Jamir Pitton Rissardo Profile picture
Dec 2, 2022 20 tweets 10 min read Read on X
Jack-in-the-box tongue!!!

“The English Hippocrates”

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

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Pathophysiology

“combination of chorea & motor impersistence”



2/
Definition

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

3/
Also known as

-jack-in-the-box, chorea
-flycatcher tongue, tardive dyskinesia
-‘bon-bon’ sign, tongue alternately pushes against the buccinator
-trombonist’s tongue, chronic alcoholism
-other: lizard tongue, chameleon tongue, snake tongue, adder tongue, harlequin tongue

4/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Neurology Made Interesting

5/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Rakanuzzaman Neuro Academy

6/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

youtube.com/shorts/a_lIlZX… via: Tony scaria

7/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

youtube.com/shorts/hSkc43c… via: Medscribe

8/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

youtube.com/shorts/hSkc43c… via: Medscribe

9/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Dr. Abhijit Gadewar

10/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Dr Khan Medics

11/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning
via: Tech, Med & More

12/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

youtube.com/shorts/t_CzX6F… via: Dheeraj Anupa

13/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Dr. Prodigious

14/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

youtube.com/shorts/vRGaDda… via: DocAsim

15/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Dr. Prodigious

16/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Everest

17/
Jack-in-the-box tongue

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

- chorea
- motor impersistence
- positioning & compensatory repositioning

via: Dove Medical Press

18/
Jack-in-the-box tongue

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

Videofluoroscopic swallow in HD
- look at tongue movements

via: Karen Sheffler

19/

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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/
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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
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2/ Image
Clinical history

What EXACTLY happened before, during, and after the event?

-open-ended quest at begining, than close
-LOC, incotinence
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*avoid term fainting
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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
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3/
Read 23 tweets
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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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