You have covered a lot of ground and are now adept at being able to quickly identify (bracket) which level of the nervous system is likely affected based on the history and exam (signs and symptoms). Now that you know WHERE the problem is you will need to begin to hypothesize WHAT it could be. In other words, what is the specific problem/pathology at the level in question.

This list of potential diagnoses should take the patient’s profile into consideration (i.e., age, gender, medical history). The possibilities will help further direct your testing and possibly even therapeutic intervention.

A good place to start is a mnemonic such as “CITTEN DVM.” Each letter stands for a specific category, and working your way through the list each time you are evaluating a problem will help you consider most of the possibilities with the confidence that a reliable system can provide.

There are several variants of this mnemonic that will accomplish the same thing, so pick one and stick with it. CITTEN DVM seems
to be as good as any in giving you a place to start and preventing you from overlooking some of the most important problems that can occur at various levels of the NeurAxis. You can also use this mnemonic when assessing problems of the heart, lungs, gastrointestinal tract, and so on. It will provide a level of organization to your presentation on oral rounds, keeping the conversation moving as you consider the various etiologic possibilities and probabilities.