Jamir Pitton Rissardo

@theneurolander

Oct 15, 2022 • 25 tweets • 12 min read • Read on X

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Movement Disorders - Ballism

“chorea that affects proximal joints such as shoulder or hip” Mov Disord Society, 2011

- Freq causes: vascular and metabolic

- Good response to antipsychotics, usually self-limiting

#MedTwitter #neurotwitter #EndNeurophobia #movementdisorder

1/

First report

In 1927 James Purdon Martin
Hemichorea resulting from a local lesion of the brain

doi.org/10.1093/brain/…

2/

Hemichorea-hemiballismus: nonketotic hyperglycemia

doi.org/10.1212/WNL.0b… via: Neurology

3/

Hemiballismus: parietal lobe infarction

doi.org/10.7759/cureus… via: Cureus

4/

Hemichorea-hemiballismus: nonketotic hyperglycemia

doi.org/10.14802%2Fjmd… via: Journal of Movement Disorders

5/

Hemiballismus: Lacunar infarct in the right centrum semiovale

doi.org/10.4103%2Faian… via: Annals of Indian Academy of Neurology

6/

Bilateral chorea–ballism: hyperthyroidism

doi.org/10.1002/mds.20… via: Movement Disorders

7/

Hemichorea-hemiballismus: vaccine-Induced

doi.org/10.5334%2Ftohm… via: Tremor and Other Hyperkinetic Movements

8/

Hemichorea-hemiballismus: nonketotic hyperglycemia

doi.org/10.1002/mds.21… via: Movement Disorders

9/

Hemichorea-hemiballismus: nonketotic hyperglycemia

doi.org/10.14802%2Fjmd… via: Journal of Movement Disorders

10/

Bilateral ballism: herpes encephalitis with thalamic lesion

doi.org/10.1016/j.park… via: Parkinsonism & Related Disorders

11/

Hemichorea-hemiballismus: cryptococcal Meningitis

doi.org/10.7759/cureus… via: Cureus

12/

Hemichorea-hemiballismus: nonketotic hyperglycemia

doi.org/10.1007/s10072… via: Neurological Sciences

13/

Hemichorea-hemiballismus: intracranial toxoplasmosis and tuberculosis

doi.org/10.5334%2Ftohm… via: Tremor and Other Hyperkinetic Movements

14/

Bilateral chorea-ballism: after cardiac arrest

doi.org/10.1212/wnl.64… via: Neurology

15/

Bilateral ballism: limb-shaking transient ischemic attacks

doi.org/10.1016/j.jstr… via: Journal of Stroke and Cerebrovascular Diseases

16/

Hemiballismus: insular and temporal lobe infarct

doi.org/10.1001/jamane… via: JAMA Neurology

17/

Bilateral ballism: fever-induced

doi.org/10.1002/mds.21… via: Movement Disorders

18/

Hemichorea-hemiballism: after external ventricular drainage

doi.org/10.14802%2Fjmd… via: Journal of Movement Disorders

19/

Hemichorea-hemiballismus: diabetic ketoacidosis

doi.org/10.1016%2Fj.ds… via: Diabetes Metab Syndr

20/

Hemichorea‐hemiballism: CNS tuberculosis

doi.org/10.1002%2Fmdc3… via: Mov Disord Clin Pract

21/

Hemiballismus: anti-Yo

doi.org/10.1016/j.jocn… via: Journal of Clinical Neuroscience

22/

Hemichorea-hemiballismus: after clipping MCA aneurysm

doi.org/10.4103%2F2152… via: Surg Neurol Int

23/

Hemichorea-hemiballism: postoperative stroke

doi.org/10.7916%2FD8C5… via: Tremor and Other Hyperkinetic Movements

24/

Hemichorea-hemiballism: Nonketotic Hyperglycemia

doi.org/10.7916%2FD8QZ… via: Tremor and Other Hyperkinetic Movements

25/

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More from @theneurolander

Jamir Pitton Rissardo

@theneurolander

Feb 1

Syncope vs Seizure

Fainting by love in Philadelphia Museum of Art
The Doctor's Visit by Jan Steen

#Neurology #Seizure #Syncope #Neuroscience

1/

Syncope spectrum

-Normal
-Prodrome→ early autonomic sx
-Presyncope→ near-syncope
-Intermediary→ gray-out/ syncope threshold
-Syncope
-Recovery

2/

Clinical history

What EXACTLY happened before, during, and after the event?

-open-ended quest at begining, than close
-LOC, incotinence
-Witness and recurrence
*avoid term fainting
-Triggers (sleep dep, drugs, stand) vs premonitory symptoms

3/

Jamir Pitton Rissardo

@theneurolander

Jan 29

Cognitive Changes

Alois Alzheimer (1864 – 1915), German psychiatrist and neuropathologist

1/

Referral

-word-finding difficulty (tip-of-the-tongue phenomenon)
-memory complaints (often vague, sometimes language-related)
-dissect complaints into domains

2/

Cognitive Domains

Use SAMPLE

-Social→ behavior
-Attention→ focus
-Memory→ retention
-Perceptual/ visuospatial→ navigation
-Language→ only language
-Executive function→ multisteps

3/

Jamir Pitton Rissardo

@theneurolander

Jan 25

Headache - Basics

Figure from Codex Vindobonensis 93 (12th century)

1/

Primary or Secondary?

1st question - onset

Hyperacute→ think vascular
Acute/subacute→ broader ddx
Chronic→ reassure if unchanged

Use SNOOP4 for screen secondary causes

2/

Characterize

-Pain features - "SOCRATES"
> quality (throbbing, pressure, stabbing)
> duration & frequency
> associated sx (photo/phonophobia, N/V, auto sx)

3/

Jamir Pitton Rissardo

@theneurolander

Jan 19

Diagnosing Neuropathy
Clinical Pearls

"There are numbness, tingling, and burning pains in the feet, with weakness of the legs, so that the patient walks with difficulty and unsteadiness"

Sir William Osler (1849 – 1919), Canadian physician

1/

Presentation
Referral "neuropathy," self-dx googling numbness/tingling
-hard≠numbness≠tingling≠weak

-true negative sx (loss) are more specific
>unable feel floor T°
>unable sense sand/cold surfaces

-positive sx (gain) are non-SP
>dd: CVI, MSK, compression, positional
2/

Localizing

P.neuropathy patterns
-stocking-glove distribution
>1st stocking (knee) level → 2nd hands: likely DM
-dist → prox progression in limbs
-symmetric sensory loss

3/

Jamir Pitton Rissardo

@theneurolander

Jan 12

Tuning Forks

"If you want to find the secrets of the universe, think in terms of energy, frequency, and vibration"

Nikola Tesla (1856 –1943), Serbian-American engineer

1/

History

1550 Gerolamo Cardano - transmission of sound per skull
1684 Schelhammer - fork to differentiate hearing disorders
1711 John Shore - invented TF
1834 Johann Heinrich Scheibler - different frequencies
1855 - Weber test
1870 - technical improvements

2/

TF Parts

Prongs (wings), stem (handle), and foot (base)

3/

Jamir Pitton Rissardo

@theneurolander

Oct 12, 2025

Head (Holocephalic) tremor

"... is just an irritation..."

Katherine Hepburn

1/

imdb.com/pt/name/nm0000031/?reasonForLanguagePrompt=browser_header_mismatch

ET

- no-no
- type 1 (enhanced) & 2 (msc activation not req for posture)
- ET meds, if no response botox

2/ youtube.com/shorts/uMA_wPY…

PD

- yes-yes
- jaw & lip→ PD

3/

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