Mini Neuro Tweetorial #2 : Cord and Cauda
👉 Starts at Foramen magnum.
👉 Ends at lower edge of L1 vertebra
👉 So can LP below L1.
👉 Whole cord C8/T12/L5/S5/C1 31 nerves.
👉 7 Cervical vert but 8 nerves. C1 goes over the top.
👉 Cord much shorter than the canal.
👉 Cord has corticospinal tract (CST)
👉 CST is Upper motor neuron (UMN).
👉 CST Synapses at anterior horn cell to form
👉 Motor Roots which are Lower motor neuron (LMN)
👉 These exit cord anterior. Forms root.
👉 Exits canal at foramina
👉 In cord we correlate clinical findings primarily with dermatomal and myotomal level. Secondarily with side.
👉We need to know our myotomal /dermatomal landmarks
👉 Highest dermatome ? C2 back of head
👉 Lowest dermatome ? S5 Perianal
🟢 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.
👉L Sided Weakness FACE|ARM|TRUNK|LEG ALL same side
👉L Hemisensory reduction/Loss
👉L Homonymous Hemianopia (No vision to LT. Pt looks RT)
👉Right Higher function loss: Extinction/Anosognosia
L cortical 🧠 damage causes a clinical subset of
👉R Sided Weakness FACE|ARM|TRUNK|LEG all same side
👉R Hemisensory reduction/Loss
👉R Homonymous Hemianopia (No vision to RT. Pt looks LT)
👉Left Higher function loss: Language(Dysphasia)
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.