داکتر محمد صمیم سردار M.Samim sardar

07/08/2025

🧠PATHOLOGICAL REFLEXES

💥1. Babinski Reflex

Test: Stroke the lateral aspect of the sole of the foot.

💡Normal Response: Flexion (downward movement) of the big toe.

💡Abnormal (Positive Babinski): Extension (upward movement) of the big toe and fanning of other toes.
📌Significance: Indicates upper motor neuron lesion (e.g., stroke, spinal cord injury) if seen in adults. Normal in infants (

05/08/2025

Brain Tumor with Edema: Role of Dexamethasone (IV Steroids)
1. Background: Brain Tumors and Edema
Brain tumors (primary or metastatic) often cause vasogenic edema due to disruption of the blood-brain barrier (BBB), leading to fluid leakage into the extracellular space.
Symptoms of edema: Headache, nausea, vomiting, seizures, focal neurological deficits, altered mental status.
Mechanism: Tumor-secreted factors (e.g., VEGF) increase vascular permeability → edema → mass effect → raised intracranial pressure (ICP).
2. Dexamethasone for Vasogenic Edema
Mechanism:
Stabilizes BBB by downregulating VEGF and inflammatory mediators.
Reduces capillary permeability → decreases fluid leakage into brain tissue.
Indications:
Symptomatic peritumoral edema (headache, neurological deficits).
Pre- and post-operative management to reduce swelling.
Palliation in metastatic brain tumors.
Dosing:
Initial (loading) dose: 10 mg IV, then 4 mg IV/PO every 6 hours (typical maintenance).
High-dose steroids (severe cases): Up to 16 mg/day or more.
Tapering: Gradual reduction over days-weeks to avoid adrenal suppression.
3. Clinical Benefits
Rapid symptom relief (often within 24–72 hours).
Reduces ICP and mass effect.
Improves surgical outcomes if given pre-operatively.
4. Side Effects & Monitoring
Short-term: Hyperglycemia, insomnia, mood changes, GI irritation (consider PPI prophylaxis).
Long-term: Immunosuppression, osteoporosis, myopathy, Cushing’s syndrome.
Monitoring: Blood glucose, infection risk, electrolyte imbalances.
5. Alternatives & Adjuncts
Osmotic therapy (Mannitol/Hypertonic saline): For acute ICP crisis.
Bevacizumab (Anti-VEGF): For refractory edema (e.g., glioblastoma).
Surgery/Radiation: Definitive treatment for tumor-related edema.

Dr . Mohammad Samim Sardar
Neurosurgeon. MD

03/08/2025

• Classifications of Adolescent Idiopathic Scoliosis (AIS):
1. JR Cobb’s classification of scoliosis (1948, historical).
2. King Classification (King et al, 1983, 5 types).
3. Lenke Classification (Lawrence Lenke & the Harms Study Group (HSG), has improved inter- & intra-observer reliability).
4. SRS 3D classification system.

*****

• Stable vertebra: the VB cephalad to the lumbar curve that is most closely bisected by CSVL.

• Curve flexibility: defined by measuring Cobb angle during bending films & dividing it by the Cobb angle in up-right AP radiographs & then multiplying by 100.

• Flexibility index: the percentage of correction (flexibility) of the thoracic curve minus the percentage of correction of the lumbar curve.

Dr.mohammad Samim Sardar
MD. Neurosurgeon

02/08/2025

Rest is not just physical.....

30/07/2025

Level of Neurosurgery services

Basic Neurosurgery:
1.Craniotomy for Trauma
2.LP
3.shunt placement
4.Simple spinal surgery

Intermediate Level:
1.Brain tumor Resection
2.Spinal fusion
3.MVD
4.Endoscopic procedure
5.peeipheral Nerve surgery

Advanced:
1.Skull base Surgery
2.C.V Surgery
3.Functional Neurosurgery
4.Pediatric Neurosurgery
5.Complex Spinal Surgery
6.Sterotactic Radiosurgery

Dr. Mohammad Samim Sardar
Neurosurgeon
Lecturer in Medical faculty

28/07/2025

19/07/2025

Performing Joint Aspiration @(Knee)@

:
1. Position the patient comfortably to access the effusion.
2. Clean the knee with povidone-iodine for 10 minutes, covering 2–3 inches above and below the knee.
3. Draping is optional but reduces infection risk.
4. Prepare a sterile field with necessary equipment (syringes, needles, hemostat, sterile cup).
5. Don sterile gloves, drape if desired, and locate the superior pole of the patella.

:
6. Identify joint space by palpating for fluid lateral to the patella.
7. Prepare 3–5 mL of 1% lidocaine with a 25-gauge needle for anesthesia.
8. Mark entry at the lateral patella margin intersecting the superior patella line. Inject lidocaine subcutaneously at a 45° sagittal and 30° frontal angle, directing caudally.
9. Advance the needle to desired depth, aspirating for blood to confirm placement.
10. Administer anesthesia while withdrawing the needle.

