BrainWaves: A Neurology Podcast

Latest Episodes:

#30 GBS: 2021 Update May 06, 2021

This week on the program, we have remastered one of our earliest (and most interesting!) episodes on Guillain-Barre syndrome. With an important announcement from Jim Siegler.

Produced by James E. Siegler. Music courtesy of Lee Rosevere. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Dimachkie MM and Saperstein DS. Acquired immune demyelinating neuropathies. Continuum (Minneap Minn). 2014;20:1241-60.
Osler W. The principles and practice of medicine. New York: Appleton; 1892.
Gray H. History of lumbar puncture (rachicentesis): The operation and the idea. Arch Neurol Psych. 1921;6:61-69.
Asbury AK. Guillain-Barre syndrome: historical aspects. Annals of neurology. 1990;27 Suppl:S2-6.
Afifi AK. The landry-guillain-barre strohl syndrome 1859 to 1992 a historical perspective. J Family Community Med. 1994;1:30-4.
Bril V and Katzberg HD. Acquired immune axonal neuropathies. Continuum (Minneap Minn). 2014;20:1261-73.
Iodice V and Sandroni P. Autonomic neuropathies. Continuum (Minneap Minn). 2014;20:1373-97.
Lehmann HC, Hartung HP, Kieseier BC and Hughes RA. Guillain-Barre syndrome after exposure to influenza virus. Lancet Infect Dis. 2010;10:643-51.
Sivadon-Tardy V, Orlikowski D, Porcher R, Sharshar T, Durand MC, Enouf V, Rozenberg F, Caudie C, Annane D, van der Werf S, Lebon P, Raphael JC, Gaillard JL and Gault E. Guillain-Barre syndrome and influenza virus infection. Clin Infect Dis. 2009;48:48-56.
Stowe J, Andrews N, Wise L and Miller E. Investigation of the temporal association of Guillain-Barre syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. American journal of epidemiology. 2009;169:382-8.
Tam CC, O'Brien SJ, Petersen I, Islam A, Hayward A and Rodrigues LC. Guillain-Barre syndrome and preceding infection with campylobacter, influenza and Epstein-Barr virus in the general practice research database. PloS one. 2007;2:e344.
Tam CC, O'Brien SJ and Rodrigues LC. Influenza, Campylobacter and Mycoplasma infections, and hospital admissions for Guillain-Barre syndrome, England. Emerg Infect Dis. 2006;12:1880-7.
Dawood FS, Chaves SS, Perez A, Reingold A, Meek J, Farley MM, Ryan P, Lynfield R, Morin C, Baumbach J, Bennett NM, Zansky S, Thomas A, Lindegren ML, Schaffner W, Finelli L and Emerging Infections Program N. Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010. The Journal of infectious diseases. 2014;209:686-94.
McDermott M, Gelb DJ, Wilson K, Pawloski M, Burke JF, Shelgikar AV and London ZN. Sex Differences in Academic Rank and Publication Rate at Top-Ranked US Neurology Programs. JAMA Neurol. 2018;75:956-961.
Keddie S, Pakpoor J, Mousele C, Pipis M, Machado PM, Foster M, Record CJ, Keh RYS, Fehmi J, Paterson RW, Bharambe V, Clayton LM, Allen C, Price O, Wall J, Kiss-Csenki A, Rathnasabapathi DP, Geraldes R, Yermakova T, King-Robson J, Zosmer M, Rajakulendran S, Sumaria S, Farmer SF, Nortley R, Marshall CR, Newman EJ, Nirmalananthan N, Kumar G, Pinto AA, Holt J, Lavin TM, Brennan KM, Zandi MS, Jayaseelan DL, Pritchard J, Hadden RDM, Manji H, Willison HJ, Rinaldi S, Carr AS and Lunn MP. Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barre syndrome. Brain. 2021;144:682-693.
Lunn MP, Cornblath DR, Jacobs BC, Querol L, van Doorn PA, Hughes RA and Willison HJ. COVID-19 vaccine and Guillain-Barre syndrome: let's not leap to associations. Brain. 2021;144:357-360.

#181 A primer on ICP management Apr 22, 2021

The field of neurocritical care and traumatic brain injury management is rapidly evolving. We are shifting from older (but not entirely outdated) monitoring techniques to novel diagnostic and therapeutic advances in critical care medicine. Managing intracranial pressure crises involves the careful tiptoeing of a line between maintaining brain circulation and yet reducing intracranial fluid volume. And many of our interventions rely on one simple mathematical construct:

CPP = MAP - ICP

[Cerebral perfusion pressure = Mean arterial pressure – Intracranial pressure]

The importance of this formula cannot be understated. So we are spending 35 minutes today reviewing it, and discussing pearls and pitfalls of ICP monitoring and management. But believe me, it’s worth it.

Produced by James E. Siegler and Jon Rosenberg. Music courtesy of Unheard Music Concepts, Rafael Archangel, Milton Arias, and Quincas Moreira. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Rosner MJ and Coley IB. Cerebral perfusion pressure, intracranial pressure, and head elevation. Journal of neurosurgery. 1986;65:636-41.
Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J, Machamer J, Chaddock K, Celix JM, Cherner M, Hendrix T and Global Neurotrauma Research G. A trial of intracranial-pressure monitoring in traumatic brain injury. The New England journal of medicine. 2012;367:2471-81.
Kristiansson H, Nissborg E, Bartek J, Jr., Andresen M, Reinstrup P and Romner B. Measuring elevated intracranial pressure through noninvasive methods: a review of the literature. J Neurosurg Anesthesiol. 2013;25:372-85.
Armstead WM. Cerebral Blood Flow Autoregulation and Dysautoregulation. Anesthesiol Clin. 2016;34:465-77.
Oddo M, Crippa IA, Mehta S, Menon D, Payen JF, Taccone FS and Citerio G. Optimizing sedation in patients with acute brain injury. Crit Care. 2016;20:128.
Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW and Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80:6-15.
Okonkwo DO, Shutter LA, Moore C, Temkin NR, Puccio AM, Madden CJ, Andaluz N, Chesnut RM, Bullock MR, Grant GA, McGregor J, Weaver M, Jallo J, LeRoux PD, Moberg D, Barber J, Lazaridis C and Diaz-Arrastia RR. Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial. Critical care medicine. 2017;45:1907-1914.
Harary M, Dolmans RGF and Gormley WB. Intracranial Pressure Monitoring-Review and Avenues for Development. Sensors (Basel). 2018;18.
Koenig MA. Cerebral Edema and Elevated Intracranial Pressure. Continuum (Minneap Minn). 2018;24:1588-1602.
Jahns FP, Miroz JP, Messerer M, Daniel RT, Taccone FS, Eckert P and Oddo M. Quantitative pupillometry for the monitoring of intracranial hypertension in patients with severe traumatic brain injury. Crit Care. 2019;23:155.
Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K and Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocritical care. 2020;32:647-666.
Robba C, Pozzebon S, Moro B, Vincent JL, Creteur J and Taccone FS. Multimodal non-invasive assessment of intracranial hypertension: an observational study. Crit Care. 2020;24:379.

#180 The art of the pivot Apr 08, 2021

What do hip weakness, headache, and neglect have in common? At minimum, they can all be approached with simple neurodiagnostic heuristics. But there's more to neurology and medicine than having an approach to "leg weakness" or an approach to "headache". You have to adapt to new information as it presents itself. You have to know when, and how, to pivot.

Produced by James E. Siegler, Minal Patel, and Jesse Thon. Voiceovers by Taryn Hester and Terri Yeager. Music for our program today was courtesy of Lee Rosevere, Rafael Archangel, E’s Jammy Jams, Kai Engel, and Jon Watts under a Creative Commons license. Our theme song was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Rozen TD. Trigeminal neuralgia and glossopharyngeal neuralgia. Neurol Clin. 2004;22:185-206.
Tarulli AW and Raynor EM. Lumbosacral radiculopathy. Neurol Clin. 2007;25:387-405.
Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM, American Academy of Neurology S and European Federation of Neurological S. AAN-EFNS guidelines on trigeminal neuralgia management. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2008;15:1013-28.
Dyck PJ and Thaisetthawatkul P. Lumbosacral plexopathy. Continuum (Minneap Minn). 2014;20:1343-58.
Beume LA, Hieber M, Kaller CP, Nitschke K, Bardutzky J, Urbach H, Weiller C and Rijntjes M. Large Vessel Occlusion in Acute Stroke. Stroke; a journal of cerebral circulation. 2018;49:2323-2329.
Menon BK. Neuroimaging in Acute Stroke. Continuum (Minneap Minn). 2020;26:287-309.

#179 RBD and synucleinopathies Mar 25, 2021

Who doesn’t enjoy their sleep? For most of us, it can be the most relaxing escape. And for others, a disturbance of sleep may be the first clue to a neurodenerative condition.

Produced by James E. Siegler. Dr. Avidan reports that he receives royalties from Elsevier, is a consultant for Merck, and is a speaker for Eisai and Harmony. Music for our program today was by Andy Cohen, Purple Planet Music, Steve Combs, Yan Terrien, and Shane Ivers, whose music can be found at silvermansound.com. Our theme song was composed by Jimothy Dalton. Voiceover was courtesy of Taryn Hester. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Boeve BF, Silber MH, Ferman TJ, Lucas JA and Parisi JE. Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Mov Disord. 2001;16:622-30.
Gilat M, Coeytaux Jackson A, Marshall NS, Hammond D, Mullins AE, Hall JM, Fang BAM, Yee BJ, Wong KKH, Grunstein RR and Lewis SJG. Melatonin for rapid eye movement sleep behavior disorder in Parkinson's disease: A randomised controlled trial. Mov Disord. 2020;35:344-349.
Lloyd R, Tippmann-Peikert M, Slocumb N and Kotagal S. Characteristics of REM sleep behavior disorder in childhood. J Clin Sleep Med. 2012;8:127-31.
Malhotra R and Avidan AY. Neurodegenerative Disease and REM Behavior Disorder. Current treatment options in neurology. 2012;14:474-92.
McGrane IR, Leung JG, St Louis EK and Boeve BF. Melatonin therapy for REM sleep behavior disorder: a critical review of evidence. Sleep Med. 2015;16:19-26.
Porter VR and Avidan AY. Clinical Overview of REM Sleep Behavior Disorder. Semin Neurol. 2017;37:461-470.
Shin C, Park H, Lee WW, Kim HJ, Kim HJ and Jeon B. Clonazepam for probable REM sleep behavior disorder in Parkinson's disease: A randomized placebo-controlled trial. Journal of the neurological sciences. 2019;401:81-86.
St Louis EK, Boeve AR and Boeve BF. REM Sleep Behavior Disorder in Parkinson's Disease and Other Synucleinopathies. Mov Disord. 2017;32:645-658.
St Louis EK and Boeve BF. REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions. Mayo Clinic proceedings. 2017;92:1723-1736.
Teigen LN, Sharp RR, Hirsch JR, Campbell E, Timm PC, Sandness DJ, Feemster JC, Gossard TR, Faber SM, Steele TA, Rivera S, Junna MR, Lipford MC, Tippmann-Peikert M, Kotagal S, Ju YE, Howell M, Schenck CH, Videnovic A, Jennum P, Hogl B, Stefani A, Arnulf I, Heidbreder A, Lewis S, McCarter SJ, Boeve BF, Silber MH and St Louis EK. Specialist approaches to prognostic counseling in isolated REM sleep behavior disorder. Sleep Med. 2021;79:107-112.

#178 First seizure of life Mar 04, 2021

As many as 1% of the world has epilepsy, but far more than will have a seizure in their lifetime. Not everyone needs a seizure medication, some people are even harmed by them. So who warrants treatment, and what do you start with.

Consider today’s program an intro to AED decision making. For educational purposes only, of course. Not to guide any healthcare provider’s decision making.

Produced by James E. Siegler. Music courtesy of Lee Rosevere, Cellophane Sam, Jon Watts, Josh Woodward, and Rafael Archangel. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Hauser WA, Rich SS, Annegers JF and Anderson VE. Seizure recurrence after a 1st unprovoked seizure: an extended follow-up. Neurology. 1990;40:1163-70.
Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. First Seizure Trial Group (FIR.S.T. Group). Neurology. 1993;43:478-83.
Hui AC, Tang A, Wong KS, Mok V and Kay R. Recurrence after a first untreated seizure in the Hong Kong Chinese population. Epilepsia. 2001;42:94-7.
Koepp MJ and Woermann FG. Imaging structure and function in refractory focal epilepsy. The Lancet Neurology. 2005;4:42-53.
Marson A, Jacoby A, Johnson A, Kim L, Gamble C, Chadwick D and Medical Research Council MSG. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet. 2005;365:2007-13.
Manjunath R, Davis KL, Candrilli SD and Ettinger AB. Association of antiepileptic drug nonadherence with risk of seizures in adults with epilepsy. Epilepsy Behav. 2009;14:372-8.
Fountain NB. Choosing among antiepileptic drugs. Continuum (Minneap Minn). 2010;16:121-35.
Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J, Jr., Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Moshe SL, Perucca E, Scheffer IE, Tomson T, Watanabe M and Wiebe S. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55:475-82.
Krumholz A, Wiebe S, Gronseth GS, Gloss DS, Sanchez AM, Kabir AA, Liferidge AT, Martello JP, Kanner AM, Shinnar S, Hopp JL and French JA. Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;84:1705-13.
Bouma HK, Labos C, Gore GC, Wolfson C and Keezer MR. The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2016;23:455-63.
Leone MA, Giussani G, Nolan SJ, Marson AG and Beghi E. Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure. The Cochrane database of systematic reviews. 2016:CD007144.

#177 Agnosia Jan 28, 2021

To quote Donald Rumsfeld, “there are things we know we know…. we know there are some things we do not know... But there are also unknown unknowns—the ones we don't know we don't know…it is the latter category that tends to be the difficult ones.”

In neurology, the agnosias are not that dissimilar from Rumsfeld’s 'unknown unknowns.' In this week’s program, we discuss the nosology and nomenclature for the agnosias, the localization, and the importance of recognizing one.

Produced by James E. Siegler. Music courtesy of Dr. Turtle, Grossman, Ewell and Grainger, Marco Trovatelli, and Purple Planet Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Milner AD, Perrett DI, Johnston RS, Benson PJ, Jordan TR, Heeley DW, Bettucci D, Mortara F, Mutani R, Terazzi E and et al. Perception and action in 'visual form agnosia'. Brain. 1991;114 ( Pt 1B):405-28.
Zeki S and Ffytche DH. The Riddoch syndrome: insights into the neurobiology of conscious vision. Brain. 1998;121 ( Pt 1):25-45.
Biran I and Coslett HB. Visual agnosia. Current neurology and neuroscience reports. 2003;3:508-12.
Coslett HB. Apraxia, Neglect, and Agnosia. Continuum (Minneap Minn). 2018;24:768-782.
Dhont S, Derom E, Van Braeckel E, Depuydt P and Lambrecht BN. The pathophysiology of 'happy' hypoxemia in COVID-19. Respir Res. 2020;21:198.
Li YC, Bai WZ and Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020;92:552-555.
Matschke J, Lutgehetmann M, Hagel C, Sperhake JP, Schroder AS, Edler C, Mushumba H, Fitzek A, Allweiss L, Dandri M, Dottermusch M, Heinemann A, Pfefferle S, Schwabenland M, Sumner Magruder D, Bonn S, Prinz M, Gerloff C, Puschel K, Krasemann S, Aepfelbacher M and Glatzel M. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. The Lancet Neurology. 2020;19:919-929.

#33 Controversies in chronic traumatic encephalopathy Jan 14, 2021

Almost 5 years ago, we published a show on chronic traumatic encephalopathy and its relationship to American football. But a lot has happened since 2016. New rules in the NFL. Emerging data on how the developing human brain of a child or adolescent is even more vulnerable to pathologic changes following mild head injury. And a heightened awareness of the disingenuous campaign against contact sports among one of the most outspoken whistleblowers in the medical field.

This week on the program, we have remastered and updated the 2016 program. With some additional commentary on how parenthood may yield a new perspective on contact sports.

Produced by James E. Siegler. Music courtesy of Chris Haugen, Kevin McLeod, and Meydan. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Montenigro PH, Corp DT, Stein TD, Cantu RC and Stern RA. Chronic traumatic encephalopathy: historical origins and current perspective. Annu Rev Clin Psychol. 2015;11:309-30.
Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, Gronseth GS, Guskiewicz K, Mandel S, Manley G, McKeag DB, Thurman DJ and Zafonte R. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80:2250-7.
Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Cantu RC, Randolph C and Jordan BD. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005;57:719-26; discussion 719-26.
Stamm JM, Bourlas AP, Baugh CM, Fritts NG, Daneshvar DH, Martin BM, McClean MD, Tripodis Y and Stern RA. Age of first exposure to football and later-life cognitive impairment in former NFL players. Neurology. 2015;84:1114-20.
Ling H, Morris HR, Neal JW, Lees AJ, Hardy J, Holton JL, Revesz T and Williams DD. Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta Neuropathol. 2017;133:337-352.
Alosco ML, Mez J, Tripodis Y, Kiernan PT, Abdolmohammadi B, Murphy L, Kowall NW, Stein TD, Huber BR, Goldstein LE, Cantu RC, Katz DI, Chaisson CE, Martin B, Solomon TM, McClean MD, Daneshvar DH, Nowinski CJ, Stern RA and McKee AC. Age of first exposure to tackle football and chronic traumatic encephalopathy. Annals of neurology. 2018;83:886-901.
Hobson W. "From Scientist to Salesman". Available online at https://www.washingtonpost.com/graphics/2020/sports/cte-bennet-omalu/. Accessed 31 December 2020.

Best of BrainWaves 2020 Dec 31, 2020

Happy New Year, and good riddance 2020! Hopefully there is more that you will take away from the past 12 months other than your personal experience with the coronavirus pandemic. Whether you lost a job, a loved one, or an invaluable life experience, I think we can all say BRING ON 2021! So let's welcome the new year with positive mental attitude, a bit more luck, and an unquenchable thirst for knowledge.

Produced by James E. Siegler. Music courtesy of Jahzzar, Kevin McLeod, Patches, Montplaisir, Steve Combs, Lee Roosevere, Siddhartha, Soft and Furious, Magic in the Other, and Loyalty Freak Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

EEG

Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study G. A randomized, controlled trial of surgery for temporal-lobe epilepsy. The New England journal of medicine. 2001;345:311-8.
Cascino GD. Clinical indications and diagnostic yield of video-electroencephalographic monitoring in patients with seizures and spells. Mayo Clinic proceedings. 2002;77:1111-20.
Pillai J and Sperling MR. Interictal EEG and the diagnosis of epilepsy. Epilepsia. 2006;47 Suppl 1:14-22.
Bouma HK, Labos C, Gore GC, Wolfson C and Keezer MR. The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2016;23:455-63.
Debicki DB. Electroencephalography after a single unprovoked seizure. Seizure. 2017;49:69-73.

DYSFERLINOPATHY

Suresh E and Wimalaratna S. Proximal myopathy: diagnostic approach and initial management. Postgraduate medical journal. 2013;89:470-7.
Walter MC, Reilich P, Thiele S, Schessl J, Schreiber H, Reiners K, Kress W, Muller-Reible C, Vorgerd M, Urban P, Schrank B, Deschauer M, Schlotter-Weigel B, Kohnen R and Lochmuller H. Treatment of dysferlinopathy with deflazacort: a double-blind, placebo-controlled clinical trial. Orphanet J Rare Dis. 2013;8:26.
Fayssoil A, Ogna A, Chaffaut C, Chevret S, Guimaraes-Costa R, Leturcq F, Wahbi K, Prigent H, Lofaso F, Nardi O, Clair B, Behin A, Stojkovic T, Laforet P, Orlikowski D and Annane D. Natural History of Cardiac and Respiratory Involvement, Prognosis and Predictive Factors for Long-Term Survival in Adult Patients with Limb Girdle Muscular Dystrophies Type 2C and 2D. PloS one. 2016;11:e0153095.
Harris E, Bladen CL, Mayhew A, James M, Bettinson K, Moore U, Smith FE, Rufibach L, Cnaan A, Bharucha-Goebel DX, Blamire AM, Bravver E, Carlier PG, Day JW, Diaz-Manera J, Eagle M, Grieben U, Harms M, Jones KJ, Lochmuller H, Mendell JR, Mori-Yoshimura M, Paradas C, Pegoraro E, Pestronk A, Salort-Campana E, Schreiber-Katz O, Semplicini C, Spuler S, Stojkovic T, Straub V, Takeda S, Rocha CT, Walter MC, Bushby K and Jain COSC. The Clinical Outcome Study for dysferlinopathy: An international multicenter study. Neurol Genet. 2016;2:e89.
Clark KEN and Isenberg DA. A review of inflammatory idiopathic myopathy focusing on polymyositis. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2018;25:13-23.
Wicklund MP. The Limb-Girdle Muscular Dystrophies. Continuum (Minneap Minn). 2019;25:1599-1618.
Preston DC and Shapiro BE. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. 3rd ed. London; New York: Elsevier Saunders; 2013.
“rAAVrh74.MHCK7.DYSF.DV for Treatment of Dysferlinopathies.” Clinicaltrials.gov. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02710500?cond=dysferlinopathy&draw=2&rank=1 on 22 December 2019.

SPINAL DURAL AV FISTULA

Jellema K, Tijssen CC, van Rooij WJ, Sluzewski M, Koudstaal PJ, Algra A and van Gijn J. Spinal dural arteriovenous fistulas: long-term follow-up of 44 treated patients. Neurology. 2004;62:1839-41.
Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT and Thron A. Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2007;28:1249-58.
Krings T and Geibprasert S. Spinal dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2009;30:639-48.
Alexander MD, Oliff MC, Olorunsola OG, Brus-Ramer M, Nickoloff EL and Meyers PM. Patient radiation exposure during diagnostic and therapeutic interventional neuroradiology procedures. J Neurointerv Surg. 2010;2:6-10.
Cifarelli CP, Kaptain G, Yen CP, Schlesinger D and Sheehan JP. Gamma knife radiosurgery for dural arteriovenous fistulas. Neurosurgery. 2010;67:1230-5; discussion 1235.
Kim DJ, Willinsky R, Geibprasert S, Krings T, Wallace C, Gentili F and Terbrugge K. Angiographic characteristics and treatment of cervical spinal dural arteriovenous shunts. AJNR American journal of neuroradiology. 2010;31:1512-5.
Chen J and Gailloud P. Safety of spinal angiography: complication rate analysis in 302 diagnostic angiograms. Neurology. 2011;77:1235-40.
Manninen AL, Isokangas JM, Karttunen A, Siniluoto T and Nieminen MT. A comparison of radiation exposure between diagnostic CTA and DSA examinations of cerebral and cervicocerebral vessels. AJNR American journal of neuroradiology. 2012;33:2038-42.

#176 Mind blown Dec 17, 2020

I shouldn’t have to tell you that traumatic brain injury is a major cause of morbidity and mortality. I shouldn’t have to. But I will. And it is. In severe cases of head injury, there can be delayed and irreversible deterioration in the nervous system for which there is no treatment and the prognosis is grim. This week on the program, Dr. Monisha Kumar (University of Pennsylvania) discusses the worst of the worst of these scenarios, what to look out for, and expert recommendations on what to do when it happens.

Produced by James E. Siegler and Monisha Kumar. Music courtesy of Rui, Swelling, Unheard Music Concepts, Jahzzar, Ian Southerland, and TRG Banks. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Strich SJ. Diffuse degeneration of the cerebral white matter in severe dementia following head injury. Journal of neurology, neurosurgery, and psychiatry. 1956;19:163-85.
Adams JH, Graham DI, Murray LS and Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Annals of neurology. 1982;12:557-63.
Povlishock JT, Becker DP, Cheng CL and Vaughan GW. Axonal change in minor head injury. J Neuropathol Exp Neurol. 1983;42:225-42.
Gentry LR. Imaging of closed head injury. Radiology. 1994;191:1-17.
Meythaler JM, Peduzzi JD, Eleftheriou E and Novack TA. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil. 2001;82:1461-71.
Arfanakis K, Haughton VM, Carew JD, Rogers BP, Dempsey RJ and Meyerand ME. Diffusion tensor MR imaging in diffuse axonal injury. AJNR American journal of neuroradiology. 2002;23:794-802.
Scheid R, Preul C, Gruber O, Wiggins C and von Cramon DY. Diffuse axonal injury associated with chronic traumatic brain injury: evidence from T2*-weighted gradient-echo imaging at 3 T. AJNR American journal of neuroradiology. 2003;24:1049-56.
DeKosky ST, Ikonomovic MD and Gandy S. Traumatic brain injury--football, warfare, and long-term effects. The New England journal of medicine. 2010;363:1293-6.
Johnson VE, Stewart W and Smith DH. Widespread tau and amyloid-beta pathology many years after a single traumatic brain injury in humans. Brain Pathol. 2012;22:142-9.
Schrag M and Greer DM. Clinical associations of cerebral microbleeds on magnetic resonance neuroimaging. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2014;23:2489-2497.
Haghbayan H, Boutin A, Laflamme M, Lauzier F, Shemilt M, Moore L, Zarychanski R, Douville V, Fergusson D and Turgeon AF. The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Critical care medicine. 2017;45:e1280-e1288.
Izzy S, Mazwi NL, Martinez S, Spencer CA, Klein JP, Parikh G, Glenn MB, Greenberg SM, Greer DM, Wu O and Edlow BL. Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal. Neurocritical care. 2017;27:199-207.
van Eijck MM, Schoonman GG, van der Naalt J, de Vries J and Roks G. Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis. Brain Inj. 2018;32:395-402.

#175 Call your Mom Dec 03, 2020

COVID-19 is more than just a threat to your physical health. Even if you are never infected, you may not be free of it. In today's program, we take lessons from prior pandemics and consider the sociocultural effects of a global infectious disease.

Be advised, this one is of the "sentimental" variety.

