Jamir Pitton Rissardo Profile picture
Dec 1, 2022 19 tweets 10 min read Read on X
Milkmaid’s grip!!!

“motor impersistence of the hand”

Philippus Aureolus Theophrastus Paracelsus Bombastus von Hohenheim (1493–1541)
(Paracelsus)
first coined the term Chorea Sancti Viti

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Pathophysiology

“combination of chorea & motor impersistence”

Motor impersistence
- inability to maintain tetanic muscle contraction
- positioning & compensatory repositioning
- independent of chorea
- linearly progressive (marker of disease severity?)
- frontal lobe

2/
Examples of motor impersistence

- Milkmaid’s grip
- inability to maintain eye closure
- ‘Jack in the box’ tongue

3/
Milkmaid’s grip – definition

“alternating squeezing and releasing of the finger like a milking motion, when asked to maintain a constant, firm grip of examiner’s fingers”

- fluctuating pressure on handshake

4/
Milkmaid’s grip – features

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

5/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Medchrome

6/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: allornonelaw

7/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Pakistan Academy of Pediatrics

8/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Pediatrics By Dr.Anand

9/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: shailesh Patil

10/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

youtube.com/shorts/tAg0Ohr… via: Dr Khan Medics

11/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Doctor Sajid Vlog

12/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

youtube.com/shorts/8-uN5Dp… via: pediatric videos

13/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

youtube.com/shorts/Z43DViI… via: Dr Gauhar Mahmood Azeem

14/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

youtube.com/shorts/eXhQe8y… via: Medicine classroom

15/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Nicolas Laing

16/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: RHDAustralia

17/
Milkmaid’s grip

“alternating squeezing and releasing of the finger when asked to maintain a constant grip”

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: RHDAustralia

18/

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Jan 26, 2023
Diencephalon location
- around the 3rd ventricle

The cavity of the diencephalon is ----- the 3rd ventricle
All of the structures of the diencephalon are around the 3rd ventricle, so the cavity of the diencephalon is the 3rd ventricle.

2/
Diencephalon embryology

- prosencephalon

3/ Image
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Jan 12, 2023
The Examination in Coma

“the father of modern neurological surgery”

American neurosurgeon Harvey Williams Cushing (1869–1939)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/ Image
Definition

“a state of unarousable unresponsiveness”

Parts
a. level of consciousness
b. vital signs (BP & breathing pattern)
c. cranial nerves (fundoscopy + vision + brainstem)
d. motor & sensory
e. reflex
f. meningeal signs

2/
Level of consciousness

Normal
Clouding of consciousness
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Stupor
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3/ Image
Read 30 tweets
Dec 26, 2022
Drifts!!!

French neurologist Jean Alexandre Barré (1880–1967)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
The four types of drift

“pronator, cerebellar, parietal, and functional”

- pronator drift (pyramidal drift) was the 1st to be described
- Dr. Barre was the 1st to report it

2/
Pronator drift (Barre’s sign)

progress from distal to proximal

1st downward arm drift
2nd forearm pronation
3rd flexion of the wrist and elbow

3/
Read 18 tweets
Dec 22, 2022
Brachial plexus!!!

“Erb-Duchenne palsy, Erb-Charcot paralysis, Erb's point, Erb-Westphal symptom, Erb's spot”

German neurologist Wilhelm Heinrich Erb (1840–1921)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Components

“Ready To Drink Cold Beer”

Root (5): C5-T1
Trunk (3): upper, middle, lower
Division (6): anterior & posterior from each of the trunks
Cord (3): lateral, posterior, medial
Branch (5)

2/
How are roots formed?

“formed by the anterior (ventral) rami of C5 to T1 spinal nerves”

Extent
- interscalene triangle (bounded by anterior scalene and middle scalene)

3/
Read 24 tweets
Dec 21, 2022
Signs of tetany!!!

“Trousseau sign of malignancy, Trousseau sign of latent tetany, Trousseau–Lallemand bodie”

French internist Armand Trousseau (1801–1867)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Definition

Tetanus
- it is different disease w/ different pathology

Tetanic contractions (physiologic tetanus)
- broad range of muscle contraction types

Tetany
- a type of tetanic contraction

2/
Clinical manifestations of tetany

“spasm and tonic contractions of the skeletal muscles, principally the distal muscles of the extremities”

3/
Read 25 tweets
Dec 19, 2022
Meningeal signs

“Brudziński neck sign, Brudziński symphyseal sign, Brudziński cheek sign, Brudzinski's reflex”

Polish pediatrician Józef Polikarp Brudziński (1874–1917)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Definitions

Meningitis
-inflammation of leptomeninges & underlying subarachnoid CSF

Meningismus
-morbid state characterized by meningitic syndrome (triad: headache, photophobia, nuchal rigidity)

Meningism
-synonymous of meningismus
-neck stiffness w/o meningeal inflammation
2/
Mechanism

“maneuvers used to elicit meningeal signs produce tension on inflamed and hypersensitive spinal nerve roots, and the resulting signs are postures, protective muscle contractions, or other movements that minimize the stretch and distortion of the meninges and roots”

3/
Read 27 tweets

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