Saturday, August 15, 2015

Neurology Mnemonics


Neurology Mnemonics


Peripheral nervous examination "Tall People 
R
un-over Small Children":
Tone
Power
Reflexes
Sensation
Co-ordination/ Clonus


Alzheimer's disease: progressive phases ABCD:
Amnesic phase (forgetting keys, leaving cooker on)
Behavioural problems (antisocial, wandering)
Cortical phase (incontinence, falls)
Decerebrate phase (return of primitive reflexes)


Hydrocephalus: Normal pressure hydrocephalus DDx 3 W's:
Wet: urinary incontinence
Wobbly: gait abnormality
Wacky: dementia, memory problems


Cerebellar signs PINARD'S:
Past pointing
Intention tremor
Nystagmus
Ataxia
Rebound
Dysdiadokinesia
Slurred speech
[Note: If you haven't done Obs yet, a Pinard's is for listening to a baby's
heart on mother's abdomen]


Multiple sclerosis: signs and symptoms INSULAR:
Intention tremor
Nystagmus
Slurred speech
Uthoff's phenomenon
Lhermitte's sign
Ataxia
Rebound


Conscious change: causes AEIOU TIPS:
Alcohol
Encephalopathy
Infection
Opioid
Uremia
Trauma
Insulin
Psychosis
Syncope


Decreased level of consciousness: metabolic causes 
METABOLIC
:
Major end organs (liver, kidney)
Endocrine/ Electrolytes
Toxins
Acid
Base disorders
Oxygenation
Lung (PE, pneumonia)
Infection/ Inflammatory/ Iatrogenic
Calcium


Peripheral neuropathy: differential STAGLAND:
Sarcoid
Thyroid
Amyloid
Guillian-Barre
Lead
Alcohol
Nutritional
Drugs/ Diabetes


Dementia: treatable causes DEMENTIA:
Drug toxicity
Emotional (depression, anxiety, OCD, etc.)
Metabolic (electrolytes, liver dz, kidney dz, COPD)
Eyes/ Ears (peripheral sensory restrictions)
Nutrition (vitamin, iron deficiencies/ NPH [Normal Pressure
Hydrocephalus]
Tumors/ Trauma (including chronic subdural hematoma)
Infection (meningitis, encephalitis, pneumonia, syphilis)
Arteriosclerosis and other vascular disease


Whipple's disease: features [for neurologists] A WHIPPLES
DOOM
:
Arthralgias
Whipplei (organism)
Hypothalamic involvement
Intestinal involvement/ Intestinal biopsy required
PAS positive macrophages
PCR positivity
Lymphadenopathy
Extrapyramidal involvement
Septran treat with
Dementia
Ocular abnormalities (vertical gaze palsy)
Oculomasticatory myorhythmia
Myoclonus


Congenital myopathy: features DREAMS:
Dominantly inherited, mostly
Reflexes decreased
Enzymes normal
Apathetic floppy baby
Milestones delayed


Chorea: common causes St. VITUS'S DANCE:
Sydenhams
Vascular
Increased RBC's (polycythemia)
Toxins: CO, Mg, Hg
Uremia
SLE
Senile chorea
Drugs
APLA syndrome
Neurodegenerative conditions: HD, neuroacanthocytosis, DRPLA
Conception related: pregnancy, OCP's
Endocrine: hyperthyroidism, hypo-, hyperglycemia


Status epilepticus: treatment "Thank Goodness
All Cerebral Bursts Dissipate":
Thiamine
Glucose
Ativan
Cerebyx
Barbiturate
Diprivan


Balint's syndrome SOOT:
Simultagnosia
Optic ataxia
Ocular apraxia
Tunnel vision


Visual loss: persistent bilateral sudden onset visual loss
differential
 FLOP:
Functional
Leber's hereditary neuropathy
Occipital infarctions
Pituitary apoplexy


Perinaud's syndrome: clinical features PERINAUD'S:
Pseudo 6th nerve palsy/ Penial region
Eyelid Retraction
Internuclear ophthalmoplegia
Nystagmus
Accomodation reflex present
Upward gaze palsy
Defective convergence/ Decerebrate rigidity
Skew deviation


Benidict's syndrome: site affected Benidict's test
for sugar gives red precipitate.
Similarly, Benidict's syndrome affects rednucleus.


