- Twitch's design closely resembles that of the Skaven, a devious and warlike race of anthropomorphic rats from the franchise. The Medieval skin reflects this similarity more than his original skin.
- Spray and Pray is a generic phrase used to describe the random spraying of bullets with an automatic weapon hoping to hit something.
- Twitch was designed by Guinsoo..
- Deadly Venom displays an "X" symbol upon reaching 6 stacks. This is most likely a reference about how infected houses during the Bubonic Plague would be marked with an "X" on the door.
- Twitch's title is likely a reference to the , which in Europe during Medieval times, and was transmitted by rats or more specificly, their fleas.
- Gangster Twitch may be a reference to the Toon Patrol weasels from , or to the actor who is famous for portraying a gangster and his misquoted line, "MMMmmm, you dirty rat!".
- Medieval Twitch was conceived by the 2 people that first hit 350 friend referrals: Grez and Greyrir Wolfwood. Grez picked the champion that would receive the skin, and Greyrir Wolfwood designed a "Medieval Twitch, with a on his cape, and a pot on his head". The idea was given to the Riot artists and Medieval Twitch was released a few months later.
- Medieval Twitch holds the distinction for being the rarest skin in the game.
- Vandal Twitch, Vandal Brand, Vandal Gragas, Vandal Vladimir, Vandal Jax all share a Vandal theme.