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Jamir Pitton Rissardo

Dec 8, 2022 • 15 tweets • 7 min read • Read on X

Scrolly

Rabbit syndrome!!!

“a peculiar extrapyramidal reaction”

Canadian psychiatrist André Villeneuve
1972, the first report

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/

Definition

“stereotyped vertical, rhythmic movements, similar to the chewing movements of a rabbit”

5 Hz
Lips produce a popping sound
Not tardive dyskinesia!
- persist stage I sleep

2/

Pathophysiology

- cholinergic system?

3/

Clinical tips
dyskinesia versus rabbit syndrome

i) tongue 10s extruded
- dyskinesia, tongue twist
- rabbit, no movement

ii) lips movement
- only vertical, rabbit syndrome
- all directions, dyskinesia

iii) movement pace
- fast & rhythmic, rabbit
- slower & irreg, dyskinesia

4/

Management

Long-term antipsychotic use, begins a few days after modification in psych treatment

Disappear after antipsychotic discontinuation

- anti-Parkinson's drugs, some

5/

Rabbit syndrome

💡after risperidone withdrawal

via: Medtext Publications

6/

Rabbit syndrome

💡amisulpride-induced

via: Srinivasa Teja

7/

Rabbit syndrome

💡paliperidone discontinuation

doi.org/10.1097/jcp.0b… via: J Clin Psychopharmacol

8/

Rabbit syndrome

💡functional

doi.org/10.5334%2Ftohm… via: Tremor Other Hyperkinet Mov (N Y)

9/

Differ

perioral & pharyngeal myorhythmia
- lower freq (1-4 Hz), when compared to rabbit syndrome

doi.org/10.1016/j.park… via: Parkinsonism Relat Disord

10/

Differ

tardive dyskinesia
- 🔄& irregular

via: Bác Sĩ Thần Kinh

11/

Differ

perioral myorhythmia
- lower freq (1-4 Hz), when compared to rabbit syndrome

💡 medullary compression by vertebral artery

doi.org/10.1007/s10072… via: Neurol Sci

12/

Differ

perioral myorhythmia
- lower freq (1-4 Hz), when compared to rabbit syndrome

💡EMG should be performed

doi.org/10.4103%2Faian… via: Ann Indian Acad Neurol

13/

NeuroTeach - Content

The blog contains all the threads and videos.

neuronland.blogspot.com/2022/11/neurot…

Have a great day!

@sdo_henrique

Differ

hereditary chin trembling (geniospasm)

💡childhood
💡improve w/ aging
💡botox-sensitive

doi.org/10.1212/WNL.00… via: Neurology @sdo_henrique

14/

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More from @theneurolander

Jamir Pitton Rissardo

@theneurolander

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/

Syncope spectrum

-Normal
-Prodrome→ early autonomic sx
-Presyncope→ near-syncope
-Intermediary→ gray-out/ syncope threshold
-Syncope
-Recovery

2/

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/

Read 19 tweets

Jamir Pitton Rissardo

@theneurolander

Jan 29

Cognitive Changes

Alois Alzheimer (1864 – 1915), German psychiatrist and neuropathologist

1/

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/

Read 22 tweets

Jamir Pitton Rissardo

@theneurolander

Jan 25

Headache - Basics

Figure from Codex Vindobonensis 93 (12th century)

1/

Primary or Secondary?

1st question - onset

Hyperacute→ think vascular
Acute/subacute→ broader ddx
Chronic→ reassure if unchanged

Use SNOOP4 for screen secondary causes

2/

Characterize

-Pain features - "SOCRATES"
> quality (throbbing, pressure, stabbing)
> duration & frequency
> associated sx (photo/phonophobia, N/V, auto sx)

3/

Read 23 tweets

Jamir Pitton Rissardo

@theneurolander

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/

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/

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

Jamir Pitton Rissardo

@theneurolander

Jan 12

Tuning Forks

"If you want to find the secrets of the universe, think in terms of energy, frequency, and vibration"

Nikola Tesla (1856 –1943), Serbian-American engineer

1/

History

1550 Gerolamo Cardano - transmission of sound per skull
1684 Schelhammer - fork to differentiate hearing disorders
1711 John Shore - invented TF
1834 Johann Heinrich Scheibler - different frequencies
1855 - Weber test
1870 - technical improvements

2/