Stroke: basic work up The 3 P's:
Pump
Pipes
Plasma


Neurofibromatosis: diagnostic criteria ROLANDO:
Relative (1st degree)
Osseous fibromas
Lisch nodules in eyes
Axillary freckling
Neurofibromas
Dime size cafe au lait spots
Optic gliomas


Proximal myopathy: differential PEACH PODS:
Polymyositis
Endocrine: hyper, hypothyroidism, Cushing's syndrome, acromegaly
Alcohol
Carcinoma
HIV infection
Periodic hypokalemic paralysis
Osteomalacia
Drugs: steroids, statins
Sarcoidosis


Dementia: reversible dementia causes DEMENTIA:
Drugs/ Depression
Elderly
Multi-infarct/ Medication
Environmental
Nutritional
Toxins
Ischemia
Alcohol


Stroke: young patient's likely causes 7 C's:
Cocaine
Consanguinity [familial such as neurofibromatosis and von Hippel-Lindau]
Cancer
Cardiogenic embol
hyperCoagulation
CNS infection [eg: HIV conditions]
Congenital arterial lesion


Encephalitis: differential HE'S LATIN AMERICAN:
Herpesviridae
Enteroviridae (esp. Polio)
Slow viruses (esp. JC, prions)
Syphilis
Legionella/ Lyme disease/ Lymphocytic meningoencephalitis
Aspergillus
Toxoplasmosis
Intracranial pressure
Neisseria meningitidis
Arboviridae
Measles/ Mumps/ Mycobacterium tuberculosis/ Mucor
E. coli
Rabies/ Rubella
Idiopathic
Cryptococcus/ Candida
Abscess
Neoplasm/ Neurocysticercosis
· Neurocysticercosis should be assumed with recent Latin American immigrant
patient unless proven otherwise.


Head trauma: rapid neuro exam · 12 P's:
Psychological (mental) status
Pupils: size, symmetry, reaction
Paired ocular movememts
Papilloedema
Pressure (BP, increased ICP)
Pulse and rate
Paralysis, Paresis
Pyramidal signs
Pin prick sensory response
Pee (incontinent)
Patellar relex (and others)
Ptosis
· Reevaluate patient every 8 hrs.


Neurofibromatosis: diagnositic criteria (type-1) CAFE
SPOT
:
Cafe-au-lait spots
Axillary, inguinal freckling
Fibroma
Eye: lisch nodules
Skeletal (bowing leg, etc)
Pedigree/ Positive family history
Optic Tumor (glioma)


Pupillary dilatation (persistent): causes 3AM:
3rd nerve palsy
Anti-muscarinic eye drops (eg to facilitate fundoscopy)
Myotonic pupil (Holmes Adie pupil): most commonly in young women, with
absent/delayed reaction to light and convergence, and of no pathological
significance.


Ocular bobbing vs. dipping "Breakfast is fast,
Dinner is slow, both go down":
Bobbing is fast.
Dipping is slow.
In both, the initial movement is down.


Huntington's: chromosome, involvement HUNT 4 DATE:
HUNTington's on chromosome 4, with cauDATE nucleus
involvement.


Pin-point pupil causes Pin-Point Pupils
are due to oPioids and Pontine Pathology


Babinski and LMN signs: conditions exhibiting them "D
MASTS
":
Diabetes
Motor neuron disease
Ataxia (friedrichs)
Subacute combined degeneration of cord
Tabo paresis
Syringobulbia


Peripheral neuropathies: differential DANG THERAPIST:
Diabetes
Amyloid
Nutritional (eg B12 deficiency)
Guillain-Barre
Toxic (eg amiodarone)
Heriditary
Endocrine
Recurring (10% of G-B) Alcohol
Pb (lead)
Idiopathic
Sarcoid
Thyroid


Dementia: some common causes DEMENTIA:
Diabetes
Ethanol
Medication
Environmental (eg CO poisoning)
Nutritional
Trauma
Infection
Alzheimer's


Vertigo: differential VOMITS:
Vestibulitis
Ototoxic drugs
Meniere's disease
Injury
Tumor
Spin (benign positional vertigo)


Ramsay-Hunt syndrome: cause and common feature "Ramsay
Hunt":
· Etiology:
Reactivated
Herpes zoster
· Complication:
Reduced
Hearing


Stroke risk factors HEADS:
Hypertension/ Hyperlipidemia
Elderly
Atrial fib
Diabetes mellitus/ Drugs (cocaine)
Smoking/ Sex (male)


Multiple sclerosis (MS): epidemiology MS is a
feminine title (Ms.) and is female predominant.