Produced by James E. Siegler. Music courtesy of Purple Planet Music, Meydn, Kevin MacLeod and Shane Ivers, which you can find at Silvermansound.com. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095-128.
Fineberg HV. Pandemic preparedness and response--lessons from the H1N1 influenza of 2009. The New England journal of medicine. 2014;370:1335-42.
Shanks GD. Insights from unusual aspects of the 1918 influenza pandemic. Travel Med Infect Dis. 2015;13:217-22.
Armitage R and Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020;5:e256.
Bonaccorsi G, Pierri F, Cinelli M, Flori A, Galeazzi A, Porcelli F, Schmidt AL, Valensise CM, Scala A, Quattrociocchi W and Pammolli F. Economic and social consequences of human mobility restrictions under COVID-19. Proc Natl Acad Sci U S A. 2020;117:15530-15535.
Dinmohamed AG, Visser O, Verhoeven RHA, Louwman MWJ, van Nederveen FH, Willems SM, Merkx MAW, Lemmens V, Nagtegaal ID and Siesling S. Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands. Lancet Oncol. 2020;21:750-751.
Jeffery MM, D'Onofrio G, Paek H, Platts-Mills TF, Soares WE, 3rd, Hoppe JA, Genes N, Nath B and Melnick ER. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA internal medicine. 2020;180:1328-1333.
Rabinovitz B, Jaywant A and Fridman CB. Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: implications for the current COVID-19 pandemic. Clin Neuropsychol. 2020:1-27.
Santini ZI, Jose PE, York Cornwell E, Koyanagi A, Nielsen L, Hinrichsen C, Meilstrup C, Madsen KR and Koushede V. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020;5:e62-e70.
Wong LE, et al. Where are all the patients? New Eng J Med (2020): Published online 14 May 2020. Available at https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0193.

#174 The mental status Nov 19, 2020

The mental status exam is a keystone of the neurologic assessment. Dr. Andrea Casher (Cooper University Hospital) builds upon this metaphor in our program this week. Making a special appearance is US President Donald Trump, who underwent a mental status exam and recounts his experience.

Produced by James E. Siegler and Andrea Casher. Music courtesy of Unheard Music Concepts, Purple Planet Music, Lee Rosevere, and Scott Holmes. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Tombaugh TN and McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40:922-35.
Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL and Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695-9.
Dong Y, Sharma VK, Chan BP, Venketasubramanian N, Teoh HL, Seet RC, Tanicala S, Chan YH and Chen C. The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. Journal of the neurological sciences. 2010;299:15-8.
Gorno-Tempini ML, Hillis AE, Weintraub S, Kertesz A, Mendez M, Cappa SF, Ogar JM, Rohrer JD, Black S, Boeve BF, Manes F, Dronkers NF, Vandenberghe R, Rascovsky K, Patterson K, Miller BL, Knopman DS, Hodges JR, Mesulam MM and Grossman M. Classification of primary progressive aphasia and its variants. Neurology. 2011;76:1006-14.
Ng KP, Chiew HJ, Lim L, Rosa-Neto P, Kandiah N and Gauthier S. The influence of language and culture on cognitive assessment tools in the diagnosis of early cognitive impairment and dementia. Expert review of neurotherapeutics. 2018;18:859-869.
Rabinovitz B, Jaywant A and Fridman CB. Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: implications for the current COVID-19 pandemic. Clin Neuropsychol. 2020:1-27.

#93 Aspirin vs. Plavix: The showdown Oct 29, 2020

October 29 is World Stroke Day! Might as well know how it is best treated.

This week, Jim Siegler revisits a 2017 episode on the differences between two of the most commonly prescribed post-stroke treatments, with some key updates, recent trial results, and practice-changing paradigms.

Produced by James E. Siegler. Music courtesy of William Ross Chernoff’s Nomads, Steve Combs, Rui, Little Glass Men, and Peter Rudenko. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Jauch EC, Saver JL, Adams HP, Jr., Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW, Jr., Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H, American Heart Association Stroke C, Council on Cardiovascular N, Council on Peripheral Vascular D and Council on Clinical C. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2013;44:870-947.
The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet. 1997;349:1569-81.
CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet. 1997;349:1641-9.
Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM and Investigators F. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. The Lancet Neurology. 2007;6:961-9.
Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC and Investigators C. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. The New England journal of medicine. 2013;369:11-9.
Hong KS, Lee SH, Kim EG, Cho KH, Chang DI, Rha JH, Bae HJ, Lee KB, Kim DE, Park JM, Kim HY, Cha JK, Yu KH, Lee YS, Lee SJ, Choi JC, Cho YJ, Kwon SU, Kim GM, Sohn SI, Park KY, Kang DW, Sohn CH, Lee J, Yoon BW and Investigators C. Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke: Clopidogrel Plus Aspirin Versus Aspirin Alone. Stroke; a journal of cerebral circulation. 2016;47:2323-30.
Liu L, Wong KS, Leng X, Pu Y, Wang Y, Jing J, Zou X, Pan Y, Wang A, Meng X, Wang C, Zhao X, Soo Y, Johnston SC, Wang Y and Investigators C. Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE. Neurology. 2015;85:1154-62.
Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. Bmj. 1994;308:81-106.
Antithrombotic Trialists C. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Bmj. 2002;324:71-86.
Committee CS. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348:1329-39.
Ringleb PA, Bhatt DL, Hirsch AT, Topol EJ, Hacke W and Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events I. Benefit of clopidogrel over aspirin is amplified in patients with a history of ischemic events. Stroke; a journal of cerebral circulation. 2004;35:528-32.
Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ and investigators M. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331-7.
Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, Cacoub P, Cohen EA, Creager MA, Easton JD, Flather MD, Haffner SM, Hamm CW, Hankey GJ, Johnston SC, Mak KH, Mas JL, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Brennan DM, Fabry-Ribaudo L, Booth J, Topol EJ and Investigators C. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. The New England journal of medicine. 2006;354:1706-17.
Rothwell PM, Price JF, Fowkes FG, Zanchetti A, Roncaglioni MC, Tognoni G, Lee R, Belch JF, Wilson M, Mehta Z and Meade TW. Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet. 2012;379:1602-12.
Sahlen A, Varenhorst C, Lagerqvist B, Renlund H, Omerovic E, Erlinge D, Wallentin L, James SK and Jernberg T. Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction: experiences from SWEDEHEART registry. European heart journal. 2016;37:3335-3342.
Bath PM, Woodhouse LJ, Appleton JP, Beridze M, Christensen H, Dineen RA, Duley L, England TJ, Flaherty K, Havard D, Heptinstall S, James M, Krishnan K, Markus HS, Montgomery AA, Pocock SJ, Randall M, Ranta A, Robinson TG, Scutt P, Venables GS, Sprigg N and Investigators T. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial. Lancet. 2018;391:850-859.
Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R, Goodman SG, Windecker S, Darius H, Li J, Averkov O, Bahit MC, Berwanger O, Budaj A, Hijazi Z, Parkhomenko A, Sinnaeve P, Storey RF, Thiele H, Vinereanu D, Granger CB, Alexander JH and Investigators A. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. The New England journal of medicine. 2019;380:1509-1524.
Wang Y, Chen W, Lin Y, Meng X, Chen G, Wang Z, Wu J, Wang D, Li J, Cao Y, Xu Y, Zhang G, Li X, Pan Y, Li H, Zhao X, Liu L, Lin J, Dong K, Jing J, Johnston SC, Wang D, Wang Y and Group PPS. Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. Bmj. 2019;365:l2211.

#173 Matching during the COVID-19 pandemic Oct 22, 2020

This week on the program, we bring to you a special episode on the impact of the COVID-19 pandemic on the neurology 2021 match--and potentially MANY subsequent matches. Jim Siegler is joined by the Assistant Program Director of the Cooper Neurology Residency Program, Olga Thon, and the creators of the @NMatch2021 Twitter account (who you should DEFINITELY follow after listening to our episode). If you are an applicant for the 2021 cycle, this show is MANDATORY.

(only kidding, this is just a podcast)

Produced by James E. Siegler, with assistance by Olga Thon, Adriana Romirez, Dylan Del Papa, Justine Ker, and Alvin Singh. Music courtesy of Akash Gandi, Little Glass Men, Kevin MacLeod, Josh Woodward, Julie Maxwell, and Kai Engel. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

#83 Halloween Special: Zombies in neurology Oct 15, 2020

Halloween is one of the most exciting and festive holidays, but this year I imagine many of us are going to spend it indoors. To help pass the time, enjoy this seasonal special about the neurologic manifestations of zombie-ism. Today's program is a re-run from 2017, featuring Dr. Brian Hanrahan, and has been remastered and updated with some recent additions in light of the coronavirus pandemic.

Produced by James E. Siegler. Music courtesy of Andrew Sacco, Ars Sonor, Yan Terrien, and Unheard Music Concepts. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig, with some original recordings out of Studio 3. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Smith TC. Zombie infections: Epidemiology, treatment, and prevention. Bmj. 2015;351:h6423
Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R. "Zombie" outbreak caused by the synthetic cannabinoid amb-fubinaca in new york. The New England journal of medicine. 2017;376:235-242
Rabinovitz B, Jaywant A, Fridman CB. Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: Implications for the current covid-19 pandemic. Clin Neuropsychol. 2020:1-27
Gilmour SJ, Saito E, Yoneoka D. Importance of survival strategies after a zombie pandemic. Bmj. 2016;532:i259
Hughes DP, Andersen SB, Hywel-Jones NL, Himaman W, Billen J, Boomsma JJ. Behavioral mechanisms and morphological symptoms of zombie ants dying from fungal infection. BMC Ecol. 2011;11:13

#172 Cavernoma Oct 01, 2020

As the second most common vascular malformation in the central nervous system, cerebral cavernomas are often incidental radiographic findings. Also incidental is Jim’s interest in mediocre sci-fi television shows, such as Netflix’s recent series, Away—which incidentally includes one character with a symptomatic cerebral cavernoma. This week on the podcast, Dr. Siegler discusses with Dr. Dena Little (Cooper University Hospital) the epidemiology, clinical course, and management (including counseling) of patients with this vascular malformation.

Plus, a critical appraisal of Away’s medical consultant. 0_o

Produced by James E. Siegler and Dena Little. Music courtesy of Ars Sonor, Andrew Sacco, Chris Zabriskie, and Purple Planet Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Pozzati E, Acciarri N, Tognetti F, Marliani F and Giangaspero F. Growth, subsequent bleeding, and de novo appearance of cerebral cavernous angiomas. Neurosurgery. 1996;38:662-9; discussion 669-70.
Batra S, Lin D, Recinos PF, Zhang J and Rigamonti D. Cavernous malformations: natural history, diagnosis and treatment. Nature reviews Neurology. 2009;5:659-70.
Gross BA, Lin N, Du R and Day AL. The natural history of intracranial cavernous malformations. Neurosurgical focus. 2011;30:E24.
Horne MA, Flemming KD, Su IC, Stapf C, Jeon JP, Li D, Maxwell SS, White P, Christianson TJ, Agid R, Cho WS, Oh CW, Wu Z, Zhang JT, Kim JE, Ter Brugge K, Willinsky R, Brown RD, Jr., Murray GD, Al-Shahi Salman R and Cerebral Cavernous Malformations Individual Patient Data Meta-analysis C. Clinical course of untreated cerebral cavernous malformations: a meta-analysis of individual patient data. The Lancet Neurology. 2016;15:166-173.
Zafar A, Quadri SA, Farooqui M, Ikram A, Robinson M, Hart BL, Mabray MC, Vigil C, Tang AT, Kahn ML, Yonas H, Lawton MT, Kim H and Morrison L. Familial Cerebral Cavernous Malformations. Stroke; a journal of cerebral circulation. 2019;50:1294-1301.
Zuurbier SM, Hickman CR, Tolias CS, Rinkel LA, Leyrer R, Flemming KD, Bervini D, Lanzino G, Wityk RJ, Schneble HM, Sure U, Al-Shahi Salman R and Scottish Audit of Intracranial Vascular Malformations Steering C. Long-term antithrombotic therapy and risk of intracranial haemorrhage from cerebral cavernous malformations: a population-based cohort study, systematic review, and meta-analysis. The Lancet Neurology. 2019;18:935-941.

#171 High-convexity tight sulci Sep 17, 2020

You know the triad for normal pressure hydrocephalus (NPH). Wet, wobbly, and wacky. And you have probably heard of the Evan’s index—the relative proportion of the lateral ventricles in reference to the inner table of the skull. But you might not have heard of high-convexity tight sulci.

Now you have.

Produced by James E. Siegler. Music courtesy of Jason Shaw, Javolenus, and Lee Rosevere, under a Creative Commons License. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N and Imamura T. CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. AJNR American journal of neuroradiology. 1998;19:1277-84.
Sasaki M, Honda S, Yuasa T, Iwamura A, Shibata E and Ohba H. Narrow CSF space at high convexity and high midline areas in idiopathic normal pressure hydrocephalus detected by axial and coronal MRI. Neuroradiology. 2008;50:117-22.
Allali G, Laidet M, Armand S, Momjian S, Marques B, Saj A and Assal F. A combined cognitive and gait quantification to identify normal pressure hydrocephalus from its mimics: The Geneva's protocol. Clinical neurology and neurosurgery. 2017;160:5-11.
Graff-Radford J, Gunter JL, Jones DT, Przybelski SA, Schwarz CG, Huston J, 3rd, Lowe V, Elder BD, Machulda MM, Gunter NB, Petersen RC, Kantarci K, Vemuri P, Mielke MM, Knopman DS, Graff-Radford NR and Jack CR, Jr. Cerebrospinal fluid dynamics disorders: Relationship to Alzheimer biomarkers and cognition. Neurology. 2019;93:e2237-e2246.

#170 Myoclonus and neurodegenerative diseases Sep 03, 2020

Myoclonus is the most etiologically non-specific motor manifestation of neurologic and systemic disease. It’s like slurred speech or altered mental status. But in the appropriate context, it can become a useful clue in your differential diagnosis. Dr. John Caviness of the Mayo Clinic joins Jim Siegler this week for a discussion on this abnormal movement and what it may indicate.

Produced by James E. Siegler and John Caviness. Music courtesy of Kevin McLeod and E’s Jammy Jams. “Endings” and “What’s the Angle” were produced by Shane Ivers (https://www.silvermansound.com). The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Caviness JN. Myoclonus and neurodegenerative disease--what's in a name? Parkinsonism Relat Disord. 2003;9:185-92.
Caviness JN. Parkinsonism & related disorders. Myoclonus. Parkinsonism Relat Disord. 2007;13 Suppl 3:S375-84.
Caviness JN. Pathophysiology and treatment of myoclonus. Neurol Clin. 2009;27:757-77, vii.
Zutt R, van Egmond ME, Elting JW, van Laar PJ, Brouwer OF, Sival DA, Kremer HP, de Koning TJ and Tijssen MA. A novel diagnostic approach to patients with myoclonus. Nature reviews Neurology. 2015;11:687-97.
Levy A and Chen R. Myoclonus: Pathophysiology and Treatment Options. Current treatment options in neurology. 2016;18:21.
Caviness JN. Myoclonus. Continuum (Minneap Minn). 2019;25:1055-1080.

#109 Misnomers in medicine: Low grade glioma Aug 20, 2020

A lot can happen in two years. You might have matched into residency, graduated from fellowship, had a kid... Or several phase II trials in low grade glioma research could have been published.

Since the original airing of this episode in May 2018, there have been a few updates in neuro-oncology. We'll cover some of the major ones this week in the BrainWaves podcast.

Produced by James E. Siegler, Brian Nahed and Jorg Dietrich. Music courtesy of Ian Sutherland, Lovira, and Lee Roosevere. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

McGirt MJ, Chaichana KL, Attenello FJ, Weingart JD, Than K, Burger PC, Olivi A, Brem H and Quinones-Hinojosa A. Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery. 2008;63:700-7; author reply 707-8.
Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR and Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2012;30:3065-70.
Schiff D. Low-grade Gliomas. Continuum (Minneap Minn). 2017;23:1564-1579.
Wen PY and Huse JT. 2016 World Health Organization Classification of Central Nervous System Tumors. Continuum (Minneap Minn). 2017;23:1531-1547.
Bell EH, Zhang P, Fisher BJ, Macdonald DR, McElroy JP, Lesser GJ, Fleming J, Chakraborty AR, Liu Z, Becker AP, Fabian D, Aldape KD, Ashby LS, Werner-Wasik M, Walker EM, Bahary JP, Kwok Y, Yu HM, Laack NN, Schultz CJ, Gray HJ, Robins HI, Mehta MP and Chakravarti A. Association of MGMT Promoter Methylation Status With Survival Outcomes in Patients With High-Risk Glioma Treated With Radiotherapy and Temozolomide: An Analysis From the NRG Oncology/RTOG 0424 Trial. JAMA Oncol. 2018;4:1405-1409.
van den Bent MJ, Klein M, Smits M, Reijneveld JC, French PJ, Clement P, de Vos FYF, Wick A, Mulholland PJ, Taphoorn MJB, Lewis J, Weller M, Chinot OL, Kros JM, de Heer I, Verschuere T, Coens C, Golfinopoulos V, Gorlia T and Idbaih A. Bevacizumab and temozolomide in patients with first recurrence of WHO grade II and III glioma, without 1p/19q co-deletion (TAVAREC): a randomised controlled phase 2 EORTC trial. Lancet Oncol. 2018;19:1170-1179.
Fangusaro J, Onar-Thomas A, Young Poussaint T, Wu S, Ligon AH, Lindeman N, Banerjee A, Packer RJ, Kilburn LB, Goldman S, Pollack IF, Qaddoumi I, Jakacki RI, Fisher PG, Dhall G, Baxter P, Kreissman SG, Stewart CF, Jones DTW, Pfister SM, Vezina G, Stern JS, Panigrahy A, Patay Z, Tamrazi B, Jones JY, Haque SS, Enterline DS, Cha S, Fisher MJ, Doyle LA, Smith M, Dunkel IJ and Fouladi M. Selumetinib in paediatric patients with BRAF-aberrant or neurofibromatosis type 1-associated recurrent, refractory, or progressive low-grade glioma: a multicentre, phase 2 trial. Lancet Oncol. 2019;20:1011-1022.
Bell EH, Zhang P, Shaw EG, Buckner JC, Barger GR, Bullard DE, Mehta MP, Gilbert MR, Brown PD, Stelzer KJ, McElroy JP, Fleming JL, Timmers CD, Becker AP, Salavaggione AL, Liu Z, Aldape K, Brachman DG, Gertler SZ, Murtha AD, Schultz CJ, Johnson D, Laack NN, Hunter GK, Crocker IR, Won M and Chakravarti A. Comprehensive Genomic Analysis in NRG Oncology/RTOG 9802: A Phase III Trial of Radiation Versus Radiation Plus Procarbazine, Lomustine (CCNU), and Vincristine in High-Risk Low-Grade Glioma. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2020:JCO1902983.
Breen WG, Anderson SK, Carrero XW, Brown PD, Ballman KV, O'Neill BP, Curran WJ, Abrams RA, Laack NN, Levitt R, Galanis E, Buckner JC and Shaw EG. Final report from Intergroup NCCTG 86-72-51 (Alliance): a phase III randomized clinical trial of high-dose versus low-dose radiation for adult low-grade glioma. Neuro Oncol. 2020;22:830-837.
Ullrich NJ, Prabhu SP, Reddy AT, Fisher MJ, Packer R, Goldman S, Robison NJ, Gutmann DH, Viskochil DH, Allen JC, Korf B, Cantor A, Cutter G, Thomas C, Perentesis JP, Mizuno T, Vinks AA, Manley PE, Chi SN, Kieran MW and Consortium NFCT. A Phase II Study of Continuous Oral mTOR Inhibitor Everolimus for Recurrent, Radiographic-Progressive Neurofibromatosis Type 1-Associated Pediatric Low-Grade Glioma: A Neurofibromatosis Clinical Trials Consortium Study. Neuro Oncol. 2020.

#169 The interictal EEG Aug 06, 2020

The electroencephalogram is a nearly 100-year old neurodiagnostic instrument. And yet, we learn new things from it every day. This week on the BrainWaves podcast, Dr. Tracey Milligan (Mass General Brigham) reviews the indications and utilization of a routine scalp EEG. Also discussed:

Limitations of scalp EEG
Brain surgery
Non-epileptic events
Why YOU should consider becoming an epileptologist

Produced by James E. Siegler and Tracey Milligan. Music courtesy of Steve Combs, Lee Roosevere, Siddhartha, Soft and Furious, Patches, and Magic in the Other. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. James Siegler reports having received consulting fees from Ceribell, which produces a bedside scalp EEG with automated seizure detection. However, there is no specific reference to this device or company, nor was this episode sponsored by Ceribell. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study G. A randomized, controlled trial of surgery for temporal-lobe epilepsy. The New England journal of medicine. 2001;345:311-8.
Cascino GD. Clinical indications and diagnostic yield of video-electroencephalographic monitoring in patients with seizures and spells. Mayo Clinic proceedings. 2002;77:1111-20.
Pillai J and Sperling MR. Interictal EEG and the diagnosis of epilepsy. Epilepsia. 2006;47 Suppl 1:14-22.
Bouma HK, Labos C, Gore GC, Wolfson C and Keezer MR. The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2016;23:455-63.
Debicki DB. Electroencephalography after a single unprovoked seizure. Seizure. 2017;49:69-73.

#168 (Mis)understanding the locked-in state Jul 23, 2020

The locked-in syndrome is a rare clinical consequence following many types of neurologic injury. In general, the locked-in patient is fully paralyzed, with perhaps minimal function of the fingers, the eyes, or the mouth. What's more, the gross motor dysfunction is enormously disproportional to the cognitive function of the individual. The locked-in patient is conscious and completely aware of their surroundings. They can often hear, see, smell, and feel just as any other person would. But because of their profound physical disability, they have a very limited means of communicating even the simplest thoughts. "I feel hot." "My head hurts." "My cheek itches."

It may surprise you that the patient's perspective of their condition is wholly different from how the healthcare provider or caregiver imagines it to be. This week on the program, Dr. Lauren Elman (Pennsylvania Medical Center ALS Multi-disiplinary Clinic) reviews this discrepancy. Dr. Elman also shares her experience managing this inevitable consequence of ALS when all life-sustaining measures are desired.

REFERENCES

Patterson JR and Grabois M. Locked-in syndrome: a review of 139 cases. Stroke; a journal of cerebral circulation. 1986;17:758-64.
Trail M, Nelson ND, Van JN, Appel SH and Lai EC. A study comparing patients with amyotrophic lateral sclerosis and their caregivers on measures of quality of life, depression, and their attitudes toward treatment options. Journal of the neurological sciences. 2003;209:79-85.
Rousseau MC, Baumstarck K, Alessandrini M, Blandin V, Billette de Villemeur T and Auquier P. Quality of life in patients with locked-in syndrome: Evolution over a 6-year period. Orphanet J Rare Dis. 2015;10:88.
Kuzma-Kozakiewicz M, Andersen PM, Ciecwierska K, Vazquez C, Helczyk O, Loose M, Uttner I, Ludolph AC and Lule D. An observational study on quality of life and preferences to sustain life in locked-in state. Neurology. 2019;93:e938-e945.
Niedermeyer S, Murn M and Choi PJ. Respiratory Failure in Amyotrophic Lateral Sclerosis. Chest. 2019;155:401-408.

#167 The role of sinovenous stenosis in IIH Jul 09, 2020

Webster defines ‘idiopathic’ as “arising spontaneously or from an obscure or unknown cause”. By definition, this means idiopathic intracranial hypertension (IIH) has no proximate cause. But that’s not exactly true. This week on the podcast, we explore the recent evidence behind the theory that transverse sinus stenosis may contribute to this condition.

Disclaimer: No chicken or eggs were harmed in the making of this episode.

Produced by James E. Siegler. Music courtesy of Squire Tuck, Swelling, Three Chain Links, and Unheard Music Concepts. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Martins AN. Resistance to drainage of cerebrospinal fluid: clinical measurement and significance. Journal of neurology, neurosurgery, and psychiatry. 1973;36:313-8.
Gjerris F, Soelberg Sorensen P, Vorstrup S and Paulson OB. Intracranial pressure, conductance to cerebrospinal fluid outflow, and cerebral blood flow in patients with benign intracranial hypertension (pseudotumor cerebri). Annals of neurology. 1985;17:158-62.
Orefice G, Celentano L, Scaglione M, Davoli M and Striano S. Radioisotopic cisternography in benign intracranial hypertension of young obese women. A seven-case study and pathogenetic suggestions. Acta Neurol (Napoli). 1992;14:39-50.
Karahalios DG, Rekate HL, Khayata MH and Apostolides PJ. Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies. Neurology. 1996;46:198-202.
King JO, Mitchell PJ, Thomson KR and Tress BM. Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology. 2002;58:26-30.
Farb RI, Vanek I, Scott JN, Mikulis DJ, Willinsky RA, Tomlinson G and terBrugge KG. Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology. 2003;60:1418-24.
Rohr A, Dorner L, Stingele R, Buhl R, Alfke K and Jansen O. Reversibility of venous sinus obstruction in idiopathic intracranial hypertension. AJNR American journal of neuroradiology. 2007;28:656-9.
Sinclair AJ, Kuruvath S, Sen D, Nightingale PG, Burdon MA and Flint G. Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review. Cephalalgia. 2011;31:1627-33.
Riggeal BD, Bruce BB, Saindane AM, Ridha MA, Kelly LP, Newman NJ and Biousse V. Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. Neurology. 2013;80:289-95.
Satti SR, Leishangthem L and Chaudry MI. Meta-Analysis of CSF Diversion Procedures and Dural Venous Sinus Stenting in the Setting of Medically Refractory Idiopathic Intracranial Hypertension. AJNR American journal of neuroradiology. 2015;36:1899-904.
Dinkin MJ and Patsalides A. Venous Sinus Stenting in Idiopathic Intracranial Hypertension: Results of a Prospective Trial. J Neuroophthalmol. 2017;37:113-121.
Mohammaden MH, Husain MR, Brunozzi D, Hussein AE, Atwal G, Charbel FT and Alaraj A. Role of Resistivity Index Analysis in the Prediction of Hemodynamically Significant Venous Sinus Stenosis in Patient With Idiopathic Intracranial Hypertension. Neurosurgery. 2020;86:631-636.

#166 Not just a headache Jun 25, 2020

It’s more than just a headache. Migraine is a disturbance of normal neurological function, and as you are aware, it causes more than just severe head pain. This week on BrainWaves, Dr. Deborah Friedman (UT Southwestern) shares her experience evaluating and managing the unusual neurologic manifestations of migraine that aren’t just the misery from recurrent attacks.

