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Jamir Pitton Rissardo

Oct 23, 2022 • 13 tweets • 7 min read • Read on X

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Movement Disorders – Dystonia (Writer's cramp)

“abnormal postures and muscle spasms interfering in writing motor performance”

- Most freq focal, task-specific dystonia.
- Managed botox > orals (anticholinergic)

#MedTwitter #neurotwitter #EndNeurophobia #movementdisorder
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History #dystonia

First description

Bernardino Ramazzini (1633-1714) discussed focal hand dystonia as a muscle strain in “Scribes and Notaries” De Morbis Artificum Diatriba.

doi.org/10.1016/s0140-…

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Writer's cramp (focal hand dystonia)

doi.org/10.1002/mds.23… via: Mov Disord

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Writer's cramp (focal hand dystonia)

doi.org/10.1002/mds.23… via: Mov Disord

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Writer's cramp (focal hand dystonia)

doi.org/10.1002/mds.23… via: Mov Disord

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Writer's cramp (focal hand dystonia)

doi.org/10.1002/mds.23… via: Mov Disord

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Writer's cramp (focal hand dystonia)

doi.org/10.1007/978-1-… via: Current Clinical Neurology

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Writer's cramp (focal hand dystonia)

doi.org/10.1007/978-1-… via: Current Clinical Neurology

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Writer's cramp (focal hand dystonia)

via: Dr.Paresh Doshi

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Writer's cramp (focal hand dystonia)

via: Dr. Joaquin Farias

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Writer's cramp (focal hand dystonia)

via: Dr. Bác Sĩ Thần Kinh

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Writer's cramp (focal hand dystonia)

via: Dr.Paresh Doshi

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Writer's cramp (focal hand dystonia)

via: Dr. Dr Sudhir Kumar

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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

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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

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Jamir Pitton Rissardo

@theneurolander

Jan 29

Cognitive Changes

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

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Referral

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

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Cognitive Domains

Use SAMPLE

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

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Read 22 tweets

Jamir Pitton Rissardo

@theneurolander

Jan 25

Headache - Basics

Figure from Codex Vindobonensis 93 (12th century)

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Primary or Secondary?

1st question - onset

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

Use SNOOP4 for screen secondary causes

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Characterize

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

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Read 23 tweets

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
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Localizing

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

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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/