Top Tweets for #BBces
We were so excited to have news anchor and children's book author @gfunderburgNC9 read some of his new book today! #jeremiahsnewbeginning #lovesreading #BBCES
Gracias por todo el apoyo en este febrero!!!! #Chava_Lon @AlanMRgz @VioletaBriceno3 #BBces @YouNowenEspanol
@realbrainbook Also important to consider sphincter function post-op. Get a continence nurse/team involved to help with optimal catheter/bowel management (or learn how to do it yourself!) #BBCES
56. This patient’s evolving symptoms were caught early and surgery happened quickly. In cases where symptoms and signs have been established for a longer period of time, surgery is not usually performed as a true emergency, but expedited. #BBCES
55. Neurologically, he has 5/5 graded power in the lower limb myotomes bilaterally. Sensation to pinprick is normal bilaterally in the lower limb dermatomes, with normal reflexes. The patient is discharged from hospital with follow up planned in clinic. #BBCES
54. The surgery is a success! The patient is brought to the neurosurgery ward. Postoperatively, the patient has immediate relief of his back and leg pain, with normal power in both legs. Great! One week after, the patient is mobilising independently. #BBCES
53. Decompression involves a bilateral laminectomy and discectomy. A laminectomy involves removing the lamina of the vertebra. This exposes the herniated disc. The herniated disc and the extruded fragments are then removed (discectomy), decompressing the nerve roots. #BBCES
52. Surgical decompression! 🖋️Surgical management aims to prevent further neurological deficits by decompression of the spinal cord and/ or nerve roots. Surgery should ideally be performed within 48h of symptoms onset for better chances of stabilisation of deficits. #BBCES
@realbrainbook How do you know which level is which on the MRI? S1 can be lumbarised and L5 can be sacralised so count/look carefully! #BBCES
50. URGENT MRI! ⚠️ MRI is the gold standard imaging modality for the diagnosis of cauda equina syndrome.
An MRI scan is performed. Can you identify anything from the images below?
#BBCES
49. Now that you’re considering CES as your main differential, are there any imaging tests you’d like to perform at this stage to confirm your diagnosis and establish the cause?🦴 #BBCES
47. Disc prolapse has a variety of causes including ageing, obesity, smoking, repetitive strain, or even certain motions e.g. twisting/ turning to lift an object. CES typically results from central disc herniation. #BBCES Image: https://t.co/KOVzx1ggLB
46. In a disc prolapse, the nucleus pulposus is displaced from the intervertebral space. The displacement can be 1⃣ within the disc or 2⃣ bulge without penetration of the annulus fibrosis or 3⃣ it can herniate through the annulus fibrosis into the spinal canal #BBCES
45. Most cases of CES result from disc protrusion. The intervertebral discs are a secondary cartilaginous joint. They have a tough outer layer (the annulus fibrosis) and a gelatinous core (nucleus pulposus). #BBCES
Image: https://t.co/mFzMoTx9VL
44. Aetiology: lumbar disc prolapse, tumours, trauma e.g. fracture, infection, iatrogenic (spinal surgery or manipulation, spinal epidural injection). #BBCES
@realbrainbook IVD herniation, Spondylolisthesis, Spinal Stenosis, Traumatic Injury, Infection eg: Pott's, Tumour growth #BBCES
42. Other features of CES include back pain and sciatica, weakness and changes in sensation in the lower extremities, acute urinary retention (followed by incontinence), decreased anal tone and reduced perineal sensation. Faecal incontinence is a very late sign. #BBCES
39. The functions of these nerves are to provide motor innervation to the lower limb, genitals, internal and external anal sphincter and detrusor muscle of the bladder. These nerves also provide sensory innervation to the lower limb and perineum. #BBCES
38. The cauda equina roots have both a dorsal and ventral root. The ventral root provides motor fibres for the efferent pathway along with sympathetic fibres. The dorsal root is composed of afferent fibres for the transmission of sensation. #BBCES Image: https://t.co/74sPePgkat
37. ...distal to this area is a gathering of nerve roots forming the cauda equina (the ‘horses tail’). These spinal roots separate in pairs, exiting through the nerve root foramina. #BBCES
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