Mnemonics: Neurology

The 12 Cranial Nerves (In Order)

What needs to be memorized: Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal

Mnemonic: "Oh Oh Oh, To Touch And Feel Very Good Velvet, Ah Heaven!"

🔗 The Breakdown:

• Oh → Olfactory (CN I)
• Oh → Optic (CN II)
• Oh → Oculomotor (CN III)
• To → Trochlear (CN IV)
• Touch → Trigeminal (CN V)
• And → Abducens (CN VI)
• Feel → Facial (CN VII)
• Very → Vestibulocochlear (CN VIII)
• Good → Glossopharyngeal (CN IX)
• Velvet → Vagus (CN X)
• Ah → Accessory (CN XI)
• Heaven → Hypoglossal (CN XII)

Parkinson's Disease - Cardinal Features

What needs to be memorized: Tremor (resting), Rigidity, Akinesia/Bradykinesia, Postural instability

Mnemonic: "TRAP" - Parkinson's patients are trapped in their disease

🔗 The Breakdown:

• T → Tremor (resting, pill-rolling)
• R → Rigidity (lead-pipe, cogwheel)
• A → Akinesia/Bradykinesia (slowness of movement)
• P → Postural instability

Cerebellar Syndrome Features

What needs to be memorized: Dysdiadochokinesia, Ataxia, Nystagmus, Intention tremor, Slurred/Scanning speech, Hypotonia

Mnemonic: "DANISH" - Think of a wobbly Danish pastry, just like cerebellar patients are wobbly!

🔗 The Breakdown:

• D → Dysdiadochokinesia (can't do rapid alternating movements)
• A → Ataxia (unsteady gait)
• N → Nystagmus
• I → Intention tremor (tremor on purposeful movement)
• S → Slurred/Scanning speech
• H → Hypotonia

Stroke Recognition - FAST Assessment

What needs to be memorized: Face, Arm, Speech, Time (for emergency stroke recognition)

Mnemonic: "FAST" - Act FAST when you suspect stroke!

🔗 The Breakdown:

• F → Face drooping (ask patient to smile)
• A → Arm weakness (ask to raise both arms)
• S → Speech difficulty (slurred or incomprehensible)
• T → Time to call emergency (note time of symptom onset)

Horner's Syndrome - Classic Triad

What needs to be memorized: Ptosis, Anhidrosis, Miosis

Mnemonic: "PAM has Horner's" - Remember your classmate PAM

🔗 The Breakdown:

• P → Ptosis (partial, mild drooping)
• A → Anhidrosis (loss of sweating on affected side of face)
• M → Miosis (pupil constriction, small pupil)

Clinical pearl: Partial ptosis + Small pupil = Horner's | Complete ptosis + Dilated pupil = CN III palsy

Guillain-Barré Syndrome - Key Features

What needs to be memorized: Areflexia, Rapidly progressive, Ascending paralysis, Protein elevation in CSF, Infection preceded, Diaphragm involvement possible

Mnemonic: "A RAPID Paralysis" - GBS progresses rapidly!

🔗 The Breakdown:

• A → Areflexia (absent deep tendon reflexes)
• R → Rapidly progressive (hours to 4 weeks)
• A → Ascending paralysis (typically starts from legs upward)
• P → Protein elevated in CSF (with normal cell count = albuminocytological dissociation)
• I → Infection preceded (Campylobacter, CMV, etc.)
• D → Diaphragm affected (respiratory muscle weakness - monitor FVC!)

Multiple Sclerosis - Major Clinical Features

What needs to be memorized: Cerebellar signs, Relapsing-remitting course, INO (Internuclear Ophthalmoplegia), Motor weakness, Eye problems (Optic neuritis), Sensory symptoms

Mnemonic: "CRIMES" - MS commits crimes against the nervous system

🔗 The Breakdown:

• C → Cerebellar signs (ataxia, intention tremor)
• R → Relapsing-remitting course (most common pattern)
• I → INO - Internuclear Ophthalmoplegia
• M → Motor weakness (pyramidal signs)
• E → Eye - Optic neuritis (painful vision loss)
• S → Sensory symptoms (Lhermitte's sign - electric shock sensation on neck flexion)

Remember: Uhthoff's phenomenon - symptoms worsen with heat (like after a hot chai!)