Produced by James E. Siegler & Deborah Friedman. Music courtesy of Josh Woodward, Kevin McLeod and Lee Rosevere. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Bianchin MM, Londero RG, Lima JE and Bigal ME. Migraine and epilepsy: a focus on overlapping clinical, pathophysiological, molecular, and therapeutic aspects. Curr Pain Headache Rep. 2010;14:276-83.
Dreier JP, Reiffurth C, Woitzik J, Hartings JA, Drenckhahn C, Windler C, Friedman A, MacVicar B, Herreras O and group Cs. How spreading depolarization can be the pathophysiological correlate of both migraine aura and stroke. Acta neurochirurgica Supplement. 2015;120:137-40.
Goadsby PJ. Unique Migraine Subtypes, Rare Headache Disorders, and Other Disturbances. Continuum (Minneap Minn). 2015;21:1032-40.
Orr SL, Friedman BW, Christie S, Minen MT, Bamford C, Kelley NE and Tepper D. Management of Adults With Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache. 2016;56:911-40.
Rozen TD, Niknam RM, Shechter AL, Young WB and Silberstein SD. Cluster headache in women: clinical characteristics and comparison with cluster headache in men. Journal of neurology, neurosurgery, and psychiatry. 2001;70:613-7.
Shah DR, Dilwali S and Friedman DI. Migraine Aura Without Headache [corrected]. Curr Pain Headache Rep. 2018;22:77.
Solomon S, Grosberg BM, Friedman DI and Lipton RB. Retinal migraine. J Neuroophthalmol. 2007;27:243-4; author reply 244-5.
Tippin J, Corbett JJ, Kerber RE, Schroeder E and Thompson HS. Amaurosis fugax and ocular infarction in adolescents and young adults. Annals of neurology. 1989;26:69-77.
Viana M, Tronvik EA, Do TP, Zecca C and Hougaard A. Clinical features of visual migraine aura: a systematic review. J Headache Pain. 2019;20:64.

#165 How the other half lives Jun 11, 2020

On rounds, I sometimes joke that the two most important organs in the body are the right and left hemisphere. Only one of many, terrible, dad jokes my poor residents and students have to endure. But what happens when one organ fails, or you have to remove it?

This week on BrainWaves, we’ll review a unique neurologic condition where such incredible hemispheric dysfunction can only be treated by surgically removing half of the brain. And OMG, a show about pediatrics!

** IF YOU’RE TAKING YOUR NEUROLOGY BOARDS THIS SUMMER, CHECK OUT THE PENN NEUROLOGY BOARD REVIEW COURSE AT https://upenn.cloud-cme.com/default.aspx?P=5&EID=65373. AND FOR A DISCOUNTED RATE ON THE ONLINE OR STREAMING RESOURCES, USE PROMO CODE ‘WAVES2020’. **

Produced by James E. Siegler. Music courtesy of Ars Sonor, Daniel Birch, Jon Watts, and Lish Grooves. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Rasmussen T, Olszewski J and Lloydsmith D. Focal seizures due to chronic localized encephalitis. Neurology. 1958;8:435-45.
Hart YM, Cortez M, Andermann F, Hwang P, Fish DR, Dulac O, Silver K, Fejerman N, Cross H, Sherwin A and et al. Medical treatment of Rasmussen's syndrome (chronic encephalitis and epilepsy): effect of high-dose steroids or immunoglobulins in 19 patients. Neurology. 1994;44:1030-6.
Andrews PI, Dichter MA, Berkovic SF, Newton MR and McNamara JO. Plasmapheresis in Rasmussen's encephalitis. Neurology. 1996;46:242-6.
Leach JP, Chadwick DW, Miles JB and Hart IK. Improvement in adult-onset Rasmussen's encephalitis with long-term immunomodulatory therapy. Neurology. 1999;52:738-42.
Bien CG, Granata T, Antozzi C, Cross JH, Dulac O, Kurthen M, Lassmann H, Mantegazza R, Villemure JG, Spreafico R and Elger CE. Pathogenesis, diagnosis and treatment of Rasmussen encephalitis: a European consensus statement. Brain. 2005;128:454-71.
Varadkar S, Bien CG, Kruse CA, Jensen FE, Bauer J, Pardo CA, Vincent A, Mathern GW and Cross JH. Rasmussen's encephalitis: clinical features, pathobiology, and treatment advances. The Lancet Neurology. 2014;13:195-205.
Tan AP, Wong YLJ, Lin BJ, Yong HRC and Mankad K. Clinico-radiological approach to cerebral hemiatrophy. Childs Nerv Syst. 2018;34:2377-2390.

#164 Lewy Body Dementia May 28, 2020

Lewy Body Dementia may be the second most common neuropathologic cause of dementia behind Alzheimer disease, but it remains largely a clinical diagnosis with limited treatment options. This week on BrainWaves, Dr. Amy Colcher (Cooper University Hospital) reviews the diagnostic criteria and management strategies for patients and their caregivers who suffer from this condition.

Plus, a sort of tribute to Robin Williams.

Produced by James E. Siegler and Amy Colcher. Music courtesy of Andrew Sacco, Axletree, Damiano Baldoni, Josh Woodward, and Julie Maxwell. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

McKeith IG. Spectrum of Parkinson's disease, Parkinson's dementia, and Lewy body dementia. Neurol Clin. 2000;18:865-902.
Frieling H, Hillemacher T, Ziegenbein M, Neundorfer B and Bleich S. Treating dopamimetic psychosis in Parkinson's disease: structured review and meta-analysis. Eur Neuropsychopharmacol. 2007;17:165-71.
Galvin JE, Duda JE, Kaufer DI, Lippa CF, Taylor A and Zarit SH. Lewy body dementia: the caregiver experience of clinical care. Parkinsonism Relat Disord. 2010;16:388-92.
Koga S, Aoki N, Uitti RJ, van Gerpen JA, Cheshire WP, Josephs KA, Wszolek ZK, Langston JW and Dickson DW. When DLB, PD, and PSP masquerade as MSA: an autopsy study of 134 patients. Neurology. 2015;85:404-12.
Stinton C, McKeith I, Taylor JP, Lafortune L, Mioshi E, Mak E, Cambridge V, Mason J, Thomas A and O'Brien JT. Pharmacological Management of Lewy Body Dementia: A Systematic Review and Meta-Analysis. Am J Psychiatry. 2015;172:731-42.
Desmarais P, Massoud F, Filion J, Nguyen QD and Bajsarowicz P. Quetiapine for Psychosis in Parkinson Disease and Neurodegenerative Parkinsonian Disorders: A Systematic Review. J Geriatr Psychiatry Neurol. 2016;29:227-36.
McKeith IG, Boeve BF, Dickson DW, Halliday G, Taylor JP, Weintraub D, Aarsland D, Galvin J, Attems J, Ballard CG, Bayston A, Beach TG, Blanc F, Bohnen N, Bonanni L, Bras J, Brundin P, Burn D, Chen-Plotkin A, Duda JE, El-Agnaf O, Feldman H, Ferman TJ, Ffytche D, Fujishiro H, Galasko D, Goldman JG, Gomperts SN, Graff-Radford NR, Honig LS, Iranzo A, Kantarci K, Kaufer D, Kukull W, Lee VMY, Leverenz JB, Lewis S, Lippa C, Lunde A, Masellis M, Masliah E, McLean P, Mollenhauer B, Montine TJ, Moreno E, Mori E, Murray M, O'Brien JT, Orimo S, Postuma RB, Ramaswamy S, Ross OA, Salmon DP, Singleton A, Taylor A, Thomas A, Tiraboschi P, Toledo JB, Trojanowski JQ, Tsuang D, Walker Z, Yamada M and Kosaka K. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017;89:88-100.
Armstrong MJ. Lewy Body Dementias. Continuum (Minneap Minn). 2019;25:128-146.
Taylor JP, McKeith IG, Burn DJ, Boeve BF, Weintraub D, Bamford C, Allan LM, Thomas AJ and O'Brien JT. New evidence on the management of Lewy body dementia. The Lancet Neurology. 2020;19:157-169.

#163 What’s the buzz? May 14, 2020

Can you hear that too? You can’t? Well, that doesn’t mean I’m having auditory hallucinations. It could just be tinnitus, which describes the irritating sound of ringing, buzzing, clicking, or hissing that affect 10-20% of the world's population. But is this a ringing in the ears, or a ringing in the brain?

Produced by James E. Siegler. Music courtesy of Andrew Sacco, Jon Watts, Kai Engel, Lovira, Patches, and Kevin McLeod. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Arenberg IK, Countryman LF, Bernstein LH and Shambaugh GE, Jr. Van Gogh had Meniere's disease and not epilepsy. JAMA : the journal of the American Medical Association. 1990;264:491-3.
Sullivan M, Katon W, Russo J, Dobie R and Sakai C. A randomized trial of nortriptyline for severe chronic tinnitus. Effects on depression, disability, and tinnitus symptoms. Archives of internal medicine. 1993;153:2251-9.
Dobie RA. A review of randomized clinical trials in tinnitus. Laryngoscope. 1999;109:1202-11.
Lockwood AH, Salvi RJ, Burkard RF, Galantowicz PJ, Coad ML and Wack DS. Neuroanatomy of tinnitus. Scand Audiol Suppl. 1999;51:47-52.
Palomar Garcia V, Abdulghani Martinez F, Bodet Agusti E, Andreu Mencia L and Palomar Asenjo V. Drug-induced otoxicity: current status. Acta Otolaryngol. 2001;121:569-72.
Crummer RW and Hassan GA. Diagnostic approach to tinnitus. Am Fam Physician. 2004;69:120-6.
Lockwood AH. Tinnitus. Neurol Clin. 2005;23:893-900, viii.
Mattox DE and Hudgins P. Algorithm for evaluation of pulsatile tinnitus. Acta Otolaryngol. 2008;128:427-31.
Han BI, Lee HW, Kim TY, Lim JS and Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol. 2009;5:11-9.
Langguth B, Kreuzer PM, Kleinjung T and De Ridder D. Tinnitus: causes and clinical management. The Lancet Neurology. 2013;12:920-930.

#162 Just because you couldn't attend the AAN's annual meeting... Apr 30, 2020

It’s 2020, and for the first time in its 72-year history, the American Academy of Neurology has cancelled its annual meeting because of the COVID-19 pandemic. But that does not mean we (BrainWaves producers, not the AAN) can’t provide a few major updates to advances in neurology and neurotherapeutics! This week on the program, Jim Siegler is joined by Dr. Sammita Satyanarayan (Stanford) on a whirlwind tour of some of the latest advances in neurology from this past year. Enjoy!

DISCLAIMER: BrainWaves: A Neurology Podcast is not a product of the American Academy of Neurology (AAN) or its affiliates. Any content discussed on the program does not reflect the opinions of the AAN or its leadership nor does it contain any copyrighted material by the AAN or its affiliates. This program is neither published in collaboration with the AAN nor is it intended to plagiarize any content or programming of the AAN or its affiliates. The opinions discussed in this program are those of the producers and are not reflective of their employers or affiliates. This episode was produced by Sammita Satyanarayan and James E. Siegler. Music courtesy of E’s Jammy Jams, Lee Roosevere, Rui, and Steve Combs. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Dodick D, Lipton RB, Martin V, Papademetriou V, Rosamond W, MaassenVanDenBrink A, et al. Consensus statement: Cardiovascular safety profile of triptans (5-ht agonists) in the acute treatment of migraine. Headache. 2004;44:414-425
Hall GC, Brown MM, Mo J, MacRae KD. Triptans in migraine: The risks of stroke, cardiovascular disease, and death in practice. Neurology. 2004;62:563-568
Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. The New England journal of medicine. 2018;378:1573-1582
Kuca B, Silberstein SD, Wietecha L, Berg PH, Dozier G, Lipton RB, et al. Lasmiditan is an effective acute treatment for migraine: A phase 3 randomized study. Neurology. 2018;91:e2222-e2232
Cortese I, Muranski P, Enose-Akahata Y, Ha SK, Smith B, Monaco M, et al. Pembrolizumab treatment for progressive multifocal leukoencephalopathy. The New England journal of medicine. 2019;380:1597-1605
Goadsby PJ, Wietecha LA, Dennehy EB, Kuca B, Case MG, Aurora SK, et al. Phase 3 randomized, placebo-controlled, double-blind study of lasmiditan for acute treatment of migraine. Brain. 2019;142:1894-1904
Tabrizi SJ, Leavitt BR, Landwehrmeyer GB, Wild EJ, Saft C, Barker RA, et al. Targeting huntingtin expression in patients with huntington's disease. The New England journal of medicine. 2019;380:2307-2316
Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, et al. Effect of intravenous tenecteplase dose on cerebral reperfusion before thrombectomy in patients with large vessel occlusion ischemic stroke: The extend-ia tnk part 2 randomized clinical trial. JAMA : the journal of the American Medical Association. 2020. Epub ahead of print.

#161 Rule out spinal dural AV fistula Apr 16, 2020

As my wife and I are raising our 9-month old daughter, and she is eating more solid food, I can’t help but think about how important it is she keep an open mind to new food groups. But being open minded is not just a lesson for toddlers. I emphasize it every day on rounds when seeing patients for a “stroke consult”, or a consult for “ICU delirium”. If you reduce yourself to the same anchoring biases that you've grown accustomed to, you’ll never entertain the possibility of other important, and treatable conditions. Or tasty foods.

This week on the BrainWaves Podcast, Dr. Brian Jankowitz (Cooper University Hospital Vascular Neurosurgeon) joins Jim in a discussion about a rare, but treatable cause of myelopathy. A condition you won’t want to miss.

Produced by Brian Jankowitz and James E. Siegler. Music courtesy of Kevin McLeod, Lee Rosevere, and Loyalty Freak Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Jellema K, Tijssen CC, van Rooij WJ, Sluzewski M, Koudstaal PJ, Algra A and van Gijn J. Spinal dural arteriovenous fistulas: long-term follow-up of 44 treated patients. Neurology. 2004;62:1839-41.
Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT and Thron A. Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2007;28:1249-58.
Krings T and Geibprasert S. Spinal dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2009;30:639-48.
Alexander MD, Oliff MC, Olorunsola OG, Brus-Ramer M, Nickoloff EL and Meyers PM. Patient radiation exposure during diagnostic and therapeutic interventional neuroradiology procedures. J Neurointerv Surg. 2010;2:6-10.
Cifarelli CP, Kaptain G, Yen CP, Schlesinger D and Sheehan JP. Gamma knife radiosurgery for dural arteriovenous fistulas. Neurosurgery. 2010;67:1230-5; discussion 1235.
Kim DJ, Willinsky R, Geibprasert S, Krings T, Wallace C, Gentili F and Terbrugge K. Angiographic characteristics and treatment of cervical spinal dural arteriovenous shunts. AJNR American journal of neuroradiology. 2010;31:1512-5.
Chen J and Gailloud P. Safety of spinal angiography: complication rate analysis in 302 diagnostic angiograms. Neurology. 2011;77:1235-40.
Manninen AL, Isokangas JM, Karttunen A, Siniluoto T and Nieminen MT. A comparison of radiation exposure between diagnostic CTA and DSA examinations of cerebral and cervicocerebral vessels. AJNR American journal of neuroradiology. 2012;33:2038-42.

#160 Pluses and minuses of perfusion imaging Apr 02, 2020

Perfusion imaging employs concepts that date back to the early 1830s, and it leverages hardware and software that emerged around the same time at multidetector helical CT scans. But it has only become popular in recent years for thrombectomy decision-making.

If I'm being honest, I often never use it for this purpose. So what other purposes might it serve? And how does it work? This week, we review the fundamental concepts of perfusion CT, its utility in stroke care, and how it might prove useful for other neurologic conditions as well.

** IF YOU’RE TAKING YOUR NEUROLOGY BOARDS THIS SUMMER, CHECK OUT THE PENN NEUROLOGY BOARD REVIEW COURSE. FOR A DISCOUNTED RATE ON THE ONLINE OR STREAMING RESOURCES, USE PROMO CODE ‘WAVES2020’. **

Produced by James E. Siegler. Music courtesy of Julie Maxwell, John Bartmann, Kai Engel, and Pachyderm. Our theme song was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Some of the voices you heard throughout the program were those of Dr. Mathias Prokop, Radbound Medical Center, Netherlands; Terri Yeager, Comprehensive Stroke Program Coordinator at Cooper University Hospital; and a recording that was produced by GE Healthcare, which are freely available on YouTube. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Campbell BC, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM and Parsons MW. Comparison of computed tomography perfusion and magnetic resonance imaging perfusion-diffusion mismatch in ischemic stroke. Stroke; a journal of cerebral circulation. 2012;43:2648-53.
Boned S, Padroni M, Rubiera M, Tomasello A, Coscojuela P, Romero N, Muchada M, Rodriguez-Luna D, Flores A, Rodriguez N, Juega J, Pagola J, Alvarez-Sabin J, Molina CA and Ribo M. Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept. J Neurointerv Surg. 2017;9:66-69.
Martins N, Aires A, Mendez B, Boned S, Rubiera M, Tomasello A, Coscojuela P, Hernandez D, Muchada M, Rodriguez-Luna D, Rodriguez N, Juega JM, Pagola J, Molina CA and Ribo M. Ghost Infarct Core and Admission Computed Tomography Perfusion: Redefining the Role of Neuroimaging in Acute Ischemic Stroke. Interv Neurol. 2018;7:513-521.
Campbell BCV, Ma H, Ringleb PA, Parsons MW, Churilov L, Bendszus M, Levi CR, Hsu C, Kleinig TJ, Fatar M, Leys D, Molina C, Wijeratne T, Curtze S, Dewey HM, Barber PA, Butcher KS, De Silva DA, Bladin CF, Yassi N, Pfaff JAR, Sharma G, Bivard A, Desmond PM, Schwab S, Schellinger PD, Yan B, Mitchell PJ, Serena J, Toni D, Thijs V, Hacke W, Davis SM, Donnan GA, Extend E and Investigators E. Extending thrombolysis to 4.5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. Lancet. 2019;394:139-147.
Siegler JE, Messe SR, Sucharew H, Kasner SE, Mehta T, Arora N, Starosciak AK, De Los Rios La Rosa F, Barnhill NR, Mistry AM, Patel K, Assad S, Tarboosh A, Dakay K, Wagner J, Bennett A, Jagadeesan B, Streib C, Weber SA, Chitale R, Volpi JJ, Mayer SA, Yaghi S, Jayaraman MV, Khatri P and Mistry EA. Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study. J Neuroimaging. 2019. Epub ahead of print.
Barber PA, Demchuk AM, Zhang J and Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet. 2000;355:1670-4.
Wintermark M, Reichhart M, Thiran JP, Maeder P, Chalaron M, Schnyder P, Bogousslavsky J and Meuli R. Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Annals of neurology. 2002;51:417-32.
Parsons MW, Pepper EM, Chan V, Siddique S, Rajaratnam S, Bateman GA and Levi CR. Perfusion computed tomography: prediction of final infarct extent and stroke outcome. Annals of neurology. 2005;58:672-9.
Campbell BC, Weir L, Desmond PM, Tu HT, Hand PJ, Yan B, Donnan GA, Parsons MW and Davis SM. CT perfusion improves diagnostic accuracy and confidence in acute ischaemic stroke. Journal of neurology, neurosurgery, and psychiatry. 2013;84:613-8.
Mangla R, Ekhom S, Jahromi BS, Almast J, Mangla M and Westesson PL. CT perfusion in acute stroke: know the mimics, potential pitfalls, artifacts, and technical errors. Emerg Radiol. 2014;21:49-65.
Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, McTaggart RA, Torbey MT, Kim-Tenser M, Leslie-Mazwi T, Sarraj A, Kasner SE, Ansari SA, Yeatts SD, Hamilton S, Mlynash M, Heit JJ, Zaharchuk G, Kim S, Carrozzella J, Palesch YY, Demchuk AM, Bammer R, Lavori PW, Broderick JP, Lansberg MG and Investigators D. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. The New England journal of medicine. 2018;378:708-718.
Van Cauwenberge MGA, Dekeyzer S, Nikoubashman O, Dafotakis M and Wiesmann M. Can perfusion CT unmask postictal stroke mimics? A case-control study of 133 patients. Neurology. 2018;91:e1918-e1927.
Siegler JE, Olsen A, Pulst-Korenberg J, Cristancho D, Rosenberg J, Raab L, Cucchiara B and Messe SR. Multicenter Volumetric Assessment of Artifactual Hypoperfusion Patterns using Automated CT Perfusion Imaging. J Neuroimaging. 2019;29:573-579.

Update: Musings on COVID-19 Mar 29, 2020

Imagine what it would have been like, to have lived in 1918. Spanish influenza killed approximately 3% of the world’s population. Other than the world war, international travel was fairly limited. There was no social media. No flu vaccine. No mechanical ventilators. No World Health Organization.

A century later, we’re facing the next great pandemic. And what have we learned? What do we know?

From the neurologic complications of SARS-CoV-2, to non-infectious consequences, the environmental impact of a pandemic, and lessons learned polio, we hope to leave you with a few important take-home messages, a silver lining—and some food for thought—about the ongoing COVID pandemic.

REFERENCES

Murata K, Inoue O, Akutsu M and Iwata T. Neuromotor effects of short-term and long-term exposures to trichloroethylene in workers. Am J Ind Med. 2010;53:915-21.
Umapathi T, Kor AC, Venketasubramanian N, Lim CC, Pang BC, Yeo TT, Lee CC, Lim PL, Ponnudurai K, Chuah KL, Tan PH, Tai DY and Ang SP. Large artery ischaemic stroke in severe acute respiratory syndrome (SARS). Journal of neurology. 2004;251:1227-31.
Li Y, Wang M, Zhou Y, Chang J, Xian Y, Mao L, Hong C, Chen S, Wang Y, Wang H, Li M, Jin H and Hu B. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Lancet. 2020;Epub ahead of print.
Mao L, Wang M, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Hu Y, Li Y, Jin H and Hu B. Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: A Retrospective Case Series Study. Lancet. 2020;Epub ahead of print.
Perbellini L, Olivato D, Zedde A and Miglioranzi R. Acute trichloroethylene poisoning by ingestion: clinical and pharmacokinetic aspects. Intensive care medicine. 1991;17:234-5.
Guehl D, Bezard E, Dovero S, Boraud T, Bioulac B and Gross C. Trichloroethylene and parkinsonism: a human and experimental observation. European journal of neurology : the official journal of the European Federation of Neurological Societies. 1999;6:609-11.
Gash DM, Rutland K, Hudson NL, Sullivan PG, Bing G, Cass WA, Pandya JD, Liu M, Choi DY, Hunter RL, Gerhardt GA, Smith CD, Slevin JT and Prince TS. Trichloroethylene: Parkinsonism and complex 1 mitochondrial neurotoxicity. Annals of neurology. 2008;63:184-92.
Wang G, Zhang Z, Ayala C, Dunet DO, Fang J and George MG. Costs of hospitalization for stroke patients aged 18-64 years in the United States. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2014;23:861-8.
West JB. The physiological challenges of the 1952 Copenhagen poliomyelitis epidemic and a renaissance in clinical respiratory physiology. J Appl Physiol (1985). 2005;99:424-32.

#159 The pupil can be a great teacher Mar 19, 2020

They say the eyes are the window to the soul. Well, maybe. They also happen to be the first organ we (perhaps, unknowingly) examine whenever we encounter a patient. This week on the program, we build on the prior episode about anisocoria (featuring Dr. Ali Hamedani, episode 74) and discuss the examination of the pupil, and all that these 3-5 millimeters of tissue can teach us.

Plus, some Dad jokes at the end...

Produced by James E. Siegler. Music courtesy of Chris Haugen, Daniel Birch, and Lee Roosevere. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Bouffard MA. The Pupil. Continuum (Minneap Minn). 2019;25:1194-1214.
Liu G, Volpe NJ and Galetta S. Neuro-Ophthalmology: Diagnosis and Management: Elsevier; 2018.

https://www.amazon.com/Liu-Volpe-Galettas-Neuro-Ophthalmology-Management/dp/032334044X

#158 Teaching through clinical cases: A primer on proximal weakness Mar 05, 2020

Generalized weakness is a common complaint. Much of the time, we as neurologists don’t even see these patients in the hospital or the clinic. But more often than not, “generalized” weakness may be the only way a patient describes difficulty brushing their hair or climbing stairs. In these situations, it’s not exactly generalized weakness. It’s something else. This week on BrainWaves, we review the major patterns of weakness that characterize the most common muscle disorders. With a quick review of EMG findings. Enjoy!

Produced by James E. Siegler. Music courtesy of Jahzzar, Kevin McLeod, Patches, and Montplaisir. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Suresh E and Wimalaratna S. Proximal myopathy: diagnostic approach and initial management. Postgraduate medical journal. 2013;89:470-7.
Walter MC, Reilich P, Thiele S, Schessl J, Schreiber H, Reiners K, Kress W, Muller-Reible C, Vorgerd M, Urban P, Schrank B, Deschauer M, Schlotter-Weigel B, Kohnen R and Lochmuller H. Treatment of dysferlinopathy with deflazacort: a double-blind, placebo-controlled clinical trial. Orphanet J Rare Dis. 2013;8:26.
Fayssoil A, Ogna A, Chaffaut C, Chevret S, Guimaraes-Costa R, Leturcq F, Wahbi K, Prigent H, Lofaso F, Nardi O, Clair B, Behin A, Stojkovic T, Laforet P, Orlikowski D and Annane D. Natural History of Cardiac and Respiratory Involvement, Prognosis and Predictive Factors for Long-Term Survival in Adult Patients with Limb Girdle Muscular Dystrophies Type 2C and 2D. PloS one. 2016;11:e0153095.
Harris E, Bladen CL, Mayhew A, James M, Bettinson K, Moore U, Smith FE, Rufibach L, Cnaan A, Bharucha-Goebel DX, Blamire AM, Bravver E, Carlier PG, Day JW, Diaz-Manera J, Eagle M, Grieben U, Harms M, Jones KJ, Lochmuller H, Mendell JR, Mori-Yoshimura M, Paradas C, Pegoraro E, Pestronk A, Salort-Campana E, Schreiber-Katz O, Semplicini C, Spuler S, Stojkovic T, Straub V, Takeda S, Rocha CT, Walter MC, Bushby K and Jain COSC. The Clinical Outcome Study for dysferlinopathy: An international multicenter study. Neurol Genet. 2016;2:e89.
Clark KEN and Isenberg DA. A review of inflammatory idiopathic myopathy focusing on polymyositis. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2018;25:13-23.
Wicklund MP. The Limb-Girdle Muscular Dystrophies. Continuum (Minneap Minn). 2019;25:1599-1618.
Preston DC and Shapiro BE. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. 3rd ed. London; New York: Elsevier Saunders; 2013.
“rAAVrh74.MHCK7.DYSF.DV for Treatment of Dysferlinopathies.” Clinicaltrials.gov. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02710500?cond=dysferlinopathy&draw=2&rank=1 on 22 December 2019.

