AFTER SOURCING THROUGH MANY WEBSITES
FINALLY, THE MYOTOMES

5-6: deltoids
5-6: biceps
7-8: triceps
C6: wrist extension
C7: wrist flexion
C8: thumbs extension
T1: little finger abduction


L2 hip flexion
L3 knee extension (L4 knee flexion)
L4 knee flexion
L5 dorsiflexion
L5 big toe dorsiflexion
S1 plantarflexion
S1: tip toe

The NNI stuff from Charanya:

The black tract: corticospinal/pyramidal tract which decussates at the brainstem before synapsing at the anterior horn cells at their respective spinal levels

The blue one: Spinothalamic

Okay case scenario1: Patient comes in for weakness of the biceps

So, is it a NERVE or a NERVE ROOT problem?

Nerve: Musculocutaneous nerve C5-7 (mainly C5)

What other nerves have C5? That will be the axillary nerve (C5, C6)

Which means if its a musculocutaneous nerve problem, deltoids weekness and regimental badge sign will be absent

If its a nerve root problem, then biceps weakness will be accompanied by deltoids weakness (abduction) and regimental badge sign

Case Scenario 2:

If a patient presents:

- flccidity of the LL

- upgoing plantars

The lesion is probably in the conus medullaris where both spinal cord and peripheral nerves exist and may present as such

Case scenario 3:

Patient presented with hemiparesis without facial involvement:

1. Spinal cord or brainstem lesion below level of pons (where CN*VII nerves are)

2. Cortical lesion of motor cortex sparing the region responsible for facial motor (facial nerve UMN)

General Thought Flow:

Patient with right hemiparesis:

Q1: sensory loss on the Left side?

- Yes: spinal cord lesion, Brown Sequard

- No: above

Q2: cranial nerve lesion?

- Yes: brainstem lesion. Gauge the site wrt Cranial nerves involved. Do jaw jerk

- No: higher up or below the level of exiting cranial nerves (e.g. caudal medulla)

Q3: Aphasia, neglect, visual deficits

- Yes: cortical lesion

- No: subcortical or caudal brainstem lesion

Drugs and Slugs

Pathetic me's blogging from the TTSH ADO office.

Vancomycin: a glycopeptide antibiotic
Target group: Gram +ve antibiotic
Mode of administration:
Intravenously for systemic infections (Vancomycin cannot cross intestinal lining
Orally for Clostridium difficile infection (Pseudomembranous colitis)

Administration of Vancomycin should be throguh slow infusion of diluted solution over at least one hour. This is to avoid complications such as thrombophlebitis and red man syndrome.

Since activity of Vancomycin is time related (duration of time where drug concentration is above MIC), trough monitoring may be useful in the administration of vancomycin (in the patient we saw, it was 1mg q5days)

Indications: Gram +ve infections unresponsive to other less toxic bacteria
1. MRSA/MRSE
2. Pseudomembranous colitis relapse or unresponsive to metronidazole

Side effects:
Common: local pain, thrombophlebitis
Rare:
1. Ototoxicity
2. Nephrotoxicity: especially in those with concurrent intake of nephrotoxins (aminoglycosides)
3. Anaphylaxis, erythema multiforme, SJS, TENS
4. Red Man Syndrome

Ulcers

Duodenal ulcers are relieved by food intake
Stomach ulcers are exacerbated by food intake