:
11. Replace with an 18-gauge needle attached to a 20–30 mL syringe.
12. Insert the needle medially and caudally at 45° lateral and 30° caudal angles. Aspirate synovial fluid as the needle enters the joint space behind the patella.

Dr. Mohammad Samim Sardar

18/07/2025

Cauda equina Vs Conus medullaris syndrome

16/07/2025

Complications of shunt in patients with HCP.

15/07/2025

خونریزی خارج جمجمه‌ای نوزدان 👶🩸💀

کاپوت ساکسیدانئوم (Caput Succedaneum)
محل: بین پوست و اپی کرانیال آپونوروز
ویژگی: تورم نرم که محدود به استخوان خاصی نیست و طی چند روز خود به خود بهبود میابد.

سفال هماتوم (Cephalohematoma)
محل: بین پریوست و استخوان
ویژگی: برجستگی عمقی و سفت که محدود به استخوانی خاص است.

ساب گالئال (Subgaleal Hematoma)
محل: بین پریوست و اپی کرانیال آپونوروز
ویژگی: محدود به استخوان خاصی نیست و می‌تواند کل سر را درگیر کند. خون زیادی تجمع میابد و تورم به تدریج بزرگتر شده که می‌تواند منجر به شوک شود.

11/07/2025

(( Secondary headaches ))

1. Subarachnoid Hemorrhage (SAH)

Key symptom: Sudden, worst headache of life (“thunderclap headache”)

Diagnosis:
• CT scan shows bleeding
• Spinal fluid (CSF) is yellow (xanthochromic)

Management:
• Control blood pressure (avoid rebleeding)
• Find bleeding spot via CT or angiography
• Repair aneurysm (clip or coil)
• Give nimodipine to prevent vasospasm (stroke risk)

Complications:
• Increased brain pressure (ICP), hydrocephalus
• Rebleeding (within 24h)
• Vasospasm (stroke-like signs 4–10 days later)
• Hyponatremia (low sodium)
• Seizures

2. Cerebral Venous Sinus Thrombosis (CVST)

Key symptom: Gradual or sudden headache

Diagnosis:
• Papilledema (eye swelling)
• CT/MRI: “Dense triangle” or “cord” sign

Management:
• Start heparin (blood thinner)
• If treatment fails: endovascular therapy

Complications:
• Increased brain pressure
• Brain swelling or bleeding
• Seizures

3. Brain Abscess

Key symptom: Headache + fever + brain symptoms

Diagnosis:
• MRI: Ring-enhancing lesions
• Positive blood cultures

Management:
• Antibiotics
• Surgery if mass is large
• Steroids if pressure is high

4. Meningitis

Key symptom: Headache, fever, neck stiffness, confusion

Diagnosis:
• CSF: Very high WBCs, low glucose, high protein, bacteria stain positive

Management:
1. Do lumbar puncture (if no brain mass)
2. Start antibiotics right away (ceftriaxone + vancomycin + acyclovir ± ampicillin)
3. Dexamethasone for Strep pneumoniae
4. Manage brain pressure

Complications:
• Brain damage
• Hearing loss
• Seizures

5. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

Key symptom: Headache + vision problems

Diagnosis:
• Papilledema
• CT: normal
• CSF: high pressure, but normal fluid

Management:
• Weight loss, stop trigger meds (e.g., tetracyclines)
• Acetazolamide/topiramate
• If severe vision loss: steroids, repeat spinal taps, surgery

Complication:
• Permanent vision loss if untreated.

08/07/2025

(cervical radiculopathy)
A pinched nerve is a damaged or compressed nerve. It develops when a nerve root is injured or inflamed. The nerve root is the part where a nerve branches off from the spinal cord.

A pinched nerve in the neck may feel like pins and needles. It might also cause pain and weakness in the shoulder, arm, or hand.

Exercises for a C7 pinched nerve (cervical radiculopathy) focus on reducing pressure on the nerve and improving neck and arm mobility.



Common symptoms include:

●pins and needles
●muscle weakness
●burning sensation
●numbness
●pain that radiates outward
●pain when moving your neck or head
●poor neck range of motion.

■ Gentle Stretches:
》Cervical Retraction (Chin Tucks):

》Neck Tilts:

》Neck Extensions
》Shoulder Blade Squeezes

》Shoulder Rolls

■ Nerve Glides
》Median Nerve Glide

》Ulnar Nerve Glide

■ Strengthening Exercises:
》Scapular Rows
》Wall Angels
》Deep Neck Flexor Exercises
》Chin Tuck with Neck Extension
》Shoulder Rolls

■ Others
》rest
》soft cervical collar
》hot or cold compress
》practicing good posture
》nonsteroidal anti-inflammatory drugs (NSAIDs)
》acupuncture
》massage
》yoga