For great video examples of EMG findings in nerve and muscle disease, check out KImura & Kohara's YouTube recordings: https://www.youtube.com/watch?v=6-3PP_S-Q8I&list=PLCC_NQWOABCY18PEzlGELGOR_-IDNaDQ_

#80 The meningitis that keeps coming back: 2020 update Feb 27, 2020

This week on BrainWaves, we're revisiting the 2017 episode on recurrent meningitis featuring Dr. Jon Rosenberg (New York Presbyterian-Columbia). While we may not have made much headway in the treatment of these patients since the original show came out, we have made some progress in the neurodiagnostics.

Produced by James E. Siegler and Jon Rosenberg. Music courtesy of Coldnoise, Three Chain Links, and Uncanny. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Zunt JR and Baldwin KJ. Chronic and subacute meningitis. Continuum (Minneap Minn). 2012;18:1290-318.
Ginsberg L and Kidd D. Chronic and recurrent meningitis. Pract Neurol. 2008;8:348-61.
Rosenberg J and Galen BT. Recurrent Meningitis. Curr Pain Headache Rep. 2017;21:33.
Baldwin KJ and Avila JD. Diagnostic Approach to Chronic Meningitis. Neurol Clin. 2018;36:831-849.
Wilson MR, O'Donovan BD, Gelfand JM, Sample HA, Chow FC, Betjemann JP, Shah MP, Richie MB, Gorman MP, Hajj-Ali RA, Calabrese LH, Zorn KC, Chow ED, Greenlee JE, Blum JH, Green G, Khan LM, Banerji D, Langelier C, Bryson-Cahn C, Harrington W, Lingappa JR, Shanbhag NM, Green AJ, Brew BJ, Soldatos A, Strnad L, Doernberg SB, Jay CA, Douglas V, Josephson SA and DeRisi JL. Chronic Meningitis Investigated via Metagenomic Next-Generation Sequencing. JAMA Neurol. 2018;75:947-955.
Wilson MR, Sample HA, Zorn KC, Arevalo S, Yu G, Neuhaus J, Federman S, Stryke D, Briggs B, Langelier C, Berger A, Douglas V, Josephson SA, Chow FC, Fulton BD, DeRisi JL, Gelfand JM, Naccache SN, Bender J, Dien Bard J, Murkey J, Carlson M, Vespa PM, Vijayan T, Allyn PR, Campeau S, Humphries RM, Klausner JD, Ganzon CD, Memar F, Ocampo NA, Zimmermann LL, Cohen SH, Polage CR, DeBiasi RL, Haller B, Dallas R, Maron G, Hayden R, Messacar K, Dominguez SR, Miller S and Chiu CY. Clinical Metagenomic Sequencing for Diagnosis of Meningitis and Encephalitis. The New England journal of medicine. 2019;380:2327-2340.

#157 Checkpoint inhibitor neurotoxicity Feb 20, 2020

Immune checkpoint inhibitors have revolutionized cancer treatment. Unlike chemotherapy, which essentially includes cellular toxins that can cause widespread and unnecessary tissue damage, checkpoint inhibitors are used to train the body’s natural immune system to fight off the cancer. And while they are extraordinarily effective options for patients with malignant disease, they are not without risk. Every day, we are learning more and more about the autoimmune side effects of these novel therapies.

This week on the BrainWaves Podcast, Dr. Justine Cohen (University of Pennsylvania) shares her experience managing patients with checkpoint inhibitor neurotoxicity.

Produced by James E. Siegler and Justine Cohen. Music courtesy of Jon Watts, Kai Engel, and Kevin McLeod--as well as a cameo appearance by the Checkpoints. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Bhatia S, Tykodi SS and Thompson JA. Treatment of metastatic melanoma: an overview. Oncology (Williston Park). 2009;23:488-96.
Hottinger AF. Neurologic complications of immune checkpoint inhibitors. Curr Opin Neurol. 2016;29:806-812.
Wick W, Hertenstein A and Platten M. Neurological sequelae of cancer immunotherapies and targeted therapies. Lancet Oncol. 2016;17:e529-e541.
Cohen JV and Buchbinder EI. The Evolution of Adjuvant Therapy for Melanoma. Curr Oncol Rep. 2019;21:106.
Cohen JV, Wang N, Venur VA, Hadfield MJ, Cahill DP, Oh K and Brastianos PK. Neurologic complications of melanoma. Cancer. 2019. Epub ahead of print.
Graus F and Dalmau J. Paraneoplastic neurological syndromes in the era of immune-checkpoint inhibitors. Nat Rev Clin Oncol. 2019;16:535-548.
Zekeridou A and Lennon VA. Neurologic Autoimmunity in the Era of Checkpoint Inhibitor Cancer Immunotherapy. Mayo Clinic proceedings. 2019;94:1865-1878.
Zubiri L, Allen IM, Taylor MS, Guidon AC, Chen ST, Schoenfeld SR, Neilan TG, Sise ME, Mooradian MJ, Rubin KM, Leaf RK, Parikh AR, Faje A, Gainor JF, Cohen JV, Fintelmann FJ, Kohler MJ, Dougan M and Reynolds KL. Immune-Related Adverse Events in the Setting of PD-1/L1 Inhibitor Combination Therapy. Oncologist. 2019. Epub ahead of print.

#156 Off-label clobazam in drug-resistant epilepsy Feb 06, 2020

The sole FDA approved indication for clobazam is as a therapeutic adjunct in Lennox Gastaut Syndrome. But as more and more clinicians publish their experience with the off-label success of certain therapies, we may see new indications for this and other pharmacologic agents in the treatment of neurologic disease.

Produced by James E. Siegler. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Music courtesy of Chris Zabriskie, Milton Arias, and John Bartmann. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Schmidt D, Rohde M, Wolf P and Roeder-Wanner U. Clobazam for refractory focal epilepsy. A controlled trial. Archives of neurology. 1986;43:824-6.
Keene DL, Whiting S and Humphreys P. Clobazam as an add-on drug in the treatment of refractory epilepsy of childhood. Can J Neurol Sci. 1990;17:317-9.
Remy C. Clobazam in the treatment of epilepsy: a review of the literature. Epilepsia. 1994;35 Suppl 5:S88-91.
Montenegro MA, Cendes F, Noronha AL, Mory SB, Carvalho MI, Marques LH and Guerreiro CA. Efficacy of clobazam as add-on therapy in patients with refractory partial epilepsy. Epilepsia. 2001;42:539-42.
Ng YT and Collins SD. Clobazam. Neurotherapeutics. 2007;4:138-44.
Montenegro MA, Arif H, Nahm EA, Resor SR, Jr. and Hirsch LJ. Efficacy of clobazam as add-on therapy for refractory epilepsy: experience at a US epilepsy center. Clin Neuropharmacol. 2008;31:333-8.
Mahmoud SH and Rans C. Systematic review of clobazam use in patients with status epilepticus. Epilepsia Open. 2018;3:323-330.
Bresnahan R, Martin-McGill KJ, Williamson J, Michael BD and Marson AG. Clobazam add-on therapy for drug-resistant epilepsy. The Cochrane database of systematic reviews. 2019;10:CD004154.

YOUTUBE EXCERPTS (shared via fair use)

Kathryn Davis, MD (Hospital of the University of Pennsylvania): https://www.youtube.com/watch?v=XInZ7Y0lgKg

Patty McGoldrick, NP, MPA (Beth Israel Deaconness Medical Center/Roosevelt Hospital): https://www.youtube.com/watch?v=sE2BkYXqxJs&t=14s

#155 Teaching through clinical cases: Handed the diagnosis Jan 23, 2020

In a patient with isolated, progressive hand numbness and weakness, there is a much to be learned about the clinical exam. Often, its all you need. This week, Dr. Aakriti Kothiwal (Cooper University Hospital) presents this week's clinical case and helps localize the lesion.

Produced by James E. Siegler and Aakriti Kothiwal. Music courtesy of Jazzar, Lee Rosevere, and Loyalty Freak Music. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Gross PT and Jones HR, Jr. Proximal median neuropathies: electromyographic and clinical correlation. Muscle Nerve. 1992;15:390-5.
Gross PT and Tolomeo EA. Proximal median neuropathies. Neurol Clin. 1999;17:425-45, v.
Peters N, Muller-Schunk S, Freilinger T, During M, Pfefferkorn T and Dichgans M. Ischemic stroke of the cortical "hand knob" area: stroke mechanisms and prognosis. Journal of neurology. 2009;256:1146-51.
Bouche P. Compression and entrapment neuropathies. Handbook of clinical neurology. 2013;115:311-66.
Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, Caliandro P and Hobson-Webb LD. Carpal tunnel syndrome: clinical features, diagnosis, and management. The Lancet Neurology. 2016;15:1273-1284.
Aamodt WW, Siegler JE and Elman L. Teaching NeuroImages: Acute infarction of the left medial lemniscus masquerading as a peripheral neuropathy. Neurology. 2017;88:e178.
Hobson-Webb LD and Juel VC. Common Entrapment Neuropathies. Continuum (Minneap Minn). 2017;23:487-511.

#154 All that restricts does not infarct Jan 09, 2020

The common teaching is that restricted diffusion on MRI indicates stroke—acute cerebral infarction. When, more specifically, the changes on DWI and ADC indicate impairment in the random movement of water molecules in a given tissue. With slower movement, as in energy-depleted tissues with failing ATP-dependent sodium/potassium channels, high cellularity, or a highly viscous extra-cellular space, there is restricted diffusion (of water) and a corresponding bright signal on DWI. These and other considerations are the focus of this week's episode of BrainWaves.

Produced by James E. Siegler. Music courtesy of Uncanny and Kevin McLeod. Sound effects by Mike Koenig. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Filippi M, Iannucci G, Cercignani M, Assunta Rocca M, Pratesi A and Comi G. A quantitative study of water diffusion in multiple sclerosis lesions and normal-appearing white matter using echo-planar imaging. Archives of neurology. 2000;57:1017-21.
Meyer JR, Gutierrez A, Mock B, Hebron D, Prager JM, Gorey MT and Homer D. High-b-value diffusion-weighted MR imaging of suspected brain infarction. AJNR American journal of neuroradiology. 2000;21:1821-9.
Roberts TP and Rowley HA. Diffusion weighted magnetic resonance imaging in stroke. Eur J Radiol. 2003;45:185-94.
McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS and Teksam M. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189:904-12.
Maier SE, Sun Y and Mulkern RV. Diffusion imaging of brain tumors. NMR Biomed. 2010;23:849-64.
Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O and Kennedy PG. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2010;17:999-e57.
Hegde AN, Mohan S, Lath N and Lim CC. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics. 2011;31:5-30.
Aliaga ES and Barkhof F. MRI mimics of multiple sclerosis. Handbook of clinical neurology. 2014;122:291-316.
Starkey J, Kobayashi N, Numaguchi Y and Moritani T. Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations. Radiographics. 2017;37:562-576.

Best of BrainWaves 2019 Dec 26, 2019

2019 was a big year. The year of the Mueller report. The American college admissions scandals. Brexit. But it was also the year the US Women's team won the World Cup, and lobbied for the equal pay of women and men in sports. It was the year of NMO, in which several pivotal trials showed benefit of disease modulating therapy in this condition. The year Will Smith played Genie in Aladdin.

2019 was a great year. And as we wrap up 2019, this week's episode includes some of the highlights. Enjoy!

Produced by James E. Siegler with support from Erika Mejia, Rajat Dhar, and the entire Siegler family. Music courtesy of Axletree, Chris Zabriskie, John Paston, Kevin Mcleod, Josh Woodward, Steve Combs, Lee Rosevere, Scott Holmes, Advent Chamber Orchestra, Coldnoise, and Pachyderm. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

[BRAIN FOOD]

Kennedy DO, Wightman EL, Reay JL, Lietz G, Okello EJ, Wilde A and Haskell CF. Effects of resveratrol on cerebral blood flow variables and cognitive performance in humans: a double-blind, placebo-controlled, crossover investigation. Am J Clin Nutr. 2010;91:1590-7.
Devore EE, Kang JH, Breteler MM and Grodstein F. Dietary intakes of berries and flavonoids in relation to cognitive decline. Annals of neurology. 2012;72:135-43.
Norton S, Matthews FE, Barnes DE, Yaffe K and Brayne C. Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. The Lancet Neurology. 2014;13:788-94.
Morris MC, Tangney CC, Wang Y, Sacks FM, Barnes LL, Bennett DA and Aggarwal NT. MIND diet slows cognitive decline with aging. Alzheimers Dement. 2015;11:1015-22.
Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martinez-Gonzalez MA, Martinez-Lapiscina EH, Fito M, Perez-Heras A, Salas-Salvado J, Estruch R and Ros E. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA internal medicine. 2015;175:1094-1103.
Newman JC, Covarrubias AJ, Zhao M, Yu X, Gut P, Ng CP, Huang Y, Haldar S and Verdin E. Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice. Cell Metab. 2017;26:547-557 e8.
Miller MG, Hamilton DA, Joseph JA and Shukitt-Hale B. Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial. Eur J Nutr. 2018;57:1169-1180.
Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmuller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM and consortium O. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. The Lancet Neurology. 2018;17:671-680.
Radd-Vagenas S, Duffy SL, Naismith SL, Brew BJ, Flood VM and Fiatarone Singh MA. Effect of the Mediterranean diet on cognition and brain morphology and function: a systematic review of randomized controlled trials. Am J Clin Nutr. 2018;107:389-404.
Xu W, Wang H, Wan Y, Tan C, Li J, Tan L and Yu JT. Alcohol consumption and dementia risk: a dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2017;32:31-42.
Lefevre-Arbogast S, Gaudout D, Bensalem J, Letenneur L, Dartigues JF, Hejblum BP, Feart C, Delcourt C and Samieri C. Pattern of polyphenol intake and the long-term risk of dementia in older persons. Neurology. 2018;90:e1979-e1988.
Liu QP, Wu YF, Cheng HY, Xia T, Ding H, Wang H, Wang ZM and Xu Y. Habitual coffee consumption and risk of cognitive decline/dementia: A systematic review and meta-analysis of prospective cohort studies. Nutrition. 2016;32:628-36.

[OF MEASLES AND MEN]

Murch SH, Anthony A, Casson DH, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Valentine A, Davies SE and Walker-Smith JA. Retraction of an interpretation. Lancet. 2004;363:750.
Perry RT and Halsey NA. The clinical significance of measles: a review. The Journal of infectious diseases. 2004;189 Suppl 1:S4-16.
Campbell H, Andrews N, Brown KE and Miller E. Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol. 2007;36:1334-48.
Poland GA and Jacobson RM. The age-old struggle against the antivaccinationists. The New England journal of medicine. 2011;364:97-9.
Maglione MA, Das L, Raaen L, Smith A, Chari R, Newberry S, Shanman R, Perry T, Goetz MB and Gidengil C. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics. 2014;134:325-37.
Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016;170:1209-1215.
Bester JC. Not a matter of parental choice but of social justice obligation: Children are owed measles vaccination. Bioethics. 2018;32:611-619.
Fournet N, Mollema L, Ruijs WL, Harmsen IA, Keck F, Durand JY, Cunha MP, Wamsiedel M, Reis R, French J, Smit EG, Kitching A and van Steenbergen JE. Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews. BMC Public Health. 2018;18:196.

Trump’s tweet: https://twitter.com/realdonaldtrump/status/449525268529815552?lang=en

[NON-INFECTIOUS NEUROLOGIC COMPLICATIONS OF ORGAN TRANSPLANT]

Senzolo M, Ferronato C and Burra P. Neurologic complications after solid organ transplantation. Transpl Int. 2009;22:269-78.
Dhar R. Neurologic complications of transplantation. Handbook of clinical neurology. 2017;141:545-572.
Mateen FJ, Dierkhising RA, Rabinstein AA, van de Beek D and Wijdicks EF. Neurological complications following adult lung transplantation. Am J Transplant. 2010;10:908-14.
Munoz P, Valerio M, Palomo J, Fernandez-Yanez J, Fernandez-Cruz A, Guinea J and Bouza E. Infectious and non-infectious neurologic complications in heart transplant recipients. Medicine (Baltimore). 2010;89:166-75.
Wu Q, Marescaux C, Wolff V, Jeung MY, Kessler R, Lauer V and Chen Y. Tacrolimus-associated posterior reversible encephalopathy syndrome after solid organ transplantation. Eur Neurol. 2010;64:169-77.
Dhar R, Young GB and Marotta P. Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy. Neurocritical care. 2008;8:253-8.

#153 Neurosarcoidosis: The 21st century great mimicker Dec 12, 2019

In the TV show, HOUSE, it's either lupus or its sarcoidosis. Only, it's never sarcoidosis. That's because sarcoidosis is such a heterogeneous condition and can affect practically any age group. In some patients, this idiopathic inflammatory disorder can also involve the nervous system. Also causing a variety of signs and symptoms ranging from mild headache to a proximal myopathy or even a CNS vasculitis. This week on the BrainWaves podcast, Dr. Jesse Thon reflects on the literature and shares his experience managing patients with this troubling condition.

Produced by Jesse Thon and James E. Siegler. Music courtesy of Steve Combs, Lovira, and Yakov Goldman. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Petereit HF, Reske D, Tumani H, Jarius S, Markus Leweke F, Woitalla D, Pfister HW and Rubbert A. Soluble CSF interleukin 2 receptor as indicator of neurosarcoidosis. Journal of neurology. 2010;257:1855-63.
Agnihotri SP, Singhal T, Stern BJ and Cho TA. Neurosarcoidosis. Semin Neurol. 2014;34:386-94.
Bitoun S, Bouvry D, Borie R, Mahevas M, Sacre K, Haroche J, Psimaras D, Pottier C, Mathian A, Hie M, Boutin DL, Papo T, Godeau B, Valeyre D, Nunes H, Amoura Z and Cohen Aubart F. Treatment of neurosarcoidosis: A comparative study of methotrexate and mycophenolate mofetil. Neurology. 2016;87:2517-2521.
Gelfand JM, Bradshaw MJ, Stern BJ, Clifford DB, Wang Y, Cho TA, Koth LL, Hauser SL, Dierkhising J, Vu N, Sriram S, Moses H, Bagnato F, Kaufmann JA, Ammah DJ, Yohannes TH, Hamblin MJ, Venna N, Green AJ and Pawate S. Infliximab for the treatment of CNS sarcoidosis: A multi-institutional series. Neurology. 2017;89:2092-2100.
Jolliffe EA, Keegan BM and Flanagan EP. Trident sign trumps Aquaporin-4-IgG ELISA in diagnostic value in a case of longitudinally extensive transverse myelitis. Mult Scler Relat Disord. 2018;23:7-8.
Wallaert B, Ramon P, Fournier EC, Hatron PY, Muir JF, Tonnel AB and Voisin C. High-dose methylprednisolone pulse therapy in sarcoidosis. Eur J Respir Dis. 1986;68:256-62.
Agbogu BN, Stern BJ, Sewell C and Yang G. Therapeutic considerations in patients with refractory neurosarcoidosis. Archives of neurology. 1995;52:875-9.
Baughman RP and Lower EE. Infliximab for refractory sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2001;18:70-4.
Baughman RP, Drent M, Kavuru M, Judson MA, Costabel U, du Bois R, Albera C, Brutsche M, Davis G, Donohue JF, Muller-Quernheim J, Schlenker-Herceg R, Flavin S, Lo KH, Oemar B, Barnathan ES and Sarcoidosis I. Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. Am J Respir Crit Care Med. 2006;174:795-802.
Rossman MD, Newman LS, Baughman RP, Teirstein A, Weinberger SE, Miller W, Jr. and Sands BE. A double-blinded, randomized, placebo-controlled trial of infliximab in subjects with active pulmonary sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2006;23:201-8.

#10 Cryptogenic stroke: 2019 update Dec 05, 2019

In 2016, when we first launched the BrainWaves podcast, cryptogenic stroke was a poorly understood concept. 3 years later, it remains poorly understood. But we are making progress. In this week's update of episode 10, we review the progress that has been made in the pathogenesis, diagnosis, and management of these patients.

Produced by James E. Siegler. The original 2016 version of this show was also produced by Dr. Noah Levinson. Music courtesy of Josh Woodward, Julie Maxwell, Dan Lebowitz, and this group called E’s Jammy Jams. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Siegler JE, Swaminathan B, Giruparajah M, Bosch J, Perera KS, Hart RG, Kasner SE and Investigators EGR. Age disparity in diagnostic evaluation of stroke patients: Embolic Stroke of Undetermined Source Global Registry Project. Eur Stroke J. 2016;1:130-138.
Jacobs BS, Boden-Albala B, Lin IF and Sacco RL. Stroke in the young in the northern Manhattan stroke study. Stroke; a journal of cerebral circulation. 2002;33:2789-93.
Hart RG, Sharma M, Mundl H, Kasner SE, Bangdiwala SI, Berkowitz SD, Swaminathan B, Lavados P, Wang Y, Wang Y, Davalos A, Shamalov N, Mikulik R, Cunha L, Lindgren A, Arauz A, Lang W, Czlonkowska A, Eckstein J, Gagliardi RJ, Amarenco P, Ameriso SF, Tatlisumak T, Veltkamp R, Hankey GJ, Toni D, Bereczki D, Uchiyama S, Ntaios G, Yoon BW, Brouns R, Endres M, Muir KW, Bornstein N, Ozturk S, O'Donnell MJ, De Vries Basson MM, Pare G, Pater C, Kirsch B, Sheridan P, Peters G, Weitz JI, Peacock WF, Shoamanesh A, Benavente OR, Joyner C, Themeles E, Connolly SJ and Investigators NE. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. The New England journal of medicine. 2018;378:2191-2201.
Diener HC, Sacco RL, Easton JD, Granger CB, Bernstein RA, Uchiyama S, Kreuzer J, Cronin L, Cotton D, Grauer C, Brueckmann M, Chernyatina M, Donnan G, Ferro JM, Grond M, Kallmunzer B, Krupinski J, Lee BC, Lemmens R, Masjuan J, Odinak M, Saver JL, Schellinger PD, Toni D, Toyoda K, Committee R-SES and Investigators. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. The New England journal of medicine. 2019;380:1906-1917.
Di Tullio M, Sacco RL, Gopal A, Mohr JP and Homma S. Patent foramen ovale as a risk factor for cryptogenic stroke. Annals of internal medicine. 1992;117:461-5.
Overell JR, Bone I and Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology. 2000;55:1172-9.
Li J, Liu J, Liu M, Zhang S, Hao Z, Zhang J and Zhang C. Closure versus medical therapy for preventing recurrent stroke in patients with patent foramen ovale and a history of cryptogenic stroke or transient ischemic attack. The Cochrane database of systematic reviews. 2015;9:CD009938.
Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, Arquizan C, Bejot Y, Vuillier F, Detante O, Guidoux C, Canaple S, Vaduva C, Dequatre-Ponchelle N, Sibon I, Garnier P, Ferrier A, Timsit S, Robinet-Borgomano E, Sablot D, Lacour JC, Zuber M, Favrole P, Pinel JF, Apoil M, Reiner P, Lefebvre C, Guerin P, Piot C, Rossi R, Dubois-Rande JL, Eicher JC, Meneveau N, Lusson JR, Bertrand B, Schleich JM, Godart F, Thambo JB, Leborgne L, Michel P, Pierard L, Turc G, Barthelet M, Charles-Nelson A, Weimar C, Moulin T, Juliard JM, Chatellier G and Investigators C. Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke. The New England journal of medicine. 2017;377:1011-1021.
Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS, Tirschwell DL and Investigators R. Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke. The New England journal of medicine. 2017;377:1022-1032.
Sondergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen-Kudsk JE, Settergren M, Sjostrand C, Roine RO, Hildick-Smith D, Spence JD, Thomassen L and Gore RCSI. Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. The New England journal of medicine. 2017;377:1033-1042.
Juul K, Tybjaerg-Hansen A, Steffensen R, Kofoed S, Jensen G and Nordestgaard BG. Factor V Leiden: The Copenhagen City Heart Study and 2 meta-analyses. Blood. 2002;100:3-10.
Kaku DA and Lowenstein DH. Emergence of recreational drug abuse as a major risk factor for stroke in young adults. Annals of internal medicine. 1990;113:821-7.
Fonseca AC and Ferro JM. Drug abuse and stroke. Current neurology and neuroscience reports. 2013;13:325.
Susac JO, Egan RA, Rennebohm RM and Lubow M. Susac's syndrome: 1975-2005 microangiopathy/autoimmune endotheliopathy. Journal of the neurological sciences. 2007;257:270-2.
Perera KS, Ng KKH, Nayar S, Catanese L, Dyal L, Sharma M, Connolly SJ, Yusuf S, Bosch J, Eikelboom JW and Hart RG. Association Between Low-Dose Rivaroxaban With or Without Aspirin and Ischemic Stroke Subtypes: A Secondary Analysis of the COMPASS Trial. JAMA Neurol. 2019. Epub ahead of print.

#152 It’s not over yet…part 2: Post-publication peer-review Nov 28, 2019

Peer review prior to publication of medical data dates back to the 9th century CE, but has only really gained steam in the past 70 or 80 years. Ideally, peer review would serve as an initial filter for data that enters a permanent public scientific record. But peer review is not without flaws. In the second installment of the BrainWaves segment, “It’s not over yet…”, we discuss publication as a potential source of bias, and highlight the reasons why it should not be the final step of the peer review process.

