Jamir Pitton Rissardo Profile picture
Nov 6, 2022 25 tweets 13 min read Read on X
The dysfunctional little brain!!!
Part I

“regulates ‘rate, range, and force’ of movement”

Irish neurologist Gordon Morgan Holmes (1876–1965)

#MedTwitter #neurotwitter #EndNeurophobia

1/
Dyssynergia

“lack of integration of the components of the act results in decomposition of movement”

- rapid ‘repetitive’ movement

via: Dr Timothy Conwell

2/
Dyssynergia

“lack of integration of the components of the act results in decomposition of movement”

- rapid ‘repetitive’ movement

via: MatthewHR1

3/
Dysmetria

“errors in judging distance and gauging the distance, speed, power, and direction of movement”

- past pointing
- hypermetria is more common

via: onlinemedicalvideo

4/
Dysmetria

“errors in judging distance and gauging the distance, speed, power, and direction of movement”

via: Dr Hashir Malik

5/
Dysmetria

“errors in judging distance and gauging the distance, speed, power, and direction of movement”

via: MatthewHR1

6/
Dysmetria

- clear instructions
- finger & foot
- index near & far

via: UCD Medicine

7/
Dysmetria

“errors in judging distance and gauging the distance, speed, power, and direction of movement”

- modified to chin test

via: Adrienne Jackson

8/
Dysmetria

“errors in judging distance and gauging the distance, speed, power, and direction of movement”

via: Mamata Chimmalgi

9/
Dysdiadochokinesia

“clumsy term (coined by Babinski) that means inability to make rapid ‘alternating’ movement”

- antagonist-agonist coordination

youtube.com/c/DrTimothyCon… via: Dr Timothy Conwell

10/
Dysdiadochokinesia

“clumsy term (coined by Babinski) that means inability to make rapid ‘alternating’ movement”

- antagonist-agonist coordination

via: Neuron Bundle

11/
Dysdiadochokinesia

“clumsy term (coined by Babinski) that means inability to make rapid ‘alternating’ movement”

- antagonist-agonist coordination

via: MatthewHR1

12/
Dysdiadochokinesia Song

Dysdiadochokinesia
indicates a cerebellar lesion
rapid alternating movements
thigh, hand and foot tapping

via: Sthornhil

13/
Holmes (Stewart-Holmes) rebound phenomenon

“reflex when one attempts to move a limb against resistance that is suddenly removed”

- antagonist-agonist coordination
- loss of checking response
- normal, spasticity, cerebellar

via: Mamata Chimmalgi

14/
Holmes (Stewart-Holmes) rebound phenomenon

“reflex that occurs when one attempts to move a limb against resistance that is suddenly removed”

- loss of checking response

youtube.com/shorts/iN5YbmY… via: Dr.Pawan Soni

15/
Holmes (Stewart-Holmes) rebound phenomenon

“reflex that occurs when one attempts to move a limb against resistance that is suddenly removed”

- checking response

via: UCD Medicine

16/
Pendular reflex

“muscle hypotonicity and the lack of normal checking of the reflex response”

- hypotonia
- decrease tonic output of the cerebellar nuclei

via: Mamata Chimmalgi

17/
Pendular reflex

“muscle hypotonicity and the lack of normal checking of the reflex response”

- hypotonia
- decrease tonic output of the cerebellar nuclei

via: Real Medicine

18/
Pendular reflex

“muscle hypotonicity and the lack of normal checking of the reflex response”

- hypotonia
- decrease tonic output of the cerebellar nuclei

via: sthornhil

19/
Cerebellar wrist

- hypotonia
- extended and arched dorsally
- fingers hyperextended
- tendency toward overpronation

20/
Scanning speech

“slow, slurred, staccato, monotonous”

- ataxic dysarthria and/or MS dysarthria
- oral motor ataxia
- speech asynergy

via: allornonelaw

21/
Scanning speech

“slow, slurred, staccato, monotonous”

- ataxic dysarthria and/or MS dysarthria
- oral motor ataxia
- speech asynergy

via: neuro by neurologist rids

22/
Scanning speech

“slow, slurred, staccato, monotonous”

- ataxic dysarthria and/or MS dysarthria
- oral motor ataxia
- speech asynergy

via: prohealthsys

23/
Scanning speech

“slow, slurred, staccato, monotonous”

- ataxic dysarthria and/or MS dysarthria
- oral motor ataxia
- speech asynergy

via: UCD Medicine

24/
To be continued…

Part 2 – Next week

List of "Twitter Threads"

neuronland.blogspot.com

25/

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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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