Neuropathy: diagnosis confirmation NEuropathy:
Nerve conduction velocity
Electromyography


Battle sign BattlE:
Behind Ear


Parkinson's disease: signs and symptoms SMART:
Shuffling gait
Mask-like facies
Akinesia
Rigidity
Tremor


Alzheimer's disease: common characteristics ALZHEIMER'S:
Anterograde amnesia is usually first sign
Life expectancy increase shows more cases in recent years
Zapped (loss of) acetylcholinergic neurons
Hereditary disease
Entire hippocampus becomes affected
Identified by neurofibrillary tangles
Mutation in amyloid genes associated w/ disease
Entorhinal areas degenerate first
Retrograde amnesia ultimaltely develops
Senile plaques are formed at synapse


Thalamic boundaries "I HIT PPL (people)":
· Directions are in alphabetical order:
Anterior: Interventricular Foramen
Inferior: Hypothalamic nuclei (plane connecting them)
Lateral: Internal capsule (posterior limb)
Medial: Third ventricle
Posterior: free Pole of Pulvinar
Superior: Lateral ventricle
· Posterior has 2 P's.


Afferent vs. efferent neurons Afferent = Arrive
Efferent = Exit


Spinal cord: afferent vs. efferent neurons "Confusing
because they both sound the SAME":
Sensory=Afferent
Motor=Efferent


Dysphasia: Broca's vs. Wernicke's causing expressive vs. receptive
BEWARE:
Broca's area: Expressive dysphasia.
Wernicke's Area: REceptive dysphasia


ALS: symptoms ALS:
Anterior horn neuron loss
Lower motor dominant effects
Spino-cortical tract (cortico-spinal tract)


Meningitis: site of TB meningitis attack TB
meningitis attacks The Base of the brain


Cerebellar deep nuclei "Fat Girls Eat
Doritos":
· From medial to lateral:
Fastigial
Globose
Emboliform
Dentate


Cerebellar peduncles: afferent vs efferent SEMA:
Superior cerebellar peduncle
Efferent (fibres)
Middle cerebellar peduncle
Afferent (fibres)


Geniculate bodies: paired to respective colliculi SLIM:
Superior colliculi: Lateral geniculate body.
Inferior colliculi: Medial geniculate body.


Cerebellar damage signs DANISH:
Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia


Cerebellar functional areas Anatomical shape/location of
cerebellar areas is a key to their function and related tract.
· Vermis = Spinocerebellar = Axial equilibrium.
Vermis: right down the axis of cerebellum, and vertically
segmented like a spinal column.
· Flocculonodular lobe = Vestibulocerebellar = Ear, eye, body
coordination.
Flocculonodular lobe: flares out to the edges, just like ears.
· Hemispheres of cerebellum = Cerebrocerebellar = Peripheral
coordination.
Hemispheres: around periphery of cerebellum, and tract to 
cerebral hemispheres
.


Auditory pathway: mandatory stops "Come I
M
Baritone":
Cochlear nucleus
Inferior colliculus
Medial geniculate nucleus
Brodmann's 41 (cortex)


Olivary nuclei: ear vs. eye roles Superior Olivary
nucleus: SOund localization.
· Inferior olivary nucleus is therefore the one for sight [tactile,
proprioception also].


Geniculocalcarine tract Lower bank of calcarine
sulcus is the Lingual gyrus: it receives input from Lower retinal
quadrants.
Therefore, Cuneus is the Upper bank of calcarine sulcus: it
receives input from Upper retinal quadrants.
· Remember: lower retinal quadrants represent superior visual field quadrants
and viceversa.


Basal ganglia: D1 vs. D2 connections D1 has 1
connection (Striatum-GPi/SNpr).
D2 has 2connections (Striatum-GPe-GPi/SNpr).


Meninges: layers in order PAD:
Piamater
Arachnoid
Dura


Coronal section of brain: structures "In Extreme
Conditions Eat People's Guts Instead of Their
Hearts":
· From insula to midline:
Insula
Extreme capsule
Claustrum
External capsule
Putamen
Globis pallidus
Internal capsule
Thalamus
Hypothalamus


Cranial nerves: sensory, motor or both [1950s style] "Some
Say Marilyn Monroe But MBrother Says
Bridget Bardot Mmm, Mmm!":
· From I to XII:
Sensory
Sensory
Motor
Motor
Both
Motor
Both
Sensory
Both
Both
Motor
Motor


Cranial nerves "One Octopus Offered 
T
wo Toddlers And Five Virgins Great Valium
And Hash":
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
V>estibulocochlear
Glossopharyngeal
Vagus
Accesory
Hypoglossal


Cranial nerves [for those with a vegetable fetish] "Oh
OOTTouch And Feel Very 
G
reen Vegetables, AHeaven!":
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Accesory
Hypoglossal


Thirst/water balance control centre: location in hypothalamus
"You look up (supra...optic) at the clouds, to check if it's going to 
rain
 (water)":
Therefore, water balance is in supraoptic nucleus.