Produced by James E. Siegler. Music courtesy of Cullah, Lee Rosevere, John Bartmann, Kevin McLeod, and Jon Watts. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Bingham C. Peer review on the Internet: A better class of conversation. Lancet. 1998;351:S10-14.
Godlee F, Gale CR and Martyn CN. Effect on the quality of peer review of blinding reviewers and asking them to sign their reports: a randomized controlled trial. JAMA : the journal of the American Medical Association. 1998;280:237-40.
Jefferson T, Alderson P, Wager E and Davidoff F. Effects of editorial peer review: a systematic review. JAMA : the journal of the American Medical Association. 2002;287:2784-6.
Jefferson T, Rudin M, Brodney Folse S and Davidoff F. Editorial peer review for improving the quality of reports of biomedical studies. The Cochrane database of systematic reviews. 2007:MR000016.
Ware M. Peer review: Benefits, perspectives, and alternatives: Publishing Research Consortium; 2008.
Mandavilli A. Peer review: Trial by Twitter. Nature. 2011;469:286-7.
Haffar S, Bazerbachi F and Murad MH. Peer Review Bias: A Critical Review. Mayo Clinic proceedings. 2019;94:670-676.

#151 It’s not over yet…part 1: Opening Pandora’s black box Nov 14, 2019

The FDA label for ACTEMRA (tocilizumab)--the first medication approved for use in giant cell arteritis in 2017--is 40 pages long. Of the information provided in this document, which includes important dosing information, dose adjustments based on leukocyte count, clinical trial and epidemiologic data, there is a box of text on the first page of the insert. "WARNING: RISK OF SERIOUS INFECTIONS" it reads.

What do you make of this warning? And with such a clear and broad-sweeping statement stamped on the medication, how do you mitigate the medico-legal risk for using this drug?

This week on the program we launch into a 2-part series focused on some of the events which follow major clinical trials. In part 1, we cover the 3 major classifications of FDA alerts for medical treatments using 2 examples from the neurologic pharmacopoeia. In part 2, we emphasize the importance of post-publication peer review. And both are equally instrumental in our medical decision making.

Produced by James E. Siegler with the support of Michael Rubenstein (University of Pennsylvania) and Zachary Newcomer (University of Florida). Music courtesy of Coldnoise, Cuicuitte, Doctor Turtle, Jahzzar, and Peter Rudenko under a CC license. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. None of what is discussed here should be misconstrued as medical advice, so don't just go prescribing drugs off-label! (Or willy nilly, as my grandmother might say) Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Schneider LS, Dagerman KS and Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA : the journal of the American Medical Association. 2005;294:1934-43.
Ballard C, Hanney ML, Theodoulou M, Douglas S, McShane R, Kossakowski K, Gill R, Juszczak E, Yu LM, Jacoby R and investigators D-A. The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. The Lancet Neurology. 2009;8:151-7.
Moore TJ, Singh S and Furberg CD. The FDA and new safety warnings. Archives of internal medicine. 2012;172:78-80.
Dorsey ER, Beck CA, Darwin K, Nichols P, Brocht AF, Biglan KM, Shoulson I and Huntington Study Group CI. Natural history of Huntington disease. JAMA Neurol. 2013;70:1520-30.
Hubers AA, van Duijn E, Roos RA, Craufurd D, Rickards H, Bernhard Landwehrmeyer G, van der Mast RC, Giltay EJ and Network RiotEHsD. Suicidal ideation in a European Huntington's disease population. J Affect Disord. 2013;151:248-58.
Shen V, Clarence-Smith K, Hunter C and Jankovic J. Safety and Efficacy of Tetrabenazine and Use of Concomitant Medications During Long-Term, Open-Label Treatment of Chorea Associated with Huntington's and Other Diseases. Tremor Other Hyperkinet Mov (N Y). 2013;3.
Schultz JL, Killoran A, Nopoulos PC, Chabal CC, Moser DJ and Kamholz JA. Evaluating depression and suicidality in tetrabenazine users with Huntington disease. Neurology. 2018;91:e202-e207.
Rose RV and Kass JS. Prescribing Antipsychotic Medications to Patients With Dementia: Boxed Warnings and Mitigation of Legal Liability. Continuum (Minneap Minn). 2019;25:254-259.
US Food and Drug Administration. Guidance for industry: warnings and precautions, contraindications, and boxed warning sections of labeling for human prescription drug and biological products—content and format. www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm075096.pdf. Published October 2011. Accessed 11 July 2019.

Halloween special 2019: Young Frankenstein Oct 31, 2019

This year, Halloween falls on a Thursday. So we've put together a special episode to celebrate it! But first...a question: What do Frankenstein's monster, Spock, and Rick Deckard all have in common? Find out in this week's episode of BrainWaves.

Produced by James E. Siegler. Special guest, Scott Kasner (Hospital of the University of Pennsylvania) with fair use of material from Young Frankenstein (1974), Star Trek: The Original Series (1966-1969), and Blade Runner (1982). Music courtesy of Grossman, Ewell and Grainger, Heftone Banjo Orchestra, Sergey Chereminisov, and Ondrosik under a Creative Commons License. Sound effects by Mike Koenig. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Labbe R, Firl A, Jr., Mufson EJ and Stein DG. Fetal brain transplant: reduction of cognitive deficits in rats with frontal cortex lesions. Science. 1983;221:470-2.
Brain transplant for Parkinson's disease. Lancet. 1987;1:1012-3.
Ignacio V, Collins VP, Suard IM and Jacque CM. Survival of astroglial cell lineage from adult brain transplant. Dev Neurosci. 1989;11:175-8.
Landau WM. Clinical neuromythology VII. Artificial intelligence: the brain transplant cure for parkinsonism. Neurology. 1990;40:733-40.
Freed CR, Breeze RE, Rosenberg NL, Schneck SA, Kriek E, Qi JX, Lone T, Zhang YB, Snyder JA, Wells TH and et al. Survival of implanted fetal dopamine cells and neurologic improvement 12 to 46 months after transplantation for Parkinson's disease. The New England journal of medicine. 1992;327:1549-55.
Landau WM. Clinical neuromythology X. Faithful fashion: survival status of the brain transplant cure for parkinsonism. Neurology. 1993;43:644-9.
Grabowski M, Johansson BB and Brundin P. Neocortical grafts placed in the infarcted brain of adult rats: few or no efferent fibers grow from transplant to host. Exp Neurol. 1995;134:273-6.
Schulz MK, McNulty JA, Handa RJ, Hogan TP, Tillotson GL, Shaw PL, Zimmer J and Castro AJ. Fetal neocortical transplants grafted into neocortical lesion cavities made in newborn rats: an analysis of transplant integration with the host brain. Cell Transplant. 1995;4:123-32.
Deacon T, Schumacher J, Dinsmore J, Thomas C, Palmer P, Kott S, Edge A, Penney D, Kassissieh S, Dempsey P and Isacson O. Histological evidence of fetal pig neural cell survival after transplantation into a patient with Parkinson's disease. Nat Med. 1997;3:350-3.
Freed CR, Greene PE, Breeze RE, Tsai WY, DuMouchel W, Kao R, Dillon S, Winfield H, Culver S, Trojanowski JQ, Eidelberg D and Fahn S. Transplantation of embryonic dopamine neurons for severe Parkinson's disease. The New England journal of medicine. 2001;344:710-9.
Bhattacharya N, Chhetri MK, Mukherjee KL, Ghosh AB, Samanta BK, Mitra R, Bhattacharya M, Bhattacharya S and Bandopadhyaya T. Can human fetal cortical brain tissue transplant (up to 20 weeks) sustain its metabolic and oxygen requirements in a heterotopic site outside the brain? A study of 12 volunteers with Parkinson's disease. Clin Exp Obstet Gynecol. 2002;29:259-66.
Kumar R and Mahapatra AK. Concept of brain transplant in pre-historic era. Childs Nerv Syst. 2009;25:393-4.
Bjorklund A, Dunnett SB, Stenevi U, Lewis ME and Iversen SD. Reinnervation of the denervated striatum by substantia nigra transplants: functional consequences as revealed by pharmacological and sensorimotor testing. Brain Res. 1980;199:307-33.

#150 Patient narrative part 2: It started with back pain… Oct 17, 2019

College is a tough time for any kid. But it should also be exciting. Then to experience the freedoms of young adulthood, only later to face the horrifying reality of a progressive neurodegenerative condition...it's not something anyone should experience. In this week's continuation of the patient narrative series, Dr. Paul McIntosh (Duke) shares his life-changing story, and his optimism, about surviving a chronic neurological illness.

Produced by James E. Siegler with the help of Paul McIntosh. For more information about Pompe Disease, check out the resources provided by the United Pompe Foundation at unitedpompe.com. Music for our program this week was courtesy of Ars Sonor, Franz Danzi, Lee Rosevere, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Kishnani PS and Howell RR. Pompe disease in infants and children. J Pediatr. 2004;144:S35-43.
Van den Hout JM, Kamphoven JH, Winkel LP, Arts WF, De Klerk JB, Loonen MC, Vulto AG, Cromme-Dijkhuis A, Weisglas-Kuperus N, Hop W, Van Hirtum H, Van Diggelen OP, Boer M, Kroos MA, Van Doorn PA, Van der Voort E, Sibbles B, Van Corven EJ, Brakenhoff JP, Van Hove J, Smeitink JA, de Jong G, Reuser AJ and Van der Ploeg AT. Long-term intravenous treatment of Pompe disease with recombinant human alpha-glucosidase from milk. Pediatrics. 2004;113:e448-57.
Klinge L, Straub V, Neudorf U, Schaper J, Bosbach T, Gorlinger K, Wallot M, Richards S and Voit T. Safety and efficacy of recombinant acid alpha-glucosidase (rhGAA) in patients with classical infantile Pompe disease: results of a phase II clinical trial. Neuromuscul Disord. 2005;15:24-31.
Kishnani PS, Corzo D, Nicolino M, Byrne B, Mandel H, Hwu WL, Leslie N, Levine J, Spencer C, McDonald M, Li J, Dumontier J, Halberthal M, Chien YH, Hopkin R, Vijayaraghavan S, Gruskin D, Bartholomew D, van der Ploeg A, Clancy JP, Parini R, Morin G, Beck M, De la Gastine GS, Jokic M, Thurberg B, Richards S, Bali D, Davison M, Worden MA, Chen YT and Wraith JE. Recombinant human acid [alpha]-glucosidase: major clinical benefits in infantile-onset Pompe disease. Neurology. 2007;68:99-109.
Wokke JH, Escolar DM, Pestronk A, Jaffe KM, Carter GT, van den Berg LH, Florence JM, Mayhew J, Skrinar A, Corzo D and Laforet P. Clinical features of late-onset Pompe disease: a prospective cohort study. Muscle Nerve. 2008;38:1236-45.
van der Ploeg AT, Clemens PR, Corzo D, Escolar DM, Florence J, Groeneveld GJ, Herson S, Kishnani PS, Laforet P, Lake SL, Lange DJ, Leshner RT, Mayhew JE, Morgan C, Nozaki K, Park DJ, Pestronk A, Rosenbloom B, Skrinar A, van Capelle CI, van der Beek NA, Wasserstein M and Zivkovic SA. A randomized study of alglucosidase alfa in late-onset Pompe's disease. The New England journal of medicine. 2010;362:1396-406.
Cupler EJ, Berger KI, Leshner RT, Wolfe GI, Han JJ, Barohn RJ, Kissel JT and Disease ACCoL-oP. Consensus treatment recommendations for late-onset Pompe disease. Muscle Nerve. 2012;45:319-33.
Beltran Papsdorf TB, Howard JF, Jr. and Chahin N. Pearls & Oy-sters: clues to the diagnosis of adult-onset acid maltase deficiency. Neurology. 2014;82:e73-5.
Gutierrez-Rivas E, Bautista J, Vilchez JJ, Muelas N, Diaz-Manera J, Illa I, Martinez-Arroyo A, Olive M, Sanz I, Arpa J, Fernandez-Torron R, Lopez de Munain A, Jimenez L, Solera J and Lukacs Z. Targeted screening for the detection of Pompe disease in patients with unclassified limb-girdle muscular dystrophy or asymptomatic hyperCKemia using dried blood: A Spanish cohort. Neuromuscul Disord. 2015;25:548-53.
Lukacs Z, Nieves Cobos P, Wenninger S, Willis TA, Guglieri M, Roberts M, Quinlivan R, Hilton-Jones D, Evangelista T, Zierz S, Schlotter-Weigel B, Walter MC, Reilich P, Klopstock T, Deschauer M, Straub V, Muller-Felber W and Schoser B. Prevalence of Pompe disease in 3,076 patients with hyperCKemia and limb-girdle muscular weakness. Neurology. 2016;87:295-8.

#149 Patient narrative part 1: The world’s disability Oct 03, 2019

Sara Henya would have you recognize her for her music, not her malady. While she may have Tourette Syndrome, she refuses to let it define her. In this week's episode of BrainWaves, we're launching a two part series featuring people who are living with a chronic neurologic illness--how they were diagnosed, how they cope with it, and of course, the neurobiology that underlies it.

Produced by James E. Siegler with Dr. Michael Rubenstein and Sara Henya. Music courtesy of Sara Henya (find her music at www.sarahenya.com), Lee Rosevere, Loyalty Freak Music, Marco Trovatello, and Steve Combs. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Pringsheim T, Holler-Managan Y, Okun MS, Jankovic J, Piacentini J, Cavanna AE, Martino D, Muller-Vahl K, Woods DW, Robinson M, Jarvie E, Roessner V and Oskoui M. Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019;92:907-915.
Pringsheim T, Okun MS, Muller-Vahl K, Martino D, Jankovic J, Cavanna AE, Woods DW, Robinson M, Jarvie E, Roessner V, Oskoui M, Holler-Managan Y and Piacentini J. Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019;92:896-906.
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Yael D, Vinner E and Bar-Gad I. Pathophysiology of tic disorders. Mov Disord. 2015;30:1171-8.
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#34 The ALS multi-disciplinary clinic Sep 26, 2019

This week on the program, our earlier episode on the multidisciplinary care of ALS patients gets a face lift. Since it originally aired in 2016, there have been several important advances in the treatment of these patients--including the first FDA approved therapy for this condition in more than 2 decades. But many of the core management strategies remain the same. Dr. Lauren Elman, Associate Professor of Neurology, Director of Research Operations and Associate Director of clinical care at the Penn Comprehensive ALS Center, shares her experience in this 2019 update.

Produced by James E. Siegler. Music courtesy of Chris Zabriskie, Nuno Adelaida, and Meydan. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

de Carvalho M, Dengler R, Eisen A, England JD, Kaji R, Kimura J, Mills K, Mitsumoto H, Nodera H, Shefner J and Swash M. Electrodiagnostic criteria for diagnosis of ALS. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2008;119:497-503.
Ludolph A, Drory V, Hardiman O, Nakano I, Ravits J, Robberecht W, Shefner J and ALS/MND WFNRGO. A revision of the El Escorial criteria - 2015. Amyotroph Lateral Scler Frontotemporal Degener. 2015;16:291-2.
Geevasinga N, Loy CT, Menon P, de Carvalho M, Swash M, Schrooten M, Van Damme P, Gawel M, Sonoo M, Higashihara M, Noto Y, Kuwabara S, Kiernan MC, Macaskill P and Vucic S. Awaji criteria improves the diagnostic sensitivity in amyotrophic lateral sclerosis: A systematic review using individual patient data. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2016;127:2684-91.
Geevasinga N, Menon P, Scherman DB, Simon N, Yiannikas C, Henderson RD, Kiernan MC and Vucic S. Diagnostic criteria in amyotrophic lateral sclerosis: A multicenter prospective study. Neurology. 2016;87:684-90.
Weiss MD, Macklin EA, Simmons Z, Knox AS, Greenblatt DJ, Atassi N, Graves M, Parziale N, Salameh JS, Quinn C, Brown RH, Jr., Distad JB, Trivedi J, Shefner JM, Barohn RJ, Pestronk A, Swenson A, Cudkowicz ME and Mexiletine ALSSG. A randomized trial of mexiletine in ALS: Safety and effects on muscle cramps and progression. Neurology. 2016;86:1474-81.
Hardiman O and van den Berg LH. Edaravone: a new treatment for ALS on the horizon? The Lancet Neurology. 2017;16:490-491.
Meininger V, Genge A, van den Berg LH, Robberecht W, Ludolph A, Chio A, Kim SH, Leigh PN, Kiernan MC, Shefner JM, Desnuelle C, Morrison KE, Petri S, Boswell D, Temple J, Mohindra R, Davies M, Bullman J, Rees P, Lavrov A and Group NOGS. Safety and efficacy of ozanezumab in patients with amyotrophic lateral sclerosis: a randomised, double-blind, placebo-controlled, phase 2 trial. The Lancet Neurology. 2017;16:208-216.
Radunovic A, Annane D, Rafiq MK, Brassington R and Mustfa N. Mechanical ventilation for amyotrophic lateral sclerosis/motor neuron disease. The Cochrane database of systematic reviews. 2017;10:CD004427.
Writing G and Edaravone ALSSG. Safety and efficacy of edaravone in well defined patients with amyotrophic lateral sclerosis: a randomised, double-blind, placebo-controlled trial. The Lancet Neurology. 2017;16:505-512.
Oskarsson B, Moore D, Mozaffar T, Ravits J, Wiedau-Pazos M, Parziale N, Joyce NC, Mandeville R, Goyal N, Cudkowicz ME, Weiss M, Miller RG and McDonald CM. Mexiletine for muscle cramps in amyotrophic lateral sclerosis: A randomized, double-blind crossover trial. Muscle Nerve. 2018.
Luo L, Song Z, Li X, Huiwang, Zeng Y, Qinwang, Meiqi and He J. Efficacy and safety of edaravone in treatment of amyotrophic lateral sclerosis-a systematic review and meta-analysis. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2019;40:235-241.
Statland JM, Moore D, Wang Y, Walsh M, Mozaffar T, Elman L, Nations SP, Mitsumoto H, Fernandes JA, Saperstein D, Hayat G, Herbelin L, Karam C, Katz J, Wilkins HM, Agbas A, Swerdlow RH, Santella RM, Dimachkie MM, Barohn RJ, Rasagiline Investigators of the Muscle Study G and Western ALSC. Rasagiline for amyotrophic lateral sclerosis: A randomized, controlled trial. Muscle Nerve. 2019;59:201-207.
Miller RG, Jackson CE, Kasarskis EJ, England JD, Forshew D, Johnston W, Kalra S, Katz JS, Mitsumoto H, Rosenfeld J, Shoesmith C, Strong MJ, Woolley SC and Quality Standards Subcommittee of the American Academy of N. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009;73:1227-33.
Miller RG, Jackson CE, Kasarskis EJ, England JD, Forshew D, Johnston W, Kalra S, Katz JS, Mitsumoto H, Rosenfeld J, Shoesmith C, Strong MJ, Woolley SC and Quality Standards Subcommittee of the American Academy of N. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009;73:1218-26.

#148 Teaching through clinical cases: A curious case of infectious encephalitis Sep 19, 2019

In this week's clinical case, Dr. Mike Bradshaw (Chicago Medical School and Billings Clinic) walks us through the case of a young woman with HSV encephalitis.

With a twist.

SPOILER ALERT: If you don't want to know the answer, DON'T LOOK AT THE SHOWNOTES!

Produced by James E. Siegler and Mike Bradshaw. Music courtesy of Yan Terrien, Unheard Music Concepts, Steve Combs, and Montplaisir. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Bacon TH, Boon RJ, Schultz M and Hodges-Savola C. Surveillance for antiviral-agent-resistant herpes simplex virus in the general population with recurrent herpes labialis. Antimicrob Agents Chemother. 2002;46:3042-4.
Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, Cunningham R, Zuckerman M, Mutton KJ, Solomon T, Ward KN, Lunn MP, Irani SR, Vincent A, Brown DW, Crowcroft NS and Group UKHPAAoES. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010;10:835-44.
Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O and Kennedy PG. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2010;17:999-e57.
Gable MS, Sheriff H, Dalmau J, Tilley DH and Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project. Clin Infect Dis. 2012;54:899-904.
Pruss H, Finke C, Holtje M, Hofmann J, Klingbeil C, Probst C, Borowski K, Ahnert-Hilger G, Harms L, Schwab JM, Ploner CJ, Komorowski L, Stoecker W, Dalmau J and Wandinger KP. N-methyl-D-aspartate receptor antibodies in herpes simplex encephalitis. Annals of neurology. 2012;72:902-11.
Armangue T, Leypoldt F and Dalmau J. Autoimmune encephalitis as differential diagnosis of infectious encephalitis. Curr Opin Neurol. 2014;27:361-8.
Armangue T, Leypoldt F, Malaga I, Raspall-Chaure M, Marti I, Nichter C, Pugh J, Vicente-Rasoamalala M, Lafuente-Hidalgo M, Macaya A, Ke M, Titulaer MJ, Hoftberger R, Sheriff H, Glaser C and Dalmau J. Herpes simplex virus encephalitis is a trigger of brain autoimmunity. Annals of neurology. 2014;75:317-23.
Venkatesan A and Benavides DR. Autoimmune encephalitis and its relation to infection. Current neurology and neuroscience reports. 2015;15:3.
Linnoila JJ, Binnicker MJ, Majed M, Klein CJ and McKeon A. CSF herpes virus and autoantibody profiles in the evaluation of encephalitis. Neurol Neuroimmunol Neuroinflamm. 2016;3:e245.
Armangue T, Spatola M, Vlagea A, Mattozzi S, Carceles-Cordon M, Martinez-Heras E, Llufriu S, Muchart J, Erro ME, Abraira L, Moris G, Monros-Gimenez L, Corral-Corral I, Montejo C, Toledo M, Bataller L, Secondi G, Arino H, Martinez-Hernandez E, Juan M, Marcos MA, Alsina L, Saiz A, Rosenfeld MR, Graus F, Dalmau J and Spanish Herpes Simplex Encephalitis Study G. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis. The Lancet Neurology. 2018;17:760-772.
Dubey D, Pittock SJ, Kelly CR, McKeon A, Lopez-Chiriboga AS, Lennon VA, Gadoth A, Smith CY, Bryant SC, Klein CJ, Aksamit AJ, Toledano M, Boeve BF, Tillema JM and Flanagan EP. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Annals of neurology. 2018;83:166-177.

Quanta: PREVENTing relapses of Aqp4-Ab NMO Sep 12, 2019

We just used clinical trial data regarding eculizumab in myasthenia gravis as an example of how to critically appraise the literature, and in this week's program...MORE data on the efficacy of eculizumab in another neurological condition. This week on BrainWaves, the exciting results of the PREVENT trial and the future treatment of NMO spectrum disorder!

Produced by James E. Siegler. Special thanks to Dr. Olga Rosenveld Thon. Music courtesy of Unheard Music Concepts, TRG Banks, and Aitua. Sound effects by Mike Koenig and baby Sofia Joan Siegler. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Pittock SJ, Lennon VA, McKeon A, Mandrekar J, Weinshenker BG, Lucchinetti CF, O'Toole O and Wingerchuk DM. Eculizumab in AQP4-IgG-positive relapsing neuromyelitis optica spectrum disorders: an open-label pilot study. The Lancet Neurology. 2013;12:554-62.
Pittock SJ, Berthele A, Fujihara K, Kim HJ, Levy M, Palace J, Nakashima I, Terzi M, Totolyan N, Viswanathan S, Wang KC, Pace A, Fujita KP, Armstrong R and Wingerchuk DM. Eculizumab in Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder. The New England journal of medicine. 2019;381:614-625.
FDA News Release: FDA approved first treatment for neuromyelitis optica spectrum disorder, a rare autoimmune disease of the central nervous system. 27 June 2019. Available online at https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-neuromyelitis-optica-spectrum-disorder-rare-autoimmune-disease-central. Accessed 30 Aug 2019.

#147 I wonder: p-value Sep 05, 2019

One study shows that 30 minutes of exercise 5 times a week can reduce your risk of squamous cell carcinoma of the skin, p=0.001. (Let's pretend this is true). What does this mean?

Well, let's start by asking the question, how IMPORTANT is it that you reduce your risk of SCC of the skin, and how MUCH does exercise reduce that risk? If the effect of exercise is associated with a relative risk reduction of 1% in your lifetime risk of SCC, is that enough to get you to spend 1 week of your life each year on a treadmill?

In this week's "I wonder" series, Dr. Ali Hamedani joins Jim Siegler to discuss the difference between statistical significance and clinical importance, how to interpret p-values, and exactly what kinds of conclusions you should draw from clinical studies.

Produced by James E. Siegler and Ali Hamedani. Music courtesy of Jahzzar, Kevin McLeod, Sergey Cheremisinov, and the trio Grossman, Ewell and Grainger. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Gardner MJ and Altman DG. Confidence intervals rather than P values: estimation rather than hypothesis testing. Br Med J (Clin Res Ed). 1986;292:746-50.
Goodman SN. Toward evidence-based medical statistics. 1: The P value fallacy. Annals of internal medicine. 1999;130:995-1004.
Bartolucci AA, Tendera M and Howard G. Meta-analysis of multiple primary prevention trials of cardiovascular events using aspirin. The American journal of cardiology. 2011;107:1796-801.
Pocock SJ and Stone GW. The Primary Outcome Fails - What Next? The New England journal of medicine. 2016;375:861-70.
Howard JF, Jr., Utsugisawa K, Benatar M, Murai H, Barohn RJ, Illa I, Jacob S, Vissing J, Burns TM, Kissel JT, Muppidi S, Nowak RJ, O'Brien F, Wang JJ, Mantegazza R and Group RS. Safety and efficacy of eculizumab in anti-acetylcholine receptor antibody-positive refractory generalised myasthenia gravis (REGAIN): a phase 3, randomised, double-blind, placebo-controlled, multicentre study. The Lancet Neurology. 2017;16:976-986.
Muppidi S, Utsugisawa K, Benatar M, Murai H, Barohn RJ, Illa I, Jacob S, Vissing J, Burns TM, Kissel JT, Nowak RJ, Andersen H, Casasnovas C, de Bleecker JL, Vu TH, Mantegazza R, O'Brien FL, Wang JJ, Fujita KP, Howard JF, Jr. and Regain Study G. Long-term safety and efficacy of eculizumab in generalized myasthenia gravis. Muscle Nerve. 2019;60:14-24.
National Institute of Neurological D and Stroke rt PASSG. Tissue plasminogen activator for acute ischemic stroke. The New England journal of medicine. 1995;333:1581-7.
Fritz CO, Morris PE and Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen. 2012;141:2-18.

