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/

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Jamir Pitton Rissardo

Jamir Pitton Rissardo Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @theneurolander

Dec 2
Jack-in-the-box tongue!!!

“The English Hippocrates”

English physician Thomas Sydenham (1624 – 1689)
discovered Sydenham's chorea

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/ Image
Pathophysiology

“combination of chorea & motor impersistence”



2/
Definition

“unable to maintain tongue in protruded state and the tongue moves in and out”

3/ Image
Read 19 tweets
Nov 30
Glabellar reflex (Myerson's sign)!!!

"the preliminary note on a new cranial reflex"

British doctor Walker Overend (1858–1926)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/ Image
Glossary

Glabellar reflex
Habituation
Myerson’s sign
Primitive reflex

2/ Image
History

1896, Dr. Walker Overend
- first report

1901, Dr. Daniel J. McCarthy
- published a 2nd report without acknowledging Overend

1944, Dr. Abraham Myerson
- observed, mainly, in PD

1954, Dr. Doshay
- called Myerson’s sign

3/ Image
Read 16 tweets
Nov 29
Wing-beating tremor!!!

“pseudosclerotic, parkinsonism, and dystonic/choreic forms of Wilson’s disease”

American-born British neurologist Samuel Alexander Kinnier Wilson (1878–1937)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Pathophysiology

“lesion in the dentatorubrothalamic pathway”

- cerebellar outflow pathway

Complex phenomenology
- dystonic, myoclonic, rhythmic tremor?


2/
Definition

“low-frequency, high-amplitude, posture-induced proximal arm tremor, elicited by sustained abduction of the arms, with flexed elbows and palms facing downward”

- postural tremor
- wing-beating posture

3/
Read 21 tweets
Nov 28
Nystagmus series – Part VII
(seesaw & hemi-seesaw nystagmus)

“Maddox rod, double prism Maddox, red glass Maddox, Maddox cross, and Maddox wing”

British ophthalmologist Ernest Edmund Maddox (1863–1933)
(first report)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/ Image
Definition

“one half-cycle of elevation&intorsion of one eye
and
synchronous depression&extorsion of the other eye.
Next half-cycle,
vertical&torsional components are reversed”

- waveform: pendular (seesaw) & jerk (hemi-seesaw)
- hemi-seesaw: only one half-cycle

2/ Image
Pathophysiology

Jerk (hemi-seesaw)
- lesion in the interstitial nucleus of Cajal

Pendular (seesaw)
- parasellar (midbrain compression & visual field defects)
- calibration lesion

3/ Image
Read 23 tweets
Nov 25
Head retraction reflex!!!

“the great neurologist and neurosurgeon from Breslau (Wrocław)”

German neurologist and neurosurgeon Otfrid Foerster (1873–1941)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/ Image
History

Head retraction reflex is a “triphasic cutaneomuscular reflex” related to the trigeminal system with some pyramidal control.

2/ Image
Features

“reflex hammer tap below nose with head bent forward cause backward jerk of the head”

- considered a frontal release sign
- hyperreflexia
- triphasic cutaneomuscular reflex

3/ Image
Read 13 tweets
Nov 23
Corneomandibular reflex!!!

“there is hardly a more valuable test than this to uncover a supranuclear lesion of the trigeminal nerve”

Russian neurologist Robert Wartenberg (1887–1956)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
History

1902 by German doctor Von Sölder
- first description, normal patients

1918 by German neurologist Ernst Trömner
- rediscovered the reflex

1948 by Russian neurologist Robert Wartenberg
- complete description
- ‘jaw wincking phenomenon’

2/
Pathophysiology

Mesencephalic trigeminal nucleus
- there is an inhibitory interneuron ipsilateral motor nucleus of V CN

Lesions in cortico-pontine boundaries lesions
- inhibitory influence disappear
- massive activation of trigeminal motor neuron

doi.org/10.4103%2F0976…

3/
Read 9 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

:(