Geniculate bodies: medial vs. lateral system "Lateral=Light.
Medial=Music.":
Lateral geniculate body is for visual system.
Medial geniculate is for auditory system.


Cranial nerves "Old Opticians Operate
TTry Adding Fortune And Getting Vegas
Another Hotel!":
· In order from 1 to 12:
Olfactory
Optic
Occulomotor
Trochlear
Trigeminal
Abducens
Facial
Auditory
Glossopharyngeal
Vagus
Accessory
Hypoglossal


Cranial nerves [for political Americans] "Our Oval
Office Tomorrow Teeters AFlorida Adds
George Versus Al's Handcounts":
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducent
Facial
Acoustic
Glossopharyngeal
Vagus
Accessory
Hypoglossal


Auditory pathway "Hungry Girls 8(ate)
Nothing TSLIM Themselves":
Hair cells
spiral Ganglion
cranial nerve 8
cochlear Nuclei
Trapezoid body (decussation of ventral nuclei)
Superior olivary nucleus
Lateral leminiscus
Inferior colliculus
Medial geniculate body
Transverse temporal gyrus


Spinothalamic tracts: function of lateral vs. ventral "Lumbago
is conveyed by the Lateral tract":
Lumbago is lower back pain. Therefore lateral tract conveys pain, so by default,
ventral tract conveys light touch.


Geniculate bodies: medial vs. lateral system MALE:
Medial=Auditory. Lateral=Eye.
Medial geniculate body is for auditory system, lateral geniculate body is for
visual system.
Can expand to MALES to remember Lateral=Eye=Superior
colliculus (thus medial is inferior colliculus by default).


Purkinje cells in cerebellum are inhibitory to deep nuclei
Shape of a purkinje cell in 3 dimensions is same as a policeman's hand saying
"Stop".
Therefore, purkinje cells are inhibitory.


Dysphagia vs. dysphasia DysphaSia is for Speech
DysphaGia is for your Gut [swallowing].


Hypothalamus: feeding vs. satiety center "Stim the lat,
get fat":
· Stimulating lateral increases hunger.
"Stim the ven, get thin":
· Stimulating ventromedial increases satiety.


Argyll-Robertson Pupil features Argyll Robertson Pupil (ARP)
Read it from front to back: it is ARP, standing for Accomodation
Reflex Present.
Read it from back to front: it is PRA, standing for Pupillary Reflex
Absent.


Cerebellar deep nuclei "Ladies Demand Exceptional
Generosity From Men":
· The 4 nuclei, from lateral to medial:
[Lateral]
Dentate
Emboliform
Globose
Fastigial
[Medial]


Dorsal= afferent, Ventral= efferent and their functions "My
friend DAVE got kicked in the behind and screamed":
Dorsal/Afferent component is the sensation of pain coming
from the rear.
Ventral/Efferent component is the motor action of screaming
(which is done at frontof body).


Cranial nerves [for those under stress] "OOnce
One Takes The Anatomy Final A Good
Vacation Seems Heavenly":
Olfactory
Optic
Occulomotor
Trochlear
Trigeminal
Abducens
Facial
Auditory
Glossopharyngeal
Vagus
Spinal root of the accessory
Hypoglossal


Cerebellar damage signs DASHING:
Dysdiadochokinesia
Ataxia
Speech
Hypotonia
Intention tremor
Nystagmus
Gait


Hypothalamus: general functions "TALE of the
hypothalamus":
Temperature
Appetite
Libido
Emotion


Argyll-Robertson Pupil features Look at the math signs
around the two parts of the name: A-R.
The A has no sign in front, which in math means +A (+ Accommodate).
There is a subtract sign in front of the R (- React).
Therefore, pupil can accommodate, but can't react.


Spinal cord: converting ventral/ anterior/ motor/ efferent and
dorsal/ posterior/ sensory/ afferent
 A limousine:
The motor of limo is ventral and anterior on the car.
The Aerial is sensory and on the dorsal and posterior
of the limo.
· Note 1: 'A' is Afferent, and also, in a limo, the aerial on the
top of the trunk has a capital 'A' shape.
· Note 2: An aerial is a sensory thing: picks up radio waves.
· Note 3: If picked a limo up in your hand, can only see motor on ventral, since
dorsal is covered by the hood/bonnet.


