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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More from @theneurolander

Dec 1
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/
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

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