#146 Tangled up in squiggles: EEG 101 and the ictal inter-ictal continuum Aug 22, 2019

This week on the BrainWaves podcast, finally...a REAL show about BRAINWAVES! Dr. Carolina Maciel, of the University of Florida, schools Jim Siegler on how to read EEG and interpret abnormal patterns across the ictal-interictal continuum.

Produced by James E. Siegler and Carolina Maciel. Music courtesy of Chris Zabriskie, Montplaisir, Rafael Archangel, Steve Combs, Unheard Music Concepts, and Siddhartha. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Chong DJ and Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2005;22:79-91.
Benbadis SR, LaFrance WC, Jr., Papandonatos GD, Korabathina K, Lin K, Kraemer HC and Workshop NEST. Interrater reliability of EEG-video monitoring. Neurology. 2009;73:843-6.
Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, Mani R, Arif H, Jette N, Minazad Y, Kerrigan JF, Vespa P, Hantus S, Claassen J, Young GB, So E, Kaplan PW, Nuwer MR, Fountain NB and Drislane FW. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2012 version. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2013;30:1-27.
Gaspard N, Hirsch LJ, LaRoche SM, Hahn CD, Westover MB and Critical Care EEGMRC. Interrater agreement for Critical Care EEG Terminology. Epilepsia. 2014;55:1366-73.
Newey CR, Sahota P and Hantus S. Electrographic Features of Lateralized Periodic Discharges Stratify Risk in the Interictal-Ictal Continuum. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2017;34:365-369.
Rubinos C, Reynolds AS and Claassen J. The Ictal-Interictal Continuum: To Treat or Not to Treat (and How)? Neurocritical care. 2018;29:3-8.
Gerber PA, Chapman KE, Chung SS, Drees C, Maganti RK, Ng YT, Treiman DM, Little AS and Kerrigan JF. Interobserver agreement in the interpretation of EEG patterns in critically ill adults. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2008;25:241-9.
Beniczky S, Hirsch LJ, Kaplan PW, Pressler R, Bauer G, Aurlien H, Brogger JC and Trinka E. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013;54 Suppl 6:28-9.
Claassen J. How I treat patients with EEG patterns on the ictal-interictal continuum in the neuro ICU. Neurocritical care. 2009;11:437-44.

#145 Astroglia and Alzheimer’s disease Aug 08, 2019

Clean up on aisle 4!

Or should it be IL-4? In this week's installment of the BrainWaves Podcast, we submerge ourselves into the microscopic environment of Alzheimer's pathology. It's interesting, it's messy, and whoever made this mess is also responsible for the clean up.

Produced by James E. Siegler. Music courtesy of Andy Cohen, Brendan Kinsella, Cuicuitte, Damiano Baldoni, Kai Engel, Nctrnm. Sound effects by Mike Koenig, Blastfx.com, Caroline Ford, Robertv, and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Arranz AM and De Strooper B. The role of astroglia in Alzheimer's disease: pathophysiology and clinical implications. The Lancet Neurology. 2019;18:406-414.
Maragakis NJ and Rothstein JD. Mechanisms of Disease: astrocytes in neurodegenerative disease. Nat Clin Pract Neurol. 2006;2:679-89.
Wisniewski T and Konietzko U. Amyloid-beta immunisation for Alzheimer's disease. The Lancet Neurology. 2008;7:805-11.
Mattsson N, Zetterberg H, Hansson O, Andreasen N, Parnetti L, Jonsson M, Herukka SK, van der Flier WM, Blankenstein MA, Ewers M, Rich K, Kaiser E, Verbeek M, Tsolaki M, Mulugeta E, Rosen E, Aarsland D, Visser PJ, Schroder J, Marcusson J, de Leon M, Hampel H, Scheltens P, Pirttila T, Wallin A, Jonhagen ME, Minthon L, Winblad B and Blennow K. CSF biomarkers and incipient Alzheimer disease in patients with mild cognitive impairment. JAMA : the journal of the American Medical Association. 2009;302:385-93.
Breitner JC, Baker LD, Montine TJ, Meinert CL, Lyketsos CG, Ashe KH, Brandt J, Craft S, Evans DE, Green RC, Ismail MS, Martin BK, Mullan MJ, Sabbagh M, Tariot PN and Group AR. Extended results of the Alzheimer's disease anti-inflammatory prevention trial. Alzheimers Dement. 2011;7:402-11.
Yan R and Vassar R. Targeting the beta secretase BACE1 for Alzheimer's disease therapy. The Lancet Neurology. 2014;13:319-29.
Heneka MT, Carson MJ, El Khoury J, Landreth GE, Brosseron F, Feinstein DL, Jacobs AH, Wyss-Coray T, Vitorica J, Ransohoff RM, Herrup K, Frautschy SA, Finsen B, Brown GC, Verkhratsky A, Yamanaka K, Koistinaho J, Latz E, Halle A, Petzold GC, Town T, Morgan D, Shinohara ML, Perry VH, Holmes C, Bazan NG, Brooks DJ, Hunot S, Joseph B, Deigendesch N, Garaschuk O, Boddeke E, Dinarello CA, Breitner JC, Cole GM, Golenbock DT and Kummer MP. Neuroinflammation in Alzheimer's disease. The Lancet Neurology. 2015;14:388-405.
Kumar A, Singh A and Ekavali. A review on Alzheimer's disease pathophysiology and its management: an update. Pharmacol Rep. 2015;67:195-203.
Rodriguez-Arellano JJ, Parpura V, Zorec R and Verkhratsky A. Astrocytes in physiological aging and Alzheimer's disease. Neuroscience. 2016;323:170-82.
Chun H and Lee CJ. Reactive astrocytes in Alzheimer's disease: A double-edged sword. Neurosci Res. 2018;126:44-52.

#68 Teaching through clinical cases: A man with falls Aug 01, 2019

In one of our previous Teaching through Clinical Cases, Dr. Sneha Mantri (formerly a movement disorders fellow at the Philadelphia VA, now an Assistant Professor of Neurology at Duke) took us through the case of a gentleman with gait instability and falls. We are re-releasing this show with an update on the 2017 revised diagnostic criteria for the neurologic condition experienced by this patient.

Produced by James E. Siegler. Music courtesy of Julie Maxwell, Yan Terrien, Josh Woodward, Quantum Jazz, and Pachyderm. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Hess CW and Okun MS. Diagnosing Parkinson Disease. Continuum (Minneap Minn). 2016;22:1047-63.
Garbutt S, Riley DE, Kumar AN, Han Y, Harwood MR and Leigh RJ. Abnormalities of optokinetic nystagmus in progressive supranuclear palsy. Journal of neurology, neurosurgery, and psychiatry. 2004;75:1386-94.
McFarland NR. Diagnostic Approach to Atypical Parkinsonian Syndromes. Continuum (Minneap Minn). 2016;22:1117-42.
Boxer AL, Yu JT, Golbe LI, Litvan I, Lang AE and Hoglinger GU. Advances in progressive supranuclear palsy: new diagnostic criteria, biomarkers, and therapeutic approaches. The Lancet Neurology. 2017;16:552-563.
Hoglinger GU, Respondek G, Stamelou M, Kurz C, Josephs KA, Lang AE, Mollenhauer B, Muller U, Nilsson C, Whitwell JL, Arzberger T, Englund E, Gelpi E, Giese A, Irwin DJ, Meissner WG, Pantelyat A, Rajput A, van Swieten JC, Troakes C, Antonini A, Bhatia KP, Bordelon Y, Compta Y, Corvol JC, Colosimo C, Dickson DW, Dodel R, Ferguson L, Grossman M, Kassubek J, Krismer F, Levin J, Lorenzl S, Morris HR, Nestor P, Oertel WH, Poewe W, Rabinovici G, Rowe JB, Schellenberg GD, Seppi K, van Eimeren T, Wenning GK, Boxer AL, Golbe LI, Litvan I and Movement Disorder Society-endorsed PSPSG. Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Mov Disord. 2017;32:853-864.
PW Brazis, Masdeu JC, Biller J. Localization in Clinical Neurology, 6th 2011 Lippincott Williams and Wilkins.

#144 RCVS vs. Primary Angiitis of the CNS Jul 25, 2019

A 50-year-old gentleman presents with severe headaches and speech disturbance. The MRI shows acute strokes and multifocal vascular irregularities. Is it reversible cerebral vasoconstriction syndrome or primary angiitis of the central nervous system? Or is it something else entirely?

RCVS and PACNS almost always pose a challenge--even to the most astute neurologist. But, because they are treated entirely differently and their clinical trajectories depend on these treatments, it is worth knowing how experts distinguish the two. This week on the BrainWaves podcast, Dr. Jesse Thon joins Jim Siegler in a discussion about the clinical and radiographic features of these two conditions, and shares his experience in managing these patients.

Produced by James E. Siegler and Jesse Thon. Music courtesy of Nuno Adelaida, Peter Rudenko on the piano, Squire Tuck on the guitar, Swelling, and Uncanny. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Singhal AB. Diagnostic challenges in RCVS, PACNS, and other cerebral arteriopathies. Cephalalgia. 2011;31:1067-70.
Miller TR, Shivashankar R, Mossa-Basha M and Gandhi D. Reversible Cerebral Vasoconstriction Syndrome, Part 2: Diagnostic Work-Up, Imaging Evaluation, and Differential Diagnosis. AJNR American journal of neuroradiology. 2015;36:1580-8.
Miller TR, Shivashankar R, Mossa-Basha M and Gandhi D. Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course. AJNR American journal of neuroradiology. 2015;36:1392-9.
Singhal AB, Topcuoglu MA, Fok JW, Kursun O, Nogueira RG, Frosch MP and Caviness VS, Jr. Reversible cerebral vasoconstriction syndromes and primary angiitis of the central nervous system: clinical, imaging, and angiographic comparison. Annals of neurology. 2016;79:882-94.
Singhal AB and Topcuoglu MA. Glucocorticoid-associated worsening in reversible cerebral vasoconstriction syndrome. Neurology. 2017;88:228-236.
Rocha EA, Topcuoglu MA, Silva GS and Singhal AB. RCVS2 score and diagnostic approach for reversible cerebral vasoconstriction syndrome. Neurology. 2019;92:e639-e647.
Birnbaum J and Hellmann DB. Primary angiitis of the central nervous system. Archives of neurology. 2009;66:704-9.

#143 Teaching through clinical cases: A young woman with vision loss Jul 11, 2019

In this week's Teaching through Clinical Cases, Dr. Olga Rosenveld Thon (Drexel) walks us through the challenging management decisions that emerge in the care of women with demyelinating disease. Why are women prone to multiple sclerosis? How do pregnancy, breastfeeding, and menopause influence the disease course--and should these events alter the course of their therapy?

Produced by James E. Siegler and Olga Thon. Music courtesy of Cellophane Sam, Chris Zabriskie, Jon Watts, Kai Engel, and Lee Rosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

DISCLOSURES

Dr. Rosenveld Thon reports relevant financial interests in Ocrevus, as a consultant.

REFERENCES

Michel L, Foucher Y, Vukusic S, Confavreux C, de Seze J, Brassat D, Clanet M, Clavelou P, Ouallet JC, Brochet B, Pelletier J, Labauge P, Lebrun C, Lepage E, Le Frere F, Jacq-Foucher M, Barriere P, Wiertlewski S, Laplaud DA and Club Francophone de la Sclerose En P. Increased risk of multiple sclerosis relapse after in vitro fertilisation. Journal of neurology, neurosurgery, and psychiatry. 2012;83:796-802.
Nielsen NM, Westergaard T, Rostgaard K, Frisch M, Hjalgrim H, Wohlfahrt J, Koch-Henriksen N and Melbye M. Familial risk of multiple sclerosis: a nationwide cohort study. American journal of epidemiology. 2005;162:774-8.
Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P and Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. The New England journal of medicine. 1998;339:285-91.
Bove R and Chitnis T. The role of gender and sex hormones in determining the onset and outcome of multiple sclerosis. Multiple sclerosis. 2014;20:520-6.
Bove R. Women's Issues in Multiple Sclerosis. Semin Neurol. 2016;36:154-62.
Rankin K and Bove R. Caring for Women with Multiple Sclerosis Across the Lifespan. Current neurology and neuroscience reports. 2018;18:36.
Ramagopalan SV, Dobson R, Meier UC and Giovannoni G. Multiple sclerosis: risk factors, prodromes, and potential causal pathways. The Lancet Neurology. 2010;9:727-39.
Correale J, Farez MF and Ysrraelit MC. Increase in multiple sclerosis activity after assisted reproduction technology. Annals of neurology. 2012;72:682-94.
Bove R, Chitnis T and Houtchens M. Menopause in multiple sclerosis: therapeutic considerations. Journal of neurology. 2014;261:1257-68.

#142 The trigeminal autonomic cephalalgias Jun 27, 2019

In episode 142, Jim Siegler is joined by Dr. Deena Kuruvilla (Yale University School of Medicine) to discuss the 5 trigeminal autonomic cephalalgias--what we know about the pathophysiology, the diagnostic criteria, and current and future management strategies.

Produced by James E. Siegler and Deena Kuruvilla. Music courtesy of Ars Sonor, Axletree, Kevin McLeod, Lee Rosevere, and Steve Combs. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Goadsby PJ. Trigeminal autonomic cephalalgias. Continuum (Minneap Minn). 2012;18:883-895
Lambru G, Matharu MS. Sunct, suna and trigeminal neuralgia: Different disorders or variants of the same disorder? Curr Opin Neurol. 2014;27:325-331
Akram H, Miller S, Lagrata S, Hyam J, Jahanshahi M, Hariz M, et al. Ventral tegmental area deep brain stimulation for refractory chronic cluster headache. Neurology. 2016;86:1676-1682
Miller S, Akram H, Lagrata S, Hariz M, Zrinzo L, Matharu M. Ventral tegmental area deep brain stimulation in refractory short-lasting unilateral neuralgiform headache attacks. Brain. 2016;139:2631-2640
McGeeney BE. Cluster headache and other trigeminal autonomic cephalalgias. Semin Neurol. 2018;38:603-607
Khan S, Olesen A, Ashina M. Cgrp, a target for preventive therapy in migraine and cluster headache: Systematic review of clinical data. Cephalalgia. 2019;39:374-389

DISCLOSURES

Dr. Kuruvilla serves as a consultant for Lilly and Amgen pharmaceuticals.

#42 There's more to the facial nerve than Bell's Palsy Jun 20, 2019

You might think George Clooney gets his devilishly handsome smile from well polished genes or a long history of acting lessons. As it turns out, he has mild residual weakness from a remote Bell's Palsy.

In this week's installment of the BrainWaves podcast, we've got even more factoids about the facial nerve as we revisit a prior show that originally aired in January 2017. We've touched up the audio a bit, so get comfortable and grab a pen, you may want to take notes on this one.

Produced by James E. Siegler. Music courtesy of Marcos H. Bolanos, Jon Watts & Lee Rosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

1. Gilden DH. Clinical practice. Bell's Palsy. The New England journal of medicine. 2004;351:1323-31.

2. Sweeney CJ and Gilden DH. Ramsay Hunt syndrome. Journal of neurology, neurosurgery, and psychiatry. 2001;71:149-54.

3. Gaio E, Marioni G, de Filippis C, Tregnaghi A, Caltran S and Staffieri A. Facial nerve paralysis secondary to acute otitis media in infants and children. J Paediatr Child Health. 2004;40:483-6.

4. Habel A. Ueber Fortbestehen von Tic convulsif bei gleichseitiger Hemiplegie. Deutsche Med Wchnschr. 1898;24:189.

#141 The heat of the moment Jun 13, 2019

Things are heating up for BrainWaves this week as we explore an exciting new topic in our digital curriculum: Heat-related illness. From the causes to the manifestation of the various causes of hyperthermia which can ultimately lead to circulatory collapse. But don’t panic. It’s just a podcast.

Produced by James E. Siegler. Music courtesy of Ghost, John Bartmann, Kai Engel, and Marco Trovatello. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

**7 July 2019 update**

Much appreciated feedback from passionate listener Phoebe Duke (Spokane Falls Community College)! Whenever possible, submersion in cold water remains the most effective way to cool the body during heatstroke. Recommended by the AHA and other professional societies. Thanks for the input Phoebe! My

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Casa DJ, Armstrong LE, Kenny GP, O'Connor FG, Huggins RA. Exertional heat stroke: new concepts regarding cause and care. Curr Sports Med Rep 2012;11:115-123.
Wu X, Brady JE, Rosenberg H, Li G. Emergency Department Visits for Heat Stroke in the United States, 2009 and 2010. Inj Epidemiol 2014;1:8.
Al Mahri S, Bouchama A. Heatstroke. Handbook of clinical neurology 2018;157:531-545.
Morrison SF, Nakamura K. Central neural pathways for thermoregulation. Front Biosci (Landmark Ed) 2011;16:74-104.
Kenny GP, Wilson TE, Flouris AD, Fujii N. Heat exhaustion. Handbook of clinical neurology 2018;157:505-529.

#84 Neonatal abstinence syndrome Jun 06, 2019

The first wave of the opioid crisis began in 1991 when physicians began to overprescribe narcotic analgesics for pain. Eventually, addiction led to abuse and the fatality rates began to climb. In response, the US government cracked down on narcotic prescriptions--leading a surge in the price of medical grade opioids. By 2010, the cost of pharmacologic opiates was unaffordable, and users reverted back to the (now cheaper) alternative, heroin. 2013 marked the third wave of the opioid crisis, whereby synthetic, high-potency opiates like fentanyl and carfentanyl were being infused into other opiate products. With each wave, the world witnessed a spike in the number of opioid-related deaths, and thus far, our solutions have only led to new problems. But there is more to the opioid crisis than the effect of opioids on the voluntary user.

In 2017, we released a show highlighting the clinical consequences and management of opioid dependence on infants born to mothers who had used opioids during their pregnancy. This week, we have remastered the 2017 program and included an update at the end.

Produced by James E. Siegler. Music courtesy of Little Glass Men, Jason Shaw, and Chris Zabriskie. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

McQueen K and Murphy-Oikonen J. Neonatal Abstinence Syndrome. The New England journal of medicine. 2016;375:2468-2479.
Vlahov D, Des Jarlais DC, Goosby E, Hollinger PC, Lurie PG, Shriver MD and Strathdee SA. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. American journal of epidemiology. 2001;154:S70-7.
Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134:e547-61.
Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S and Alexander ER. Syringe exchange and risk of infection with hepatitis B and C viruses. American journal of epidemiology. 1999;149:203-13.
Wodak A and Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41:777-813.
Jarlenski M, Barry CL, Gollust S, Graves AJ, Kennedy-Hendricks A and Kozhimannil K. Polysubstance Use Among US Women of Reproductive Age Who Use Opioids for Nonmedical Reasons. Am J Public Health. 2017;107:1308-1310.
Hudak ML, Tan RC, Committee On D, Committee On F, Newborn and American Academy of P. Neonatal drug withdrawal. Pediatrics. 2012;129:e540-60.
Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM and Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004-2014. Pediatrics. 2018;141.
MacMillan KDL, Rendon CP, Verma K, Riblet N, Washer DB and Volpe Holmes A. Association of Rooming-in With Outcomes for Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis. JAMA Pediatr. 2018;172:345-351.
Gomez-Pomar E and Finnegan LP. The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its' Origins, Assessment, and Management. Front Pediatr. 2018;6:33.

#140 Of measles and men May 30, 2019

Since January 1, 2019, there have been nearly 900 confirmed US cases of measles across 24 states. This is 10 times greater than the number of cases in the US 3 years ago, and it is the largest outbreak the US has seen since 1994. The month of May also marks the first reported case of measles in the state of Pennsylvania, where BrainWaves is produced. So this week on the program, Jim Siegler speaks with Dr. Erika Mejia (pediatrician) about the medical and sociopolitical triggers for this outbreak, the misconceptions of the measles-mumps-rubella vaccine, and finally, what you can do to keep measles from "going viral"*.

Produced by James E. Siegler and Erika Mejia. Music courtesy of Advent Chamber Orchestra, Coldnoise, Josh Woodward, Kevin McLeod, and Lee Roosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Murch SH, Anthony A, Casson DH, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Valentine A, Davies SE and Walker-Smith JA. Retraction of an interpretation. Lancet. 2004;363:750.
Perry RT and Halsey NA. The clinical significance of measles: a review. The Journal of infectious diseases. 2004;189 Suppl 1:S4-16.
Campbell H, Andrews N, Brown KE and Miller E. Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol. 2007;36:1334-48.
Poland GA and Jacobson RM. The age-old struggle against the antivaccinationists. The New England journal of medicine. 2011;364:97-9.
Maglione MA, Das L, Raaen L, Smith A, Chari R, Newberry S, Shanman R, Perry T, Goetz MB and Gidengil C. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics. 2014;134:325-37.
Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016;170:1209-1215.
Bester JC. Not a matter of parental choice but of social justice obligation: Children are owed measles vaccination. Bioethics. 2018;32:611-619.
Fournet N, Mollema L, Ruijs WL, Harmsen IA, Keck F, Durand JY, Cunha MP, Wamsiedel M, Reis R, French J, Smit EG, Kitching A and van Steenbergen JE. Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews. BMC Public Health. 2018;18:196.
Trump’s tweet: https://twitter.com/realdonaldtrump/status/449525268529815552?lang=en

*Truth-be-told, measles claims the lives of 100,000 people around the globe every year. It has already gone viral. This was just a figure of speech.

#139 The DAWN of a new age for stroke treatment May 16, 2019

It would be an understatement to say that endovascular thrombectomy has revolutionized acute stroke management. As of 2018, the American Heart Association recommends treatment up to 24 hours after time last seen normal for select patients. This week on the BrainWaves podcast, Dr. Tudor Jovin--PI for the DAWN and REVASCAT clinical trials--summarizes the history of thrombectomy trials, and what it is about our current strategies that have breathed new life into a technique that has historically fizzled.

IF YOU'RE TAKING YOUR NEUROLOGY BOARDS, and not sure how to prepare, check out the 2019 Penn Neurology Board Review Course here [or here: https://upenn.cloud-cme.com/default.aspx?P=5&EID=54399]. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'.

Produced by James E. Siegler and Jesse Thon. Music courtesy of Cuicuitte, Coldnoise, Medyn, Jon Watts, Lee Rosevere, and Mystery Mammal. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Konstas AA, Goldmakher GV, Lee TY and Lev MH. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR American journal of neuroradiology. 2009;30:885-92.
Heit JJ and Wintermark M. Perfusion Computed Tomography for the Evaluation of Acute Ischemic Stroke: Strengths and Pitfalls. Stroke; a journal of cerebral circulation. 2016;47:1153-8.
Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Davalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millan M, Davis SM, Roy D, Thornton J, Roman LS, Ribo M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG and collaborators H. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723-31.
Gross BA, Jadhav AP, Jankowitz BT and Jovin TG. The Ongoing Revolution in Thrombectomy: Expanding Inclusion Criteria to Larger Cores. World Neurosurg. 2018;120:393-394.
Jadhav AP, Molyneaux BJ, Hill MD and Jovin TG. Care of the Post-Thrombectomy Patient. Stroke; a journal of cerebral circulation. 2018;49:2801-2807.
Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG and Investigators DT. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. The New England journal of medicine. 2018;378:11-21.
Campbell BCV, Majoie C, Albers GW, Menon BK, Yassi N, Sharma G, van Zwam WH, van Oostenbrugge RJ, Demchuk AM, Guillemin F, White P, Davalos A, van der Lugt A, Butcher KS, Cherifi A, Marquering HA, Cloud G, Macho Fernandez JM, Madigan J, Oppenheim C, Donnan GA, Roos Y, Shankar J, Lingsma H, Bonafe A, Raoult H, Hernandez-Perez M, Bharatha A, Jahan R, Jansen O, Richard S, Levy EI, Berkhemer OA, Soudant M, Aja L, Davis SM, Krings T, Tisserand M, San Roman L, Tomasello A, Beumer D, Brown S, Liebeskind DS, Bracard S, Muir KW, Dippel DWJ, Goyal M, Saver JL, Jovin TG, Hill MD, Mitchell PJ and collaborators H. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. The Lancet Neurology. 2019;18:46-55.
Roman LS, Menon BK, Blasco J, Hernandez-Perez M, Davalos A, Majoie C, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos Y, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M and collaborators H. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. The Lancet Neurology. 2018;17:895-904.

#138 A Gift from God: The neuroscience of Leonardo da Vinci May 02, 2019

Although he may never have attended university, Leonardo da Vinci (1452-1519) was a true scholar of the Renaissance. His contributions to civil and mechanical engineering, the creative arts, and natural philosophy are nothing short of extraordinary. Less well popularized--although of equal importance--were his accomplishments in the field of anatomy. This week on the BrainWaves Podcast, we delve into his discoveries, his methodology, his handedness, and the message he has left us with.

IF YOU'RE TAKING YOUR NEUROLOGY BOARDS, and not sure how to prepare, check out the 2019 Penn Neurology Board Review Course here [https://upenn.cloud-cme.com/default.aspx?P=5&EID=54399]. If Leonardo da Vinci had gone to school, he would have liked this course. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'.

Produced by James E. Siegler. Music courtesy of Sergey Chereminisov, Peter Rudenko, Fatal Injection, Andrew Sacco, Alavedra Montserrat, William McColl, and Joseph Levine. Sound effects by Mike Koenig, Mark DiAngelo, and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Keele KD. Leonardo da Vinci and anatomical demonstration. Med Biol Illus. 1952;2(4):226-232.
Keele KD. Leonardo da Vinci on vision. Proc R Soc Med. 1955;48(5):384-390.
Keele KD. Leonardo Da Vinci's Influence on Renaissance Anatomy. Med Hist. 1964;8:360-370.
Schott GD. Some neurological observations on Leonardo da Vinci's handwriting. Journal of the neurological sciences. 1979;42(3):321-329.
Pevsner J. Leonardo da Vinci's contributions to neuroscience. Trends Neurosci. 2002;25(4):217-220.
Bowen G, Gonzales J, Iwanaga J, et al. Leonardo da Vinci (1452-1519) and his depictions of the human spine. Childs Nerv Syst. 2017;33(12):2067-2070.
Pevsner J. Leonardo da Vinci's studies of the brain. Lancet. 2019;393(10179):1465-1472.
Leonardo da Vinci. Corpus of the anatomical studies in the collection of Her Majesty, the Queen, at Windsor Castle. (Clark K., and Pedretti, C., eds.), 39 Recto, Harcourt Brace Janovich.