UMN vs LMN Lesions - The "UP vs DOWN" Rule

What needs to be memorized: Upper Motor Neuron lesions cause increased tone/reflexes; Lower Motor Neuron lesions cause decreased tone/reflexes

Mnemonic: "UMN = Everything goes UP ⬆️ | LMN = Everything goes DOWN ⬇️"

🔗 The Breakdown:

• UMN (UP):
  • Tone ⬆️ (Spasticity)
  • Reflexes ⬆️ (Hyperreflexia)
  • Babinski ⬆️ (Positive/Upgoing plantar)
  • NO fasciculations
  • Minimal atrophy (disuse only)
• LMN (DOWN):
  • Tone ⬇️ (Flaccidity)
  • Reflexes ⬇️ (Hyporeflexia/Areflexia)
  • Babinski ⬇️ (Negative/Downgoing plantar)
  • Fasciculations present
  • Significant muscle wasting ⬇️

Broca's vs Wernicke's Aphasia

What needs to be memorized: Broca's = non-fluent speech with intact comprehension; Wernicke's = fluent speech with impaired comprehension

Mnemonic: "Broca = BROKEN Bolta hai, But Samajhta hai | Wernicke = WORDS flow well, Won't understand"

🔗 The Breakdown:

• Broca's Aphasia:
  • BROKEN speech (non-fluent, effortful, telegraphic)
  • BUT comprehension is intact (patient understands you)
  • Located in Broca's area (inferior Frontal gyrus) - think B for Broken, F for Front
  • Patient is frustrated (knows what they want to say, can't say it)
• Wernicke's Aphasia:
  • WORDS flow fluently (speech is easy but doesn't make sense - "word salad")
  • WON'T understand what you're saying (impaired comprehension)
  • Located in Wernicke's area (superior Temporal gyrus) - think W for Words, T for Talking
  • Patient is NOT frustrated (doesn't realize they're not making sense)

Myasthenia Gravis - The Key Concept

What needs to be memorized: Fatigable weakness, worse with activity/end of day, better with rest; commonly affects eyes (ptosis, diplopia) and bulbar muscles

Mnemonic: "My Muscles Get TIRED like a phone battery that drains through the day and needs REST to recharge"

🔗 The Breakdown:

• FATIGABLE weakness - this is THE key feature!
  • Weakness worsens with repeated use
  • Worse at end of day (like battery at 10% by evening)
  • Improves with rest (overnight "recharge")
• Clinical bedside test: "Sustained Upgaze Test"
  • Ask patient to look up continuously for 60 seconds
  • Ptosis will worsen as eye muscles fatigue (like your phone apps draining battery)
  • This confirms MG!
• Most commonly affected:
  • Eyes - Ptosis, Diplopia
  • Bulbar - Dysphagia, Dysarthria
  • Respiratory muscles - Can cause myasthenic crisis
• Diagnosis: Anti-AChR antibodies, Tensilon test (improves weakness), Decremental response on RNS

Brown-Séquard Syndrome (Hemisection of Spinal Cord)

What needs to be memorized: Ipsilateral motor & proprioception loss; Contralateral pain & temperature loss

Mnemonic: "SAME side loses Power & Position | OPPOSITE side loses Pain & Temperature"

🔗 The Breakdown:

• IPSILATERAL (Same side as lesion):
  • Power loss - UMN paralysis below lesion (corticospinal tract doesn't cross until medulla)
  • Position & Vibration sense lost below lesion (dorsal columns don't cross until medulla)
  • LMN signs AT the level of lesion
• CONTRALATERAL (Opposite side):
  • Pain & Temperature sensation lost 1-2 levels below lesion (spinothalamic tract crosses immediately)

Memory trick: Think of a cricket bat (spinal cord) cut in half - Same side loses strength & position sense, Other side loses pain sense

Cavernous Sinus Contents - The "Wall vs Inside" Concept

What needs to be memorized: CN III, IV, V1, V2 in lateral wall; CN VI, ICA, and sympathetic plexus inside the sinus

Mnemonic: "3-4 aur V1-V2 Wall mein hain, Only 6 swims INSIDE with ICA and Sympathetics"

🔗 The Breakdown:

• In the LATERAL WALL (from superior to inferior):
  • CN III (Oculomotor)
  • CN IV (Trochlear)
  • CN V1 (Ophthalmic division of Trigeminal)
  • CN V2 (Maxillary division of Trigeminal)
• INSIDE the sinus (swimming in blood):
  • CN VI (Abducens) - think: 6 ABDUCTs away into the sinus!
  • ICA (Internal Carotid Artery)
  • Sympathetic plexus around ICA

Clinical pearl: Cavernous sinus thrombosis affects ALL these structures → complete ophthalmoplegia, proptosis, periorbital edema, Horner's syndrome if sympathetics involved

Causes of Bilateral Ptosis - The "3 M's" Rule

What needs to be memorized: Myasthenia Gravis, Myotonic Dystrophy, Mitochondrial Myopathy (plus other bilateral lesions)

Mnemonic: "3 M's Make Bilateral Ptosis - think MUSCLE diseases!"

🔗 The Breakdown:

• M → Myasthenia Gravis (most common cause - look for fatigability!)
• M → Myotonic Dystrophy (look for grip myotonia, frontal balding, cataracts)
• M → Mitochondrial Myopathy - especially CPEO (Chronic Progressive External Ophthalmoplegia)

Other causes to remember:

• Oculopharyngeal Muscular Dystrophy
• Bilateral Horner's syndrome (rare)
• Bilateral CN III palsy (rare - think brainstem lesion)

Quick clinical differentiation: If ptosis worsens through the day = MG most likely!