@ajlees I saw a patient recently who had no complaints at all. It was her piano teacher who heard that something was wrong with her right hand.

@KurtSegers2 What exactly had her teacher noticed?

@ajlees How was their exam? I’m curious!

@khalidneuro Mild reduction in speed and amplitude of right fingers on sequential tapping and a whiff of rigidity at the right wrist nothing else

@ajlees Freud wrote the ‘Psychopathology of everyday life’. It would be great to be able to write a manual of ‘Neurology of everyday life’. Many similar signs and symptoms are scattered in dozens of books, but without systematic analysis.

@macNeuro A wonderful project

@ajlees #neurotwitter #MedTwitter

@nirmalregency Well known and first described by Marsden and Manfredi

@ajlees Flora might have masked that subtle sign. This helps build the case for the importance of sensitive objective biomarkers eg gait analysis, or even sensors in your car. Question of timing though, you have to either suspect & deploy or surveil everyone which is creepy & false +’s

@PaulWicks It builds the case for attentive listening and noticing. Most of medicine is immeasurable

@ajlees I went into work one day and couldn't double click my computer mouse, even though I had no problem the day before. That was over 20-yrs ago! PS I still can't do it

@YumaBev Yes ive heard that one and also pressing wrong key with more inexplicable typos. Occupation and hobbies frequently influences presentation

@ajlees To be fair I'm a perfectly healthy (as far as I know...) 30 year old and I've never managed to spread butter evenly on toast.

@A_Claudia_Lima Thats the difference you see this man had always been a smooth spreader

@ajlees This reminds me of a patient, a professional reader of religious texts, could not find rhythm in his readings - acute onset. Later found out to have a (R) Parietal infarct - probably a variant of aprosodia.

@ajlees Are you finding any relationship between symptom appearance and vaccination?

@ajlees I remember a patient with Multiple System Atrophy (MSA) in Cambridge, whose first symptom was that his percussion solos in live concerts didn't get the usual applause; he was a jazz musician & noticed that his movements got just a bit slower, enough for a musician to notice.

@ajlees Sounds like it needs a book a bit like Oliver Sacks book on migraines

@ajlees I was astonished meeting a bird watcher with a dreadful Parkinson's tremor and dyskinesia, who could still hold his binoculars steady for bird watching

@ajlees Mine was reaching out for toothpaste!