Jamir Pitton Rissardo Profile picture
Oct 26, 2022 11 tweets 7 min read Read on X
Hoffmann and his Assistant!!!

“upper limb equivalent of the Babinski sign test”

- hyperreflexia
- cervical cord

#MedTwitter #neurotwitter #EndNeurophobia

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Hoffmann's sign

“snaps the nail of the middle finger leads to flexion of the thumb and/or index”

discovered by German neurologist Johann Hoffman (1857–1919), but
it was described by his assistant Hans Curschmann in 1911

via: virtualmedstudent

2/
Mayer's reflex

“forceful passive flexion of the middle finger. Involuntary adduction of the thumb normally follows; absence of the reflex suggests a lesion”

discovered by Austrian neuropsychiatry Carl Mayer (1862–1936)

doctorlib.info/neurology/fund… via: doctorlib

3/ Image
Rossolimo's hand sign

“reflex hammer, tap the palmar surface of the metacarpophalangeal joint”

discovered by Russian neurologist Grigory Ivanovich Rossolimo (1860–1928)

musculoskeletalkey.com/reflexes/ via: Musculoskeletal Key

4/ Image
Wartenberg's sign

“taps against the patient’s fingers lead to flexion of fingers and distal phalanx of the thumb”

discovered by Russian neurologist Robert Wartenberg (1887–1956)

via: Neuron Bundle

5/
Chaddock's wrist sign

“Grasp the patient’s wrist, putting pressure on the palmaris longus tendon”
the patient flexes the wrist and extends the fingers

discovered by American neurologist Charles Gilbert Chaddock (1861–1936)

musculoskeletalkey.com/reflexes/ via: Musculoskeletal Key

6/ Image
Gordon's extension sign

“compression of the projection of the radial side of the pisiform bone lead to fingers extension”

discovered by French-American neurologist Alfred Gordon (1874–1953)

doi.org/10.1590/0004-2… via: Arq Neuropsiquiatr

7/ Image
Hachinski's sign

“raise hands from the knees and hold them at shoulder level”
upward movement of the right or left thumb

discovered by Ukrainian neurologist Vladimir Hachinski (alive)

doi.org/10.1212%2FCPJ.… via: Neurology

8/
Vernea's and Botez's reflex

“Superficial stimulation of dorsum of fingers in patients with a grasp reflex”

discovered by Romanian neurologists I. Vernea and M.I. Botez

doi.org/10.1111/j.1600… via: Acta Neurol Scand

9/ Image
Trömner's reflex

“flicks the middle finger pad leads to flexion of the thumb and/or index”

discovered by German neurologist Ernst Trömner (1868–1930)

youtube.com/shorts/kEbnFG_… via: NeurologiaBr - Dr Euldes

10/
Wazir's sign

“extended wrist is tapped at the level of the palmaris longus”

discovered by Malaysian orthopedic surgeon Wazir NN

pubmed.ncbi.nlm.nih.gov/21298241/ via: Singapore Med J

11/ Image

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More from @theneurolander

Feb 10
Dizziness

David Newman-Toker, neuro-otology
Senior author of "HINTS to diagnose stroke"

1/ Image
What is dizziness?
-Dizziness→ impaired perception of spatial orientation without vertigo
-Vertigo→ illusion of motion (spinning/non-spinning)
>Subjective (person)→ MC peripheral
>Objective (environment)→ MC central

2/
-Oscillopsia→ 'world bounces'
>can’t read signs while walking
>B/L vestibular hypofunction
-Lightheadness, syncope→ LOC
-Imbalance→ severe truncal ataxia

3/
Read 23 tweets
Feb 8
Mirror Movements (Spiegelschrift)

1st described by Dr. Friedrich Albrecht Erlenmeyer (1849–1926)
Grundzüge ihrer Physiologie und Pathologie, 1879

#NeuroPearl #NeurologyPearls #NeuroExam #NeuroCases #MedEd #AcademicMedicine #ResidentLife #NeurologyResident

1/ Image
Definition

"Involuntary movements on one side that mirror voluntary actions on the other"
-Normal in <7–10yo (corpus callosum myelination), 70% healthy children (on speed-based task)

2/
Pathophysiology

Three teories
-Overflow
> signal 'overflows' to the other hand

-Weak interhemispheric inhibition
> both hemispheres fire together

-Abnormal crossing motor pathways
>same commands go to both hands

by @AlbertoEspay @UCMovDis

3/ Image
Read 43 tweets
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/ Image
Syncope spectrum

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

2/ Image
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/ Image
Read 19 tweets
Jan 29
Cognitive Changes

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

1/ Image
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/ Image
Read 22 tweets
Jan 25
Headache - Basics

Figure from Codex Vindobonensis 93 (12th century)

1/ Image
Primary or Secondary?

1st question - onset

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

Use SNOOP4 for screen secondary causes

2/ Image
Characterize

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

3/
Read 23 tweets
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/ Image
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/ Image
Localizing

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

3/
Read 22 tweets

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