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

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

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

Atlanto Occiptal Dislocation: Cause, imaging, treatment All what you need to know, in a simplified short video youtu.be/wfNrQfO2Axo?si=6Xa2… #BSB #Neurosurgery #Brain #Spine

How pituitary surgery evolved from this to where we are now. #BSB #Neurosurgery #Brain #Spine

Clipping Techniques vs Endovascular Techniques Which one would you choose? #BSB #Neurosurgery #Brain #Spine

How many clips can you spot on this image? Where are they? What is this angiogram showing? #BSB #Neurosurgery #Brain #Spine

Both are destructive lesions Both occur around the skull base What are they? How do you differentiate between both? #BSB #Neurosurgery #Brain #Spine

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 youtu.be/FSfyUGqnTH4?si=elsL…

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

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 youtu.be/tomY1BIbwEs?si=OHHg…

What is the diagnosis? How will you manage this patient who presented with quadriparessis? #BSB #Neurosurgery #Brain #Spine

Can you recognise these common neuroradiological signs? Watch this video covering one of the most important ones youtu.be/Q5323XeyNXM?si=Itng…

A 26 years old female presented with pelvic pain What is the differential diagnosis? #BSB #Neurosurgery #Brain #Spine

What is the differential diagnosis for this MRI finding? #BSB #Neurosurgery #Brain #Spine

What is this sign called? What does it represent? #BSB #Neurosurgery #Brain #Spine

What are the findings on this MRI image? What does this represent? #BSB #Neurosurgery #Brain #Spine

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

A question for debate Would you give much of your clinical work for management level work? Is it worth it? or not?

Spot diagnosis How many types? and what is the difference? #BSB #Neurosurgery #Brain #Spine