Brain, Spine & Beyond

Your go-to knowledge platform for brain, spine and beyond. Always looking for collaborators for innovative educational content and projects.

[Brain, Spine & Beyond @BrainSpineByond]

Osmotic Demyelination Syndrome (ODS)

Cause
Rapid correction of hyponatremia

Affected Areas
Pons (CPM)
Thalamus
Extrapontine regions

Risk Factors
Chronic hyponatremia (>24 hrs)
Malnutrition
Alcoholism
Liver disease

Clinical Note
Symptoms may appear after initial improvement

[Brain, Spine & Beyond @BrainSpineByond]

SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion)

Essential Diagnostic Criteria
Serum
Effective serum osmolality <275 mOsm/kg
Effective osmolality = measured osmolality − (BUN / 2.8)

Urine
Urine osmolality >100 mOsm/kg
Urinary sodium >40 mEq/L (normal intake)

Volume Status
Clinically euvolemic
No orthostasis
No tachycardia
No dry mucosa
No edema or ascites

Exclusions
Normal renal function
Normal thyroid function
Normal adrenal function
No recent diuretic use

[Brain, Spine & Beyond @BrainSpineByond]

Ankylosing Spondylitis
Chronic inflammatory seronegative spondyloarthropathy primarily affecting the axial skeleton

Anatomy / Structural Changes
Progressive inflammation of:

1- Sacroiliac joints
2- Spine

Leads to:
1- Vertebral body squaring
2- Syndesmophyte formation
3- Progressive spinal rigidity

Characteristic Appearance
1- “Bamboo spine” due to fused vertebrae
2- Loss of normal spinal flexibility

Presentation, Diagnostic Features & Key Findings

Radiographic / Structural
1- Squared vertebral bodies
2- Syndesmophytes
3- “Bamboo spine”
4- Bilateral sacroiliitis

Genetic Association
HLA-B27 positive

Clinical Features
1- Chronic inflammatory back pain
2- Morning stiffness
3- Reduced spinal mobility

Treatment
Medical Management (Back Pain & Inflammation)
1- NSAIDs
2- Sulfasalazine
3- Immune-modulating medications (biologic agents)

Surgical Considerations — CAUTION
1- Airway management
2- Perform awake intubation
3- Rigid cervical spine increases risk during standard intubation

If instrumented fusion is required

Use long-segment fixation
Multiple fixation points recommended
Consider anterior and/or posterior instrumentation

Critical Reminder
Due to spinal rigidity:
Even minor trauma can cause severe spinal injury
Fracture-dislocation
High index of suspicion required in trauma patients

[Brain, Spine & Beyond @BrainSpineByond]

Atlanto Occiptal Dislocation: Cause, imaging, treatment
All what you need to know, in a simplified short video

https://t.co/ZYfm7Kqro4

#BSB #Neurosurgery #Brain #Spine

[Brain, Spine & Beyond @BrainSpineByond]

How pituitary surgery evolved from this to where we are now.

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[Brain, Spine & Beyond @BrainSpineByond]

Clipping Techniques vs Endovascular Techniques

Which one would you choose?

#BSB #Neurosurgery #Brain #Spine

[Brain, Spine & Beyond @BrainSpineByond]

How many clips can you spot on this image?
Where are they?

What is this angiogram showing?

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[Brain, Spine & Beyond @BrainSpineByond]

Both are destructive lesions
Both occur around the skull base

What are they?
How do you differentiate between both?

#BSB #Neurosurgery #Brain #Spine

[Brain, Spine & Beyond @BrainSpineByond]

Craniocervical junction anatomy is complex

It's essential to understand it for all spinal and cranial surgeons.

This videos goes through this complex anatomical structure from embryology to the detailed anatomical structures

https://t.co/QRLtXR87yj

[Brain, Spine & Beyond @BrainSpineByond]

Anterior vs Posterior for cervical myelopathy
A decade long debate

This June 2025 systematic review and meta analysis for 33,025 patients highlighted that:
• Anterior approach yields better neurological recovery.
• Anterior approach corrects spinal curvature more effectively.
• Anterior approach associated with less pain and reduced blood loss.
• Anterior approach leads to a shorter hospital stay.
• Anterior approach may be preferred for cervical myelopathy.

What are your thoughts?

#BSB #Neurosurgery #Brain #Spine

[Brain, Spine & Beyond @BrainSpineByond]

Many trainees struggle to understand different types of thoracolumbar fractures

AO spine classification is one of the best to help you appreciate the mechanism of injury

I simplified this classification in this video
https://t.co/Hm6LIBxtDS

[Brain, Spine & Beyond @BrainSpineByond]

What is the diagnosis?
How will you manage this patient who presented with quadriparessis?

#BSB #Neurosurgery #Brain #Spine

[Brain, Spine & Beyond @BrainSpineByond]

Can you recognise these common neuroradiological signs?

Watch this video covering one of the most important ones
https://t.co/SC0Pf8Crne

[Brain, Spine & Beyond @BrainSpineByond]

A 26 years old female presented with pelvic pain

What is the differential diagnosis?

#BSB #Neurosurgery #Brain #Spine

[Brain, Spine & Beyond @BrainSpineByond]

What is the differential diagnosis for this MRI finding?

#BSB #Neurosurgery #Brain #Spine

[Brain, Spine & Beyond @BrainSpineByond]

What is this sign called?
What does it represent?

#BSB #Neurosurgery #Brain #Spine

[Brain, Spine & Beyond @BrainSpineByond]

What are the findings on this MRI image?
What does this represent?

#BSB #Neurosurgery #Brain #Spine

[Brain, Spine & Beyond @BrainSpineByond]

What is your differential diagnosis for this patient who is 55 coming with deterioration in lower limb neurology?

What is the surgical option?

#BSB #Neurosurgery #Brain #Spine

[Brain, Spine & Beyond @BrainSpineByond]

A question for debate
Would you give much of your clinical work for management level work?

Is it worth it?
or not?

[Brain, Spine & Beyond @BrainSpineByond]

Spot diagnosis

How many types? and what is the difference?

#BSB #Neurosurgery #Brain #Spine