#137 Neurologists as medical actuaries Apr 25, 2019

For patients who survive cardiopulmonary arrest, but do not wake up, neurologists are called to the bedside to prognosticate. And the question of 'How much will this patient recover?' is not unlike 'What is the benefit of aggressive therapy to await possible recovery?' In that way, you might consider neurologists to be the actuaries of hospital medicine. In this week's program, we review the clinical and diagnostic data that neurologists incorporate into their model for outcome prediction following anoxic brain injury.

IF YOU'RE TAKING YOUR NEUROLOGY BOARDS, and not sure how to prepare, check out the 2019 Penn Neurology Board Review Course at https://upenn.cloud-cme.com/default.aspx?P=5&EID=54399. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'.

Produced by James E. Siegler. Music courtesy of Swelling, Soft and Furious, Rafael Archangel, Lovira, and Dark Room. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Young GB. Clinical practice. Neurologic prognosis after cardiac arrest. The New England journal of medicine. 2009;361:605-11.
Sandroni C, Cariou A, Cavallaro F, Cronberg T, Friberg H, Hoedemaekers C, Horn J, Nolan JP, Rossetti AO and Soar J. Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Resuscitation. 2014;85:1779-89.
Sandroni C and D'Arrigo S. Neurologic Prognostication: Neurologic Examination and Current Guidelines. Semin Neurol. 2017;37:40-47.
Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Aneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Kober L, Langorgen J, Lilja G, Moller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H and Investigators TTMT. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. The New England journal of medicine. 2013;369:2197-206.
Seder DB. Management of Comatose Survivors of Cardiac Arrest. Continuum (Minneap Minn). 2018;24:1732-1752.
Booth CM, Boone RH, Tomlinson G and Detsky AS. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA : the journal of the American Medical Association. 2004;291:870-9.
Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, Leary M, Meurer WJ, Peberdy MA, Thompson TM and Zimmerman JL. Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:S465-82.
Jorgensen EO and Holm S. The natural course of neurological recovery following cardiopulmonary resuscitation. Resuscitation. 1998;36:111-22.
Seder DB, Sunde K, Rubertsson S, Mooney M, Stammet P, Riker RR, Kern KB, Unger B, Cronberg T, Dziodzio J, Nielsen N and International Cardiac Arrest R. Neurologic outcomes and postresuscitation care of patients with myoclonus following cardiac arrest. Critical care medicine. 2015;43:965-72.

#136 Iatrogenesis Apr 18, 2019

In medicine, less is more.

Sometimes.

In this week's program, Dr. Igor Rybinnik of the Rutgers Robert Wood Johnson Medical School shares what he's learned when it comes to overtreating patients.

IF YOU'RE TAKING YOUR NEUROLOGY BOARDS, and not sure how to prepare, check out the 2019 Penn Neurology Board Review Course here [https://upenn.cloud-cme.com/default.aspx?P=5&EID=54399]. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'.

Produced by James E. Siegler and Igor Ribynnik. Music courtesy of Chris Zabriskie, Kevin McLeod, Mystery Mammal, Hyson, Fabian Measures, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Silveira MJ, Kim SY and Langa KM. Advance directives and outcomes of surrogate decision making before death. The New England journal of medicine. 2010;362:1211-8.
Klaas PB, Berge KH, Klaas KM, Klaas JP and Larson AN. When patients are harmed, but are not wronged: ethics, law, and history. Mayo Clinic proceedings. 2014;89:1279-86.
DesRoches CM, Rao SR, Fromson JA, Birnbaum RJ, Iezzoni L, Vogeli C and Campbell EG. Physicians' perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues. JAMA : the journal of the American Medical Association. 2010;304:187-93.
Mohr JC. American medical malpractice litigation in historical perspective. JAMA : the journal of the American Medical Association. 2000;283:1731-7.
Coysh T and Breen DP. A nationwide analysis of successful litigation claims in neurological practice. JRSM Open. 2014;5:2042533313518914.

#26 Considerations in the management of women with epilepsy Apr 11, 2019

When it comes to managing patients with epilepsy, there isn't a one-size-fits-all approach. And it would be wrong to assume you could treat a woman the same way you would treat a man. There are a number of special considerations to keep in mind--especially birth control and pregnancy. Not to mention the increase risk of seizures during menses for some women.

In this week's program, we revisit one of the earliest shows we put together in 2016 on the special considerations when it comes to women with epilepsy. Dr. Danielle Becker--an epileptologist at Penn--joins Jim Siegler for the discussion.

Produced by James E. Siegler. Music courtesy of Josh Woodward. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

IF YOU'RE TAKING YOUR NEUROLOGY BOARDS, and not sure how to prepare, check out the 2019 Penn Neurology Board Review Course here [https://upenn.cloud-cme.com/default.aspx?P=5&EID=54399]. BrainWaves' listeners get $150 off their enrollment fee using the promo code 'WAVES2019'.

REFERENCES

Meador K, Reynolds MW, Crean S, Fahrbach K and Probst C. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008;81:1-13.
Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW and Neurodevelopmental Effects of Antiepileptic Drugs Study G. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014;168:729-36.
Veliskova J and Desantis KA. Sex and hormonal influences on seizures and epilepsy. Horm Behav. 2013;63:267-77.
Herzog AG, Fowler KM, Smithson SD, Kalayjian LA, Heck CN, Sperling MR, Liporace JD, Harden CL, Dworetzky BA, Pennell PB, Massaro JM and Progesterone Trial Study G. Progesterone vs placebo therapy for women with epilepsy: A randomized clinical trial. Neurology. 2012;78:1959-66.
Tauboll E, Sveberg L and Svalheim S. Interactions between hormones and epilepsy. Seizure. 2015;28:3-11.
Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia. 2005;46 Suppl 9:117-24.
Reiter SF, Bjork MH, Daltveit AK, Veiby G, Kolstad E, Engelsen BA and Gilhus NE. Life satisfaction in women with epilepsy during and after pregnancy. Epilepsy Behav. 2016;62:251-257.
Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Hauser WA, Wiebe S, Gronseth GS, Thurman D, Meador KJ, Koppel BS, Kaplan PW, Robinson JN, Gidal B, Hovinga CA, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Le Guen C, American Academy of N and American Epilepsy S. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73:126-32.

#135 Brain food Apr 04, 2019

A low salt diet can reduce your risk of hypertension. A low carb diet can reduce your risk of diabetes. But is there a diet out there which can lower your risk of neurologic disease? Specifically, dementia? The answer is...maybe?

This week on the program we work our way up the food chain describing the vital micronutrients, food groups, and fad diets out there which may promote brain health--and could even lower your risk of dementia. Sit back, grab some blueberries, and enjoy!

Produced by James E. Siegler. Music courtesy of Axeltree, Chris Zabriskie, John Pazdan, Josh Woodward, Kevin McLeod, and Pachyderm. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Kennedy DO, Wightman EL, Reay JL, Lietz G, Okello EJ, Wilde A and Haskell CF. Effects of resveratrol on cerebral blood flow variables and cognitive performance in humans: a double-blind, placebo-controlled, crossover investigation. Am J Clin Nutr. 2010;91:1590-7.
Devore EE, Kang JH, Breteler MM and Grodstein F. Dietary intakes of berries and flavonoids in relation to cognitive decline. Annals of neurology. 2012;72:135-43.
Norton S, Matthews FE, Barnes DE, Yaffe K and Brayne C. Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. The Lancet Neurology. 2014;13:788-94.
Morris MC, Tangney CC, Wang Y, Sacks FM, Barnes LL, Bennett DA and Aggarwal NT. MIND diet slows cognitive decline with aging. Alzheimers Dement. 2015;11:1015-22.
Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martinez-Gonzalez MA, Martinez-Lapiscina EH, Fito M, Perez-Heras A, Salas-Salvado J, Estruch R and Ros E. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA internal medicine. 2015;175:1094-1103.
Newman JC, Covarrubias AJ, Zhao M, Yu X, Gut P, Ng CP, Huang Y, Haldar S and Verdin E. Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice. Cell Metab. 2017;26:547-557 e8.
Miller MG, Hamilton DA, Joseph JA and Shukitt-Hale B. Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial. Eur J Nutr. 2018;57:1169-1180.
Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmuller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM and consortium O. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. The Lancet Neurology. 2018;17:671-680.
Radd-Vagenas S, Duffy SL, Naismith SL, Brew BJ, Flood VM and Fiatarone Singh MA. Effect of the Mediterranean diet on cognition and brain morphology and function: a systematic review of randomized controlled trials. Am J Clin Nutr. 2018;107:389-404.
Xu W, Wang H, Wan Y, Tan C, Li J, Tan L and Yu JT. Alcohol consumption and dementia risk: a dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2017;32:31-42.
Lefevre-Arbogast S, Gaudout D, Bensalem J, Letenneur L, Dartigues JF, Hejblum BP, Feart C, Delcourt C and Samieri C. Pattern of polyphenol intake and the long-term risk of dementia in older persons. Neurology. 2018;90:e1979-e1988.
Liu QP, Wu YF, Cheng HY, Xia T, Ding H, Wang H, Wang ZM and Xu Y. Habitual coffee consumption and risk of cognitive decline/dementia: A systematic review and meta-analysis of prospective cohort studies. Nutrition. 2016;32:628-36.

#134 Myotonia Mar 21, 2019

Nobody is getting any younger. Which is too bad. Muscle cramping...fatigue...stiffness... you'll be dealing with it more and more. 'It's probably nothing,' you tell yourself. But what if it's not? Every once in a while, you might come across a case of myotonia. And you won't want to miss it. This week on BrainWaves, Dr. Noah Levinson provides a brief overview to myotonia and the conditions that are associated with it.

Produced by James E. Siegler. Music courtesy of Yshwa, Steve Combs, MMFFF, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Miller TM. Differential diagnosis of myotonic disorders. Muscle Nerve. 2008;37:293-9.
Sansone VA. The Dystrophic and Nondystrophic Myotonias. Continuum (Minneap Minn). 2016;22:1889-1915.
Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmuller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM and consortium O. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. The Lancet Neurology. 2018;17:671-680.
Thornton CA, Wang E and Carrell EM. Myotonic dystrophy: approach to therapy. Curr Opin Genet Dev. 2017;44:135-140.

#54 To thymectomize or Not to thymectomize...That is the question Mar 14, 2019

In 2016, we heard the results of the MGTX trial--a pivotal investigation that demonstrated the efficacy of thymectomy for select patients with non-thymomatous myasthenia gravis. This spring, we saw the long-term follow-up data from the MGTX investigators. In this week's re-run, we summarize these data, critique it, and reflect on how it may change clinical practice.

Produced by James E. Siegler. Music courtesy of Scott Holmes and Lee Rosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, Marx A, et al. Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the mgtx randomised trial. The Lancet. Neurology. 2019;18:259-268
Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, Marx A, et al. Randomized trial of thymectomy in myasthenia gravis. The New England journal of medicine. 2016;375:511-522
Blalock A, Harvey AM, Ford FR, Lilienthal JL. The treatment of myasthenia gravis by removal of the thymus gland. JAMA : the journal of the American Medical Association. 1941;117:1529-1533
Oosterhuis HJ. Observations of the natural history of myasthenia gravis and the effect of thymectomy. Ann N Y Acad Sci. 1981;377:678-690

#133 The sacred disease Mar 07, 2019

Before it was called epilepsy, it was a falling sickness. A disturbance of consciousness summoned by magic or demonic possession. Although it is less of a mystery today, the Sacred Disease is one neurological condition that continues to pique our curiosity. Join us as we recount the fascinating history of this mystical malady.

Produced by James E. Siegler. Music courtesy of Alavedra Montserrat, Joseph Levine, and William McColl, Damiano Baldoni, Kai Engel, Kevin McLeod, Rafael Archangel, and Unheard Music Concepts. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Temkin O. The Falling Sickness: A history of epilepsy from the Greeks to the beginnings of modern neurology, 2nd ed. Baltimore: The Johns Hopkins Press, 1971.
Pierce JMS. Disease Once Sacred: A history of the medical understanding of epilepsy. Brain. 2002;125:441-2.

#132 Teaching through clinical cases: Chasing the dragon Feb 21, 2019

Heroin was originally marketed as a cough suppressant in 1898. (Obviously, people have discovered more uses for it since then.) One hundred years later, it has paved the way for a worldwide drug abuse epidemic. Dr. Mike Rubenstein presents this week's clinical case of a very particular type of heroin use and a rare form of neurotoxicity.

Produced by James E. Siegler and Mike Rubenstein. Music courtesy of Heftone Banjo Orchestra, John Bartmann, Kai Engel, and Soft and Furious. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Kriegstein AR, Armitage BA and Kim PY. Heroin inhalation and progressive spongiform leukoencephalopathy. The New England journal of medicine. 1997;336:589-90.
Alambyan V, Pace J, Miller B, Cohen ML, Gokhale S, Singh G, Shun MC, Hammond A and Ramos-Estebanez C. The Emerging Role of Inhaled Heroin in the Opioid Epidemic: A Review. JAMA Neurol. 2018;75:1423-1434.
Wolters EC, van Wijngaarden GK, Stam FC, Rengelink H, Lousberg RJ, Schipper ME and Verbeeten B. Leucoencephalopathy after inhaling "heroin" pyrolysate. Lancet. 1982;2:1233-7.
Kriegstein AR, Shungu DC, Millar WS, Armitage BA, Brust JC, Chillrud S, Goldman J and Lynch T. Leukoencephalopathy and raised brain lactate from heroin vapor inhalation ("chasing the dragon"). Neurology. 1999;53:1765-73.

#131 Organ transplantation part 2: Non-infectious neurologic complications Feb 13, 2019

In the second half of our two-part series on complications of organ transplantation, Dr. Raj Dhar (Neurocritical Care, Washington University in St. Louis) discusses his experience managing the non-infectious complications of organ transplantation--from drug toxicities to multi-disciplinary medical care.

Produced by James E. Siegler and Raj Dhar. Music by Steve Combs, Lee Rosevere, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Senzolo M, Ferronato C and Burra P. Neurologic complications after solid organ transplantation. Transpl Int. 2009;22:269-78.
Dhar R. Neurologic complications of transplantation. Handbook of clinical neurology. 2017;141:545-572.
Mateen FJ, Dierkhising RA, Rabinstein AA, van de Beek D and Wijdicks EF. Neurological complications following adult lung transplantation. Am J Transplant. 2010;10:908-14.
Munoz P, Valerio M, Palomo J, Fernandez-Yanez J, Fernandez-Cruz A, Guinea J and Bouza E. Infectious and non-infectious neurologic complications in heart transplant recipients. Medicine (Baltimore). 2010;89:166-75.
Wu Q, Marescaux C, Wolff V, Jeung MY, Kessler R, Lauer V and Chen Y. Tacrolimus-associated posterior reversible encephalopathy syndrome after solid organ transplantation. Eur Neurol. 2010;64:169-77.
Dhar R, Young GB and Marotta P. Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy. Neurocritical care. 2008;8:253-8.

#130 Organ transplantation part 1: Neuroinfectious complications Jan 31, 2019

There is no question that organ transplantation has saved thousands of lives in recent years from fatal conditions. And over time, we've become more and more successful at maintaining the integrity of the graft and increasing longevity of organ transplant recipients. Despite these advances in transplant medicine, it is not an entirely risk-free process. In part 1 of this 2-part series of the BrainWaves podcast, Jim Siegler speaks with Dr. Linda Zhou about the neuroinfectious complications that threaten these patients.

Produced by James E. Siegler and Linda Zhou. Music by Jason Shaw, Josh Woodward, and Lee Rosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Pruitt AA. Central Nervous System Infections Complicating Immunosuppression and Transplantation. Continuum (Minneap Minn). 2018;24:1370-1396.
Dhar R. Neurologic complications of transplantation. Handbook of clinical neurology. 2017;141:545-572.
Salovin A, Glanzman J, Roslin K, Armangue T, Lynch DR and Panzer JA. Anti-NMDA receptor encephalitis and nonencephalitic HSV-1 infection. Neurol Neuroimmunol Neuroinflamm. 2018;5:e458.
Srinivasan A, Burton EC, Kuehnert MJ, Rupprecht C, Sutker WL, Ksiazek TG, Paddock CD, Guarner J, Shieh WJ, Goldsmith C, Hanlon CA, Zoretic J, Fischbach B, Niezgoda M, El-Feky WH, Orciari L, Sanchez EQ, Likos A, Klintmalm GB, Cardo D, LeDuc J, Chamberland ME, Jernigan DB, Zaki SR and Rabies in Transplant Recipients Investigation T. Transmission of rabies virus from an organ donor to four transplant recipients. The New England journal of medicine. 2005;352:1103-11.
Vora NM, Basavaraju SV, Feldman KA, Paddock CD, Orciari L, Gitterman S, Griese S, Wallace RM, Said M, Blau DM, Selvaggi G, Velasco-Villa A, Ritter J, Yager P, Kresch A, Niezgoda M, Blanton J, Stosor V, Falta EM, Lyon GM, 3rd, Zembower T, Kuzmina N, Rohatgi PK, Recuenco S, Zaki S, Damon I, Franka R, Kuehnert MJ and Transplant-Associated Rabies Virus Transmission Investigation T. Raccoon rabies virus variant transmission through solid organ transplantation. JAMA : the journal of the American Medical Association. 2013;310:398-407.
Fischer SA, Lu K and Practice ASTIDCo. Screening of donor and recipient in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:9-21.

#36 Teaching through clinical cases: Acute vestibular syndrome Jan 24, 2019

In 2016, Dr. Ali Hamedani summarized the basic principles underlying a neurologic evaluation for acute dizziness--the acute vestibular syndrome. We've remastered the prior show, and added in a few new factoids for ya in this 2019 remake. Enjoy!

Produced by James E. Siegler. Music courtesy of John Bartman and Kevin McLeod. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

1. Kerber KA. Acute constant dizziness. Continuum (Minneap Minn). 2012;18:1041-59.

2. Lempert T. Vestibular migraine. Semin Neurol. 2013;33:212-8.

3. Kim JS and Zee DS. Clinical practice. Benign paroxysmal positional vertigo. The New England journal of medicine. 2014;370:1138-47.

4. Kattah JC, Talkad AV, Wang DZ, Hsieh YH and Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke; a journal of cerebral circulation. 2009;40:3504-10.

#129 Neurologic complications of pregnancy Jan 17, 2019

For such an thrilling time in a woman's life, pregnancy can be a frightening experience for some. As a physician, I'm always a little more on edge when dealing with these patients. This week on BrainWaves, Dr. Jonathan Edlow (Emergency Medicine) of Beth Israel Deaconness Medical Center shares his experience in treating neuromedical complications in this unique patient population.

Produced by Jonathan Edlow and James E. Siegler. Music by Daniel Birch, Ian Southerland, Kevin McLeod, and John Bartmann. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Edlow JA, Caplan LR, O'Brien K and Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. The Lancet Neurology. 2013;12:175-85.
Edlow AG, Edlow BL and Edlow JA. Diagnosis of Acute Neurologic Emergencies in Pregnant and Postpartum Women. Emerg Med Clin North Am. 2016;34:943-965.
Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ and Park AL. Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes. JAMA : the journal of the American Medical Association. 2016;316:952-61.
Chen MM, Coakley FV, Kaimal A and Laros RK, Jr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstetrics and gynecology. 2008;112:333-40.
Kranick SM, Mowry EM, Colcher A, Horn S and Golbe LI. Movement disorders and pregnancy: a review of the literature. Mov Disord. 2010;25:665-71.

#128 Teaching through Clinical Cases: Thrombophilia testing Jan 03, 2019

For young patients who have no reason to clot, it's good to know which diagnostic tests you should send, when you should send them, and how they can be erroneously interpreted. Dr. Kristy Yuan, a vascular neurologist from the University of Pennsylvania, summarizes her approach in this week's clinical case.

Produced by James E. Siegler and Kristy Yuan. Music by Chris Zabriskie, How the Night Came, Doctor Turtle, and Swelling. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

1. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC and Moores L. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149:315-352.

2. Ho WK, Hankey GJ, Quinlan DJ and Eikelboom JW. Risk of recurrent venous thromboembolism in patients with common thrombophilia: a systematic review. Archives of internal medicine. 2006;166:729-36.

3. Cohn DM, Vansenne F, de Borgie CA and Middeldorp S. Thrombophilia testing for prevention of recurrent venous thromboembolism. The Cochrane database of systematic reviews. 2012;12:CD007069.

4. Connors JM. Thrombophilia Testing and Venous Thrombosis. The New England journal of medicine. 2017;377:1177-1187.

5. Garcia D and Erkan D. Diagnosis and Management of the Antiphospholipid Syndrome. The New England journal of medicine. 2018;378:2010-2021.

6. Mintzer DM, Billet SN and Chmielewski L. Drug-induced hematologic syndromes. Adv Hematol. 2009;2009:495863.

#57 Neurostimulants part 1: CAFFEINE! Dec 27, 2018

As I'm sitting in a coffee shop in upstate New York this holiday season, procrastinating on the various papers that need writing, bills that need paying, and Christmas cards that need writing, I can't help but feel comforted by the warm relief of a cup of coffee. The rich aroma and jolting heat which come with the promise of productivity. There's nothing like it. So before resigning to my post-holiday to-do list, I thought I would start the day off re-mastering a prior show we put out in 2017 on the neuroscience behind your morning mocha. Enjoy!

Produced by James E. Siegler. Music by Andy Cohen and Little Glass Men. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

1. Nawrot P, Jordan S, Eastwood J, Rotstein J, Hugenholtz A, Feeley M. Effects of caffeine on human health. Food Addit Contam. 2003;20:1-30

2. Ferre S. An update on the mechanisms of the psychostimulant effects of caffeine. J Neurochem. 2008;105:1067-1079

3. Park CA, Kang CK, Son YD, Choi EJ, Kim SH, Oh ST, et al. The effects of caffeine ingestion on cortical areas: Functional imaging study. Magn Reson Imaging. 2014;32:366-371

4. Martin ED, Buno W. Caffeine-mediated presynaptic long-term potentiation in hippocampal ca1 pyramidal neurons. J Neurophysiol. 2003;89:3029-3038

5. Ribeiro JA, Sebastiao AM. Caffeine and adenosine. J Alzheimers Dis. 2010;20 Suppl 1:S3-15 6. Pelchovitz DJ, Goldberger JJ. Caffeine and cardiac arrhythmias: A review of the evidence. The American journal of medicine. 2011;124:284-289

#127 HD part 2: Current and emerging therapeutics Dec 20, 2018

This week, part 2 of our 2-part primer on Huntington Disease. Treatment. From tried-and-true therapies to the latest-and-greatest compounds being studied in clinical trials. Enjoy!

Produced by James E. Siegler and Stephen Aradi. Music by Mike Durek, Jesse Spillane, Lee Rosevere, Jason Shaw and Dr. Turtle. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Claassen DO, Carroll B, De Boer LM, Wu E, Ayyagari R, Gandhi S and Stamler D. Indirect tolerability comparison of Deutetrabenazine and Tetrabenazine for Huntington disease. J Clin Mov Disord. 2017;4:3.
Paulsen JS, Nehl C, Hoth KF, Kanz JE, Benjamin M, Conybeare R, McDowell B and Turner B. Depression and stages of Huntington's disease. J Neuropsychiatry Clin Neurosci. 2005;17:496-502.
Bates GP, Dorsey R, Gusella JF, Hayden MR, Kay C, Leavitt BR, Nance M, Ross CA, Scahill RI, Wetzel R, Wild EJ and Tabrizi SJ. Huntington disease. Nat Rev Dis Primers. 2015;1:15005.

Quanta: Lessons learned from Dr. Kinnier Wilson (1878-1937) Dec 13, 2018

Want to make a name for yourself? Declare yourself chief of something. Or chief of many things, as Dr. S. A. Kinnier Wilson did. This week on the podcast, we commemorate his legacy and his commitment to neurology.

Produced by James E. Siegler. Music by Chris Zabriskie and Mystery Mammal. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

S. A. Kinnier Wilson (1878-1937) Lenticular-hepatic degeneration. JAMA : the journal of the American Medical Association. 1968;205:871-2.
Compston A. Progressive lenticular degeneration: a familial nervous disease associated with cirrhosis of the liver, by S. A. Kinnier Wilson, (From the National Hospital, and the Laboratory of the National Hospital, Queen Square, London) Brain 1912: 34; 295-509. Brain. 2009;132:1997-2001.
Trocello JM, Broussolle E, Girardot-Tinant N, Pelosse M, Lachaux A, Lloyd C and Woimant F. Wilson's disease, 100 years later. Rev Neurol (Paris). 2013;169:936-43.
Walshe JM. History of Wilson disease: a personal account. Handbook of clinical neurology. 2017;142:1-5.

#126 HD part 1: Differential diagnosis and clinical features Dec 06, 2018

You may be able to recognize chorea. But what does it make you think of besides Huntington Disease? In this two part series, we'll cover the clinical manifestations, differential diagnosis, and management of Huntington Disease. In part 1, Dr. Travis Lewis (University of Pennsylvania) creates a framework for hyperkinetic movement disorders and HD. Part 2 will focus on the current and future therapeutics of this neurodegenerative condition.

Produced by Travis Lewis & James E. Siegler. Music by Azevedo Silva, Chris Zabriskie, Cullah, John Bartmann, and Nuno Adelaida. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Bates GP, Dorsey R, Gusella JF, Hayden MR, Kay C, Leavitt BR, Nance M, Ross CA, Scahill RI, Wetzel R, Wild EJ and Tabrizi SJ. Huntington disease. Nat Rev Dis Primers. 2015;1:15005.
Wild EJ and Tabrizi SJ. The differential diagnosis of chorea. Pract Neurol. 2007;7:360-73.
Walker RH. Chorea. Continuum (Minneap Minn). 2013;19:1242-63.
Reilmann R, Leavitt BR and Ross CA. Diagnostic criteria for Huntington's disease based on natural history. Mov Disord. 2014;29:1335-41.
Ghosh R and Tabrizi SJ. Huntington disease. Handbook of clinical neurology. 2018;147:255-278.

