Dr. Abhishek Singh

Laparoscopic & General Surgeon | MBBS, DNB, DrNB Neurosurgery(R), FIAGES, FMAS, Alumnus @KMC_Manipal | Advancing #SurgEd & #MedEd | Highlights→Surgical Insights

[Dr. Abhishek Singh @SurgeonSingh]

Home library. Only non-academic.

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: Conus medullaris syndrome is associated with pathology to the caudal cord and lumbar nerve roots at the L1/L2 level leading to a combination of upper and lower motor neuron signs/symptoms.

This includes insensate painless urinary retention, saddle distribution of perineal numbness, faecal incontinence and sexual dysfunction. It is less often associated with sciatica or motor/sensory dysfunction in the lower limbs, it is more likely to be symmetrical and patients may have upper motor neuron signs (i.e. spasticity, hyperreflexia).

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: Cauda equina syndrome (CES) is a medical emergency and when complete, involves insensate and painless urinary retention, perineal sensory loss in a saddle distribution, altered anal tone with faecal incontinence and loss of sexual function.

It often occurs alongside bilateral sciatica and lower back pain and can be associated with lower limb paraesthesia/motor weakness.

Most patients do not present with the ‘full house’ of symptoms and can be referred to as having an ‘incomplete’ syndrome. Both complete and incomplete CES should be managed with the same degree of clinical urgency with appropriate investigations/ treatment.

[Dr. Abhishek Singh @SurgeonSingh]

#MedEd Pro-tip: An upper motor neuron (UMN) lesion anywhere along the pyramidal (corticospinal) tract from the motor strip down to L4 ≈ will result in a loss of inhibition, and the plantar reflex will be “unmasked” producing extension of the great toe.

With such an UMN lesion, there may also be exaggeration of flexor synergy resulting in dorsi flexion of the ankle, and flexion of the knee and hip (AKA triple flexor response) in addition to extension of the great toe.

[Dr. Abhishek Singh @SurgeonSingh]

#MedEd Pro-tip: The plantar reflex disappears usually at 10 months of ≈ age (range: 6 mos to 12 yrs), presumably under inhibitory control as myelination of the CNS occurs, and the normal response then converts to plantarflexion of the great toe.

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: A false localising sign occurs when pathology discrete from the area affected produces a neurological sign which may be wrongly located.

The most commonly appreciated ‘false localising sign’ is the CN VI palsy in the context of raised intra- cranial pressure. The VI nerve takes a steep perpendicular trajectory when it leaves the pons on its course to the cavernous sinus. By doing so, it is left vulnerable to pressure changes in the brain which can cause traction on the nerve and thus dysfunction.

It is not uncommon for shunt-dependent child to present with a CN VI palsy in the context of a blocked shunt and raised ICP.

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: The ventricular system is one of the ‘silent’ areas, so pathology affecting this area can be subtle and difficult to localise. Patients with ventricular disease often present with symptoms of raised intracranial pressure secondary to hydrocephalus.

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: Cerebellopontine angle lesions may result in lower cranial neuropathies causing disordered swallowing, facial weakness/hemifacial spasm and hearing loss.

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: Suprasellar region lesions are associated with deficits to the optic nerve and cranial nerves that run in the cavernous sinus (III, IV, V, VI) causing visual field loss (typically tunnel vision or bitemporal hemianopia) and diplopia (ophthalmoplegia) with or without endocrinological dysfunction.

[Dr. Abhishek Singh @SurgeonSingh]

#MedEd: Air Pollution and Chronic Kidney Disease: An Emerging Challenge.

https://t.co/YBZ6LZDT8B

[Dr. Abhishek Singh @SurgeonSingh]

@GhazalZand2631 👏🏻

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: Pineal region lesions are associated with Parinaud’s syndrome due to compression on the midbrain/tectal plate.

Symptoms include vertical gaze palsy with loss of upgaze (sunsetting eyes), nystagmus retractoris, eyelid retraction and pseudo-Argyll Robertson pupillary response (accommodates but does not react to light).

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: Eloquent cortex describes areas of the brain that if lesioned/removed will produce a distinct deficit e.g. left frontal lobe pathology can cause an expressive dysphasia and right occipital lobe lesion will produce a left homonymous hemianopia.

Certain areas of the brain (right frontal lobe, right anterior temporal lobe) are described as ‘non-eloquent’ or ‘silent’—this does not mean that they do not serve a function, rather that if they are lesioned, neurology may be too subtle to detect.

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: Lateralising a lesion in the brain follows these basic principles. The right brain serves the left side of the body and vice versa with the exception of the cerebellum and cranial nerves which have ipsilateral control.

[Dr. Abhishek Singh @SurgeonSingh]

सियावर रामचंद्र की जय।

शुभम करोति कल्याणम, अरोग्यम धन संपदा। शत्रु-बुद्धि विनाशायः दीपःज्योति नमोस्तुते॥ शुभ दीपावली।

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: Hypernatraemia is less common in neurosurgical patients but can occur especially after pituitary surgery secondary to diabetes insipidus (DI) and is also seen in traumatic brain injury (either due to direct pituitary dysfunction or as a consequence of hyperos- molar therapy).

Knowledge of the patient’s fluid balance, hourly urine output and serum/ plasma osmolality is key in guiding patient management. These patients will need a urinary catheter to ensure an accurate fluid balance is collected. If they are in a state of DI, this needs to be managed carefully with fluid therapy.

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: Approximately 12% of right handers and 15% of left handers are co-dominant for speech, and only 7% of left handers are truly right hemisphere dominant.

Why mention it then? Well it shows you have thought about the patient’s individual wiring, and on rare occa- sion, when you find a right dominant left handed with right hemispheric pathology and speech dysfunction, you will be pleased you asked.

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: Lumbar Puncture:The white cell count should be divided into percentage composition of lymphocytes (60 ± 20%), mononuclear cells (30 ± 15%) and polymorphs (2 ± 4%).

If polymorph count is most raised, this is highly suspicious for bacterial infection. Post surgery, the CSF is usually raised; if the predominant white cell remains lymphocytic this can be considered a normal inflammatory post-surgical response.

[Dr. Abhishek Singh @SurgeonSingh]

#MedTwitter Pro-tip: Holocord syringomyelia is more than a cyst—it’s a longitudinal spinal cord pathology with widespread consequences.

Assess carefully: sensory dissociation, motor weakness, and progressive spasticity often span multiple levels.

Don’t rely on localized symptoms alone—imaging may reveal a cavity extending the entire cord.

Monitor for scoliosis, kyphosis, and autonomic dysfunction, as these can develop insidiously.

Management is nuanced: treat underlying cause first, decompress where indicated, and follow progression with serial MRI.

So when evaluating suspected holocord syringomyelia, take a systematic, full-cord approach. Bookmark this. Early recognition and structured follow-up preserve function and prevent irreversible deficits.

[Dr. Abhishek Singh @SurgeonSingh]

#MedEd Worth reading: Craniovertebral junction degenerative arthritis - evolving understanding.

https://t.co/hHBNjJpXM4