Optic chiasma: what it looks like if you're a genetics star
The optic chiasma looks the same as a chiasma in meiosis, making
it easy to spot on the dissected brain.


Parasympathetic vs. sympathetic function Sympathetic nervous
system: "Fight or Flight".
Parasympathetic nervous system: "Rest and Digest".


Chemoreceptor trigger zone "Syringes Help Men
ODrugs":
Serotonin
Histamine
Muscarinic
Opioids
Dopamine


Cerebellar damage symptoms VANISHED:
Vertigo
Ataxia
Nystagmus
Intention tremor
Slurred (or Staccato) speech
Exagerrated broad based gait
Hypotonic reflexes
Dysdiadochokinesia.


Hypothalamus: feeding vs.satiety center "Late night
snack":
LATEral is snacking [feeding] center.
Therefore, ventromedial is satiety center.


Spinal tracts: simplified geography 2 posterior:
cross at the medulla.
2 lateral: ipsilateral (same side).
2 anterior: cross at the spinal level.
· See diagram.
· Note 1: Descending tracts on left of figure, ascending tracts on right.
· Note 2: For ipsilaterals: one never crosses, one crosses at the level then
doubles back farther up. The ipsilateral that crosses at the level (ventral
spinocerebellar) is the ipsilateral closest to the 2 anterior ones, which also
cross at the level.
· Tract names in each group:
Posterior 2: lateral corticalspinal, dorsal columns. Lateral 2: dorsal
spinocerebellar, ventral spinocerebellar. Anterior 2: ventral corticospinal,
spinothalamic.


Spinal tracts: Gracilus vs. Cuneatus: origin from upper vs. lower
limbs
 Gracilus is the name of a muscle in the legs, so
Fasciculus Gracilus is for the lower limbs.
By default, Fasciculus Cuneatus must be for upper limbs.


Precentral vs. postcentral gyrus: motor vs. sensory Just an
extension of the rule that anterior = ventral = efferent = motor.
The precentral gyrus is on the anterior side of the brain, so is therefore
motor.


Branchial arches: cranial nerve innervation In
Sensory/Motor/Both mnemonic 'Some Say Marry Money But My Brother
Says Big Boobs Matter More', the B's also give Brancial
arch nerves in order:
But (CN 5): 1st arch
Brother (CN7): 2nd arch
Big (CN9): 3rd arch
Boobs (CN 10): 4th arch


Temporal lobe: location of high vs. low frequency recognition
The bass clef looks like an ear.
Therefore, the bass clef [low frequency] is closer to the ear, and
the treble clef [high frequency] is more medial.


Cranial nerves: olfactory and optic numbers "You have two
eyes
 and one nose":
Optic nerve is cranial nerve two.
Olfactory nerve is cranial nerve one.
· Alternatively, note alphabetical order: oLfactory, and oPtic.


Ventricle aperatures: converting the two nomenclature types
Magendie foramen is the Medial aperture.
Luschka foramen is the Lateral aperture.


Basal ganglia: indirect vs. direct pathway The Indirect
pathway Inhibits.
Direct pathway is hence the excitatory one.


CSF circulation: function of choroid vs. arachnoid granules
Choroid Creates CSF.
Arachnoid granules Absorb CSF.


GABA vs. Glu: the excitatory vs. inhibitory transmitter in brain (eg
in basal ganglia)
 When you Glue two things together, you add (+)
those things together, therefore Glu is the excitatory one (+).
GABA is therefore the negative one.


Pituitary: which half is the adenohypophysis The Anterior
pituitary is the Adenohypophysis.


Broca's vs. Wernick's area: effect of damage to speech center
"Broca": your speech machinery is Broken.
· Broca is wanting to speak, but articulation doesn't work, and very slow.
"Wer-nick": "were" and "nick" are both words of
English language, but together they are nonsensical.
· Wernick is having good articulation, but saying words that don't make sense
together.


Lower vs. upper motor neuron lesion effects 1. "STORM,
Baby"
2. 'In a Lower motor neuron lesion, everything goes Down:
· STORM Baby tells you effects:
Strength
Tone
Other
Reflexes
Muscle mass
Babinski's sign
· In Lower all things go down: strength, tone, reflexes, muscle mass, and the
big toe down in plantar reflex (Babinski's sign is big toe up: toe up = UMNL).

No comments:

Post a Comment

Related Posts Plugin for WordPress, Blogger...