UMN lesion below up plantar, clonus, inc reflex
πŸ‘‰I/L Vibn Propn loss below lesion (Post columns)
πŸ‘‰C/L Pain temp loss below lesion (spinothalamic)

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More from @drokane

12 Sep
🟒 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)
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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