Thursday, October 23, 2008

Neuro Mnemonics

Hurray for mnemonics! Here are some of the good ones I've come across recently during my neuro revision...

Differential Diagnosis: VITAMIN C & D

V - vascular
I - infectious/inflammatory
T - trauma
A - autoimmune
M - metabolic/toxic
I - inherited/iatrogenic
N - neoplastic
C - congenital
& - other/unknown/idiopathic
D - degenerative

Coma Etiology: AEIOU TIPS

A - acidosis/alcohol
E - electrolytes/endocrine
I - infection
O - overdosed drugs
U - uremia
T - trauma to head/toxins
I - insulin (too little or too much)
P - psychotic episode
S - stroke/shock/space occupying lesion/subarachnoid hemorrhage/seizure

Seizure Differential: SICK DRIFTER

S - substrates (sugar, O2)
I - isoniazid (overdose)
C - cations (Na+, Ca2+, Mg2+)
K - kids (ecclampsia)
D - drugs: CRAP (Cocaine, Rum/EtOH, Amphetamines, PCP)
R - rum (alcohol withdrawal)
I - illnesses (chronic seizure disorder, other chronic disorder)
F - fever (meningitis, encephalitis, abscess)
T - trauma (epidural/subdural/intraparynchymal hemorrhage)
E - extras: toxocologic (TAIL = Theophylline, Acetylsalicylic acid, Isoniazid, Lithium) and the 3 Anti's (Antihistamine overdose, Antidepressant overdose, Anticonvulsants [too much dilantin, too much tegretol, benzo withdrawal])
R - rat poison (organophosphate poisoning)

Differential Diagnosis for Headache: "MM...IT ACHES!"

M - migraine
M - meningitis
I - increased intracranial pressure
T - tension headache/temporal arteritis
A - AV malformations
C - cluster headache
H - hypertension
E - eye disorders (refractory errors, glaucoma)
S - sinusitis, subarachnoid hemorrhage, systemic illness

Headache Red Flags: SNOOPS

S - systemic symptoms (fever, weight loss)
N - neuro symptoms (confusion, altered level of consciousness)
O - onset (sudden, abrupt or split second)
O - older patient (new onset or progressive, especially if >50 yrs)
P - previous history of headaches (1st headache? New or different? Change in attack frequency, severity or clinical features?)
S - secondary risk factors (HIV, systemic cancer)

Diagnostic Questions for Migraines: is it POUNDing?

P - pulsatile quality
O - over 4-72 hours
U - unilateral
N - nausea/vomiting
D - disabling intensity

Migraine Diagnosis: SULTANS

Need 2 or more of following...
S - severe
U - uni
L - lateral
T - throbbing
A - activity provokes

Need 1 of following...
N - nausea
S - sensitivity to light/sound/smell

Etiology of Delirium: I WATCH DEATH

I - infectious (encephalitis, meningitis, UTI, pneumonia)
W - withdrawal (EtOH, barbiturates, benzodiazepines)
A - acute metabolic disorders (electrolytes, hepatic/renal failure)
T - trauma (head injury, postoperative)
C - CNS pathology (stroke, hemorrhage, tumor, seizure disorder, Parkinson's)
H - hypoxia (anemia, cardiac failure, pulmonary embolus)
D - deficiencies (vitamin B12, folic acid, thiamine)
E - endocrinopathies (thyroid, glucose, parathyroid, adrenal)
A - acute vascular shock (shock, vasculitis, hypertensive encephalopathy)
T - toxins (substance use, EtOH or EtOH withdrawal, sedatives or sedative withdrawal, narcotics like morphine, anesthetics, anticholinergics, anticonvulsants, dopaminergic agnets, steroids, insulin, glyburide, antibiotics like quinolones, NSAIDs)
H - heavy metals (arsenic, lead, mercury)

Differential Diagnosis for Dementia: VITAMIN D VEST

V - vitamin deficiency (B1, B9, B12)
I - intracranial tumor
T - trauma (head injury)
A - anoxia
M - metabolic (diabetes)
I - infection (postencephalitis, HIV)
N - normal pressure hydrocephalus
D - degenerative (Alzheimer's, Huntington's, Creutzfeldt-Jakob disease)
V - vascular (multi-infarct dementia)
E - endocrine (hypothyroid)
S - space occupying lesion (chronic subdural hematoma)
T - toxic (EtOH)

Some extracranial causes of acute confusion: HIT ME

H - hypoxia (respiratory failure, heart failure, carbon monoxide, poisoning)
I - infectious (septicemia, pneumonia, UTI)
T - toxins/meds (EtOH, benzos, BB, anticholinergics)
M - metabolic (hepatic/renal failure, electrolyte imbalance, B12 deficiency)
E - endocrine (hyper/hypothyroidism, hyper/hypoglycemia, hyper/hypocorticism)

Things to ask in Hx for dementia: DEATH SHAFT

Ask about basic activities of daily living (ADLs):
D - dressing
E - eating
A - ambulating
T - toileting
H - hygiene

Ask about instrumental activities of daily living (IADLs):
S - shopping
H - housekeeping
A - accounting
F - food preparation
T - transportation

Signs and Symptoms of Parkinson's: TRAP DGEMMS

T- tremor (classic "pill-rolling")
R - rigidity (cogwheeling/ratcheting, smooth/lead pipe)
A - akinesia/bradykinesia (slow, difficulty initiating)
P - postural instability

D - dysphasia, dysphagia
G - gait abnormalities (slow shuffling, short stride, less arm swing)
E - eye abnormalities (wide eyes)
M - micrographia
M - mask-like facies
S - subcoritcal dementia



Anonymous Anonymous said...

Thanks for this post, these mnemonics are great!
Geza from Hungary

11:23 AM  
Anonymous Anonymous said...

Thank you very much, God bless you!

7:19 PM  

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