#125 No pressure Nov 22, 2018

Of the "reversible" causes of dementia, normal pressure hydrocephalus (NPH) may be the most controversial. But there is something to be said about how surgical intervention alters the physiology of patients who present with gait impairment, ventriculomegaly, and normal CSF pressure. This week on the show, we discuss the clinical features and the controversy behind this diagnosis.

Produced by James E. Siegler. Music by Ghost, Jon Watts, Julie Maxwell, Komiku, and Kevin McLeod. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Relkin N, Marmarou A, Klinge P, Bergsneider M and Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57:S4-16; discussion ii-v.
Gallia GL, Rigamonti D and Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nat Clin Pract Neurol. 2006;2:375-81.
Klassen BT and Ahlskog JE. Normal pressure hydrocephalus: how often does the diagnosis hold water? Neurology. 2011;77:1119-25.
Williams MA and Relkin NR. Diagnosis and management of idiopathic normal-pressure hydrocephalus. Neurol Clin Pract. 2013;3:375-385.
Kazui H, Miyajima M, Mori E, Ishikawa M and Investigators S-. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. The Lancet Neurology. 2015;14:585-94.

#124 Ethics of urine toxicology screening Nov 08, 2018

A patient comes into the emergency department. They've got a headache. You get some basic labs, a chest x-ray, a CT scan. And then you get a drug screen. But does this information even help you? And could it hurt the patient?

This week on the BrainWaves podcast, Dr. Emily Rosenthal shares her experience with Dr. Kelley Humbert on the ethics of toxicology "screening" and how she manages patients with a substance use disorder.

Produced by Emily Rosenthal, Kelley Humbert, and Jim Siegler. Music by Montplaisir, Lee Rosevere, and Kevin McLeod. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Bates GP, Dorsey R, Gusella JF, Hayden MR, Kay C, Leavitt BR, Nance M, Ross CA, Scahill RI, Wetzel R, Wild EJ and Tabrizi SJ. Huntington disease. Nat Rev Dis Primers. 2015;1:15005.
Silver B, Miller D, Jankowski M, Murshed N, Garcia P, Penstone P, Straub M, Logan SP, Sinha A, Morris DC, Katramados A, Russman AN, Mitsias PD and Schultz LR. Urine toxicology screening in an urban stroke and TIA population. Neurology. 2013;80:1702-9.
Eisen JS, Sivilotti ML, Boyd KU, Barton DG, Fortier CJ and Collier CP. Screening urine for drugs of abuse in the emergency department: do test results affect physicians' patient care decisions? CJEM. 2004;6:104-11.
Smith PC, Schmidt SM, Allensworth-Davies D and Saitz R. A single-question screening test for drug use in primary care. Archives of internal medicine. 2010;170:1155-60.
Lager PS, Attema-de Jonge ME, Gorzeman MP, Kerkvliet LE and Franssen EJF. Clinical value of drugs of abuse point of care testing in an emergency department setting. Toxicol Rep. 2018;5:12-17.
Tenenbein M. Do you really need that emergency drug screen? Clin Toxicol (Phila). 2009;47:286-91.
Jones HE, Kaltenbach K, Heil SH, Stine SM, Coyle MG, Arria AM, O'Grady KE, Selby P, Martin PR and Fischer G. Neonatal abstinence syndrome after methadone or buprenorphine exposure. The New England journal of medicine. 2010;363:2320-31.

#123 Things you should know about gadolinium Oct 25, 2018

Every time you order an MRI with contrast, you should think to yourself, "Why do I need contrast?"

Then, "If I need contrast, what are the risks?" This week, a show all about the risks of routine neuroimaging.

Produced by James E. Siegler. Music by Little Glass Men, Loyalty Freak Music, and Kevin McLeod. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

McDonald RJ, McDonald JS, Kallmes DF, Jentoft ME, Murray DL, Thielen KR, Williamson EE and Eckel LJ. Intracranial Gadolinium Deposition after Contrast-enhanced MR Imaging. Radiology. 2015;275:772-82.
Rogosnitzky M and Branch S. Gadolinium-based contrast agent toxicity: a review of known and proposed mechanisms. Biometals. 2016;29:365-76.
Pullicino R, Radon M, Biswas S, Bhojak M and Das K. A Review of the Current Evidence on Gadolinium Deposition in the Brain. Clin Neuroradiol. 2018;28:159-169.

Quanta: Foot drop Oct 18, 2018

What do gardeners and snow skiers have in common? Well, besides the fact that both tend to enjoy the outdoors, it turns out they are also at an increased risk of peripheral nerve injury. This week on the podcast, we review the anatomy and pathophysiology of several of the most common sites of nerve damage in the lower extremity.

Produced by James E. Siegler. Music by Lee Rosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Stewart JD. Foot drop: where, why and what to do? Pract Neurol. 2008;8:158-69.
Baima J and Krivickas L. Evaluation and treatment of peroneal neuropathy. Curr Rev Musculoskelet Med. 2008;1:147-53.
Marciniak C. Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates. Phys Med Rehabil Clin N Am. 2013;24:121-37.

#122 I wonder: Bias in clinical research Oct 11, 2018

As the name suggests, "evidence-based medicine" is dependent on published evidence to support our clinical practice and medical decision making. Implicit in this is the notion that all published evidence reflects the truth that underlies the biology, pathophysiology, and pharmacology of our health.

This is not the case.

Clinical research and published findings can be extremely limited, and what you read in Lancet and NEJM should be interpreted with caution. In this week's episode of the "I wonder" series, where Jim Siegler speaks with Ali Hamedani on various topics in medicine and neurology, the speakers review the major biases inherent to the practice and interpretation of clinical research.

Produced by James E. Siegler. Music by Jahzzar, Kai Engel, and Lee Rosevere. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet. 1988;2:349-60.
Smith GC and Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. Bmj. 2003;327:1459-61.
Kazui H, Miyajima M, Mori E, Ishikawa M and Investigators S-. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. The Lancet Neurology. 2015;14:585-94.
Montalban X, Hauser SL, Kappos L, Arnold DL, Bar-Or A, Comi G, de Seze J, Giovannoni G, Hartung HP, Hemmer B, Lublin F, Rammohan KW, Selmaj K, Traboulsee A, Sauter A, Masterman D, Fontoura P, Belachew S, Garren H, Mairon N, Chin P, Wolinsky JS and Investigators OC. Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis. The New England journal of medicine. 2017;376:209-220.

#49 Intro to CSF analysis Oct 04, 2018

There is nothing mysterious about the chemistry of the cerebrospinal fluid. Cells. Protein. Glucose. But the interplay of these unique components can give you incredible insight into the state of the central nervous system. This week, we revisit a prior episode where Dr. Mike Rubenstein reviews his approach to interpreting CSF results. And then we have an update at the end regarding recent advances in CSF analysis.

Produced by James E. Siegler and Michael Rubenstein. Music by Steve Combs. Sound effects by Mike Koenig, Daniel Simion. Voiceover by Patrick Green (German). BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. If you like what you hear, let us know and rate the show!

REFERENCES

1. Frederiks JA and Koehler PJ. The first lumbar puncture. J Hist Neurosci. 1997;6:147-53.

2. Seehusen DA, Reeves MM and Fomin DA. Cerebrospinal fluid analysis. Am Fam Physician. 2003;68:1103-8.

3. Shah KH and Edlow JA. Distinguishing traumatic lumbar puncture from true subarachnoid hemorrhage. J Emerg Med. 2002;23:67-74.

4. Deisenhammer F, Bartos A, Egg R, Gilhus NE, Giovannoni G, Rauer S, Sellebjerg F and Force ET. Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2006;13:913-22.

5. Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Hausler M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, Brown WD, Terborg C and Gilden DH. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology. 2008;70:853-60.

6. Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL and Dominguez SR. Acute flaccid myelitis: A clinical review of US cases 2012-2015. Annals of neurology. 2016;80:326-38.

#121 Pain in the eye Sep 27, 2018

When is eye pain an ophthalmological issue, and when is it a neurological issue? This week, neuro-ophthalmologist and glaucoma specialist Dr. Ahmara Ross simplifies ocular pain for the day-to-day neurologist.

Produced by James E. Siegler and Ahmara Ross. Music by Yan Terrien, Unheard Music Concepts, Steve Combs, and Scott Holmes. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Fiore DC, Pasternak AV and Radwan RM. Pain in the quiet (not red) eye. Am Fam Physician. 2010;82:69-73.
Lee AG, Al-Zubidi N, Beaver HA and Brazis PW. An update on eye pain for the neurologist. Neurol Clin. 2014;32:489-505.
Waldman CW, Waldman SD and Waldman RA. A practical approach to ocular pain for the non-ophthalmologist. Pain Manag. 2014;4:413-26.
Friedman DI. The Eye and Headache. Continuum (Minneap Minn). 2015;21:1109-17.

Quanta: The TOLEDO trial Sep 20, 2018

Apomorphine has a more than 20 year history as a therapeutic adjunct in the management of idiopathic Parkinson Disease. And yet, no randomized, placebo-controlled clinical trial to show for it.

As of July 2018, now there is. In this week's episode of BrainWaves, Dr. Siegler discusses the relevance, the strengths, and the weaknesses of the recently published TOLEDO trial.

Produced by James E. Siegler. Music by Ondrosik and Rod Hamilton. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

1. Katzenschlager R, Poewe W, Rascol O, Trenkwalder C, Deuschl G, Chaudhuri KR, Henriksen T, van Laar T, Spivey K, Vel S, Staines H and Lees A. Apomorphine subcutaneous infusion in patients with Parkinson's disease with persistent motor fluctuations (TOLEDO): a multicentre, double-blind, randomised, placebo-controlled trial. The Lancet Neurology. 2018;17:749-759.

#120 Fungal brain disease Sep 13, 2018

In 2012, more than 13,000 Americans were inadvertently exposed to contaminated medical equipment, resulting in one of the largest fungal outbreaks in US history. Despite rapid mobilization by the CDC and FDA, 751 patients died from complications of fungal brain infections.

But this is more the exception than the rule when it comes to fungal infections of the central nervous system. This week on the BrainWaves podcast, we review the common (and uncommon) clinical, radiographic, and diagnostic features of fungal brain disease. Enjoy!

Produced by James E. Siegler. Music by Jahzzar, Swelling, The Insider, and Chris Zabriskie. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Kainer MA, Reagan DR, Nguyen DB, Wiese AD, Wise ME, Ward J, Park BJ, Kanago ML, Baumblatt J, Schaefer MK, Berger BE, Marder EP, Min JY, Dunn JR, Smith RM, Dreyzehner J, Jones TF and Tennessee Fungal Meningitis Investigation T. Fungal infections associated with contaminated methylprednisolone in Tennessee. The New England journal of medicine. 2012;367:2194-203.
Smith RM, Schaefer MK, Kainer MA, Wise M, Finks J, Duwve J, Fontaine E, Chu A, Carothers B, Reilly A, Fiedler J, Wiese AD, Feaster C, Gibson L, Griese S, Purfield A, Cleveland AA, Benedict K, Harris JR, Brandt ME, Blau D, Jernigan J, Weber JT, Park BJ and Multistate Fungal Infection Outbreak Response T. Fungal infections associated with contaminated methylprednisolone injections. The New England journal of medicine. 2013;369:1598-609.
McCotter OZ, Smith RM, Westercamp M, Kerkering TM, Malani AN, Latham R, Peglow SL, Mody RK, Pappas PG and Chiller TM. Update on Multistate Outbreak of Fungal Infections Associated with Contaminated Methylprednisolone Injections, 2012-2014. MMWR Morbidity and mortality weekly report. 2015;64:1200-1.
Schwartz S, Kontoyiannis DP, Harrison T and Ruhnke M. Advances in the diagnosis and treatment of fungal infections of the CNS. The Lancet Neurology. 2018;17:362-372.
Benedict K and Park BJ. Invasive fungal infections after natural disasters. Emerg Infect Dis. 2014;20:349-55.
Brouwer MC, Tunkel AR, McKhann GM, 2nd and van de Beek D. Brain abscess. The New England journal of medicine. 2014;371:447-56.
Wilson MR, O'Donovan BD, Gelfand JM, Sample HA, Chow FC, Betjemann JP, Shah MP, Richie MB, Gorman MP, Hajj-Ali RA, Calabrese LH, Zorn KC, Chow ED, Greenlee JE, Blum JH, Green G, Khan LM, Banerji D, Langelier C, Bryson-Cahn C, Harrington W, Lingappa JR, Shanbhag NM, Green AJ, Brew BJ, Soldatos A, Strnad L, Doernberg SB, Jay CA, Douglas V, Josephson SA and DeRisi JL. Chronic Meningitis Investigated via Metagenomic Next-Generation Sequencing. JAMA Neurol. 2018.
Baddley JW, Salzman D and Pappas PG. Fungal brain abscess in transplant recipients: epidemiologic, microbiologic, and clinical features. Clin Transplant. 2002;16:419-24.

#119 Say WHAT? Aug 30, 2018

The sudden onset of vertigo can turn your world upside down. Literally. "I felt like I was going to die," Mike said, as it was happening to him. This week on the show, a patient (and a neurologist) recounts his experience with an acute neurologic syndrome, and its long-term consequences.

Produced by James E. Siegler and Michael Rubenstein. Music by Axletree, Chris Zabriskie, Heftone Banjo Orchestra, and Lee Rosevere. Sound effects by Mike Koenig, Daniel Simion. Voiceover by Dr. Ali Hamedani. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Lee H, Sohn SI, Jung DK, Cho YW, Lim JG, Yi SD, Lee SR, Sohn CH and Baloh RW. Sudden deafness and anterior inferior cerebellar artery infarction. Stroke; a journal of cerebral circulation. 2002;33:2807-12.
Baloh RW. Clinical practice. Vestibular neuritis. The New England journal of medicine. 2003;348:1027-32.
Lee H, Kim JS, Chung EJ, Yi HA, Chung IS, Lee SR and Shin JY. Infarction in the territory of anterior inferior cerebellar artery: spectrum of audiovestibular loss. Stroke; a journal of cerebral circulation. 2009;40:3745-51.
Kattah JC, Talkad AV, Wang DZ, Hsieh YH and Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke; a journal of cerebral circulation. 2009;40:3504-10.
Beyea JA, Agrawal SK and Parnes LS. Recent advances in viral inner ear disorders. Curr Opin Otolaryngol Head Neck Surg. 2012;20:404-8.

#13 The broken heart syndrome Aug 23, 2018

When the heart stops working, the brain stops working. But if the brain stops working, does the heart shut down? In this episode, Dr. David Manly (Duke Cardiology) discusses the pathogenesis and management of the reversible syndromes of neurogenic stress cardiomyopathy. In full disclosure, this is a re-mastered re-run of a prior episode posted June 29, 2016. With some updates at the end.

Produced by James E. Siegler. Music by Lee Rosevere. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

1. Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation. 2008;118:397-409

2. Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008;5:22-29

3. Paur H, Wright PT, Sikkel MB, Tranter MH, Mansfield C, O'Gara P, et al. High levels of circulating epinephrine trigger apical cardiodepression in a beta2-adrenergic receptor/gi-dependent manner: A new model of takotsubo cardiomyopathy. Circulation. 2012;126:697-706

4. Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, et al. Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA : the journal of the American Medical Association. 2011;306:277-286

5. Banki NM, Kopelnik A, Dae MW, Miss J, Tung P, Lawton MT, et al. Acute neurocardiogenic injury after subarachnoid hemorrhage. Circulation. 2005;112:3314-3319

6. Yoshimura S, Toyoda K, Ohara T, Nagasawa H, Ohtani N, Kuwashiro T, et al. Takotsubo cardiomyopathy in acute ischemic stroke. Annals of neurology. 2008;64:547-554

7. Grabowski A, Kilian J, Strank C, Cieslinski G, Meyding-Lamade U. Takotsubo cardiomyopathy--a rare cause of cardioembolic stroke. Cerebrovascular diseases. 2007;24:146-148

8. Finsterer J, Wahbi K. Cns-disease affecting the heart: Brain-heart disorders. Journal of the neurological sciences. 2014;345:8-14

9. Stiermaier T, Moeller C, Oehler K, Desch S, Graf T, Eitel C, Vonthein R, Schuler G, Thiele H and Eitel I. Long-term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences. European journal of heart failure. 2016;18:650-6.

#118 Subcortical kinds of cortical signs Aug 16, 2018

Lesion localization is a critical skill for any neurologist. The so-called "cortical signs" are symptoms or exam findings which are often associated with cortical neuron injury--aphasia, neglect, gaze preference. But they are also seen after injury to subcortical structures, including white matter tracts, the thalamus, and basal ganglia. In this week's installment of the BrainWaves podcast, we'll attempt to localize subcortical lesions based on these major cortical signs.

Produced by James E. Siegler. Music by Aussenseiter, Gnagno, Yshwa, and Kevin McLeod. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Maeshima S and Osawa A. Thalamic Lesions and Aphasia or Neglect. Current neurology and neuroscience reports. 2018;18:39.
Bogousslavsky J, Regli F and Uske A. Thalamic infarcts: clinical syndromes, etiology, and prognosis. Neurology. 1988;38:837-48.
Karnath HO, Himmelbach M and Rorden C. The subcortical anatomy of human spatial neglect: putamen, caudate nucleus and pulvinar. Brain. 2002;125:350-60.
Lam YW and Sherman SM. Functional organization of the thalamic input to the thalamic reticular nucleus. J Neurosci. 2011;31:6791-9.
Tijssen CC. Contralateral conjugate eye deviation in acute supratentorial lesions. Stroke; a journal of cerebral circulation. 1994;25:1516-9.
Fridriksson J, den Ouden DB, Hillis AE, Hickok G, Rorden C, Basilakos A, Yourganov G and Bonilha L. Anatomy of aphasia revisited. Brain. 2018. Epub ahead of print.
Nadeau SE and Crosson B. Subcortical aphasia. Brain Lang. 1997;58:355-402; discussion 418-23.

#117 Top-down visual processing: From photoreceptors to grandmother neurons Aug 02, 2018

How visual information transforms from pixels into people is more complex than dots becoming lines, lines becoming shapes, and shapes becoming faces. Your brain makes assumptions about all kinds of sensory information--even without you knowing it. Dr. Geoffrey Aguirre, a neuroscientist who specializes in vision processing, explains how we know what we can't really explain.

Produced by James E. Siegler & Geoff Aguirre. Music by Cullah, Jon Watts, Lovira, Loyalty Freak Music, and Scott Holmes. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Thompson P. Margaret Thatcher: a new illusion. Perception. 1980;9:483-4.
Psalta L, Young AW, Thompson P and Andrews TJ. The Thatcher illusion reveals orientation dependence in brain regions involved in processing facial expressions. Psychol Sci. 2014;25:128-36.

#116 Pain in the neck Jul 19, 2018

Some have estimated the annual cost of chronic back or neck pain in the US to exceed $200 billion per year. And the economic burden is almost as unbearable as the pain faced by patients. This week on the program, we discuss the clinical and radiographic aspects of structural spine disease--or spondylosis--and expert recommendations on how to manage it.

Produced by James E. Siegler. Music by Steve Combs and Scott Holmes. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making, especially not for back surgery.

REFERENCES

Baron EM and Young WF. Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery. 2007;60:S35-41.
Stino AM and LoRusso SJ. Myelopathies Due to Structural Cervical and Thoracic Disease. Continuum (Minneap Minn). 2018;24:567-583.
Rindler RS, Chokshi FH, Malcolm JG, Eshraghi SR, Mossa-Basha M, Chu JK, Kurpad SN and Ahmad FU. Spinal Diffusion Tensor Imaging in Evaluation of Preoperative and Postoperative Severity of Cervical Spondylotic Myelopathy: Systematic Review of Literature. World Neurosurg. 2017;99:150-158.
Witiw CD, Tetreault LA, Smieliauskas F, Kopjar B, Massicotte EM and Fehlings MG. Surgery for degenerative cervical myelopathy: a patient-centered quality of life and health economic evaluation. Spine J. 2017;17:15-25.
Farrokhi MR, Ghaffarpasand F, Khani M and Gholami M. An Evidence-Based Stepwise Surgical Approach to Cervical Spondylotic Myelopathy: A Narrative Review of the Current Literature. World Neurosurg. 2016;94:97-110.

#23 Autoimmune and paraneoplastic limbic encephalitis Jul 12, 2018

It seems like a new antibody in autoimmune central nervous system disorders is being discovered every day. Well, maybe not that frequently. But autoimmune encephalitis may now be as common as infectious encephalitis. In this week's program, we revisit an episode from 2016 where Dr. Ramani Balu (neurocritical care) shares his experience in evaluating and managing patients with these conditions.

Produced by James E. Siegler. Music by Three Chain Links, Lee Rosevere, and Kevin McLeod. Sound effects by Mike Koenig. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

1. Anderson NE and Barber PA. Limbic encephalitis - a review. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2008;15:961-71.

2. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J and Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012;79:1094-100.

3. Lancaster E, Martinez-Hernandez E and Dalmau J. Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology. 2011;77:179-89.

4. Rosenfeld MR and Dalmau JO. Paraneoplastic disorders of the CNS and autoimmune synaptic encephalitis. Continuum (Minneap Minn). 2012;18:366-83.

5. Titulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F and Dalmau J. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. The Lancet Neurology. 2013;12:157-65.

6. Irani SR, Michell AW, Lang B, Pettingill P, Waters P, Johnson MR, Schott JM, Armstrong RJ, A SZ, Bleasel A, Somerville ER, Smith SM and Vincent A. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Annals of neurology. 2011;69:892-900.

7. Dubey D, Pittock SJ, Kelly CR, McKeon A, Lopez-Chiriboga AS, Lennon VA, Gadoth A, Smith CY, Bryant SC, Klein CJ, Aksamit AJ, Toledano M, Boeve BF, Tillema JM and Flanagan EP. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Annals of neurology. 2018;83:166-177.

#115 Novel immunotherapies in demyelinating disease Jul 05, 2018

In 2017, neuroimmunology experts revised the criteria with which we diagnose multiple sclerosis, they encouraged more aggressive treatment, and now they have introduced novel therapeutic agents into our pharmacologic armamentarium. Dr. Christopher Perrone explains how these newer agents work and how effective they are in patients with demyelinating disease.

Produced by James E. Siegler. Music by Steve Combs, Pachyderm, and Lee Rosevere. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Hauser SL, Bar-Or A, Comi G, Giovannoni G, Hartung HP, Hemmer B, Lublin F, Montalban X, Rammohan KW, Selmaj K, Traboulsee A, Wolinsky JS, Arnold DL, Klingelschmitt G, Masterman D, Fontoura P, Belachew S, Chin P, Mairon N, Garren H, Kappos L, Opera I and Investigators OIC. Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis. The New England journal of medicine. 2017;376:221-234.
Hauser SL, Waubant E, Arnold DL, Vollmer T, Antel J, Fox RJ, Bar-Or A, Panzara M, Sarkar N, Agarwal S, Langer-Gould A, Smith CH and Group HT. B-cell depletion with rituximab in relapsing-remitting multiple sclerosis. The New England journal of medicine. 2008;358:676-88.
Hemmer B, Nessler S, Zhou D, Kieseier B and Hartung HP. Immunopathogenesis and immunotherapy of multiple sclerosis. Nat Clin Pract Neurol. 2006;2:201-11.
Montalban X, Hauser SL, Kappos L, Arnold DL, Bar-Or A, Comi G, de Seze J, Giovannoni G, Hartung HP, Hemmer B, Lublin F, Rammohan KW, Selmaj K, Traboulsee A, Sauter A, Masterman D, Fontoura P, Belachew S, Garren H, Mairon N, Chin P, Wolinsky JS and Investigators OC. Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis. The New England journal of medicine. 2017;376:209-220.
Selter RC and Hemmer B. Update on immunopathogenesis and immunotherapy in multiple sclerosis. Immunotargets Ther. 2013;2:21-30.
Maloney DG, Grillo-Lopez AJ, White CA, Bodkin D, Schilder RJ, Neidhart JA, Janakiraman N, Foon KA, Liles TM, Dallaire BK, Wey K, Royston I, Davis T and Levy R. IDEC-C2B8 (Rituximab) anti-CD20 monoclonal antibody therapy in patients with relapsed low-grade non-Hodgkin's lymphoma. Blood. 1997;90:2188-95.

#114 Madness Jun 28, 2018

That's what the Greeks called it. Madness. In Sanskrit, the term was rabhas, which meant "to do violence". Later, Latin and English translations would give us the present day term for it.

Rabies.

Dr. Krista Rieckert (veterinary medicine) comments on this example of a neurotropic virus that infects humans and animals alike.

Produced by James E. Siegler. Music by Ars Sonor, Cold Noise, Damiano Baldoni, Kevin MacLeod, US Army Old Guard and Drum Corps, and Ghost. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. If you're bitten by a wild animal (or a domestic one), talk to your doctor.

REFERENCES

Baer GM. Rabies--an historical perspective. Infect Agents Dis. 1994;3:168-80.
Co SJ, Mackenzie IR and Shewchuk JR. Rabies encephalitis. Radiographics. 2015;35:235-8.
Hemachudha T, Ugolini G, Wacharapluesadee S, Sungkarat W, Shuangshoti S and Laothamatas J. Human rabies: neuropathogenesis, diagnosis, and management. The Lancet Neurology. 2013;12:498-513.
Anderson LJ, Nicholson KG, Tauxe RV and Winkler WG. Human rabies in the United States, 1960 to 1979: epidemiology, diagnosis, and prevention. Annals of internal medicine. 1984;100:728-35.

#113 Teaching through clinical cases: Hypoactive delirium & antipsychotics Jun 21, 2018

This week's clinical case features a complex course of hospital-acquired delirium with an in-depth discussion on antipsychotics. Dr. Ayyappan Venkatraman reviews the pertinent psychopharmacology in dopaminergic and non-dopaminergic signaling.

Produced by James E. Siegler. Music by Unheard Music Concepts, Kevin McLeod, Lee Rosevere, and Steve Combs. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. For more information, check out http://brainwaves.me/.

REFERENCES

O'Keeffe ST and Lavan JN. Clinical significance of delirium subtypes in older people. Age and ageing. 1999;28:115-9.
Lacasse H, Perreault MM and Williamson DR. Systematic review of antipsychotics for the treatment of hospital-associated delirium in medically or surgically ill patients. Ann Pharmacother. 2006;40:1966-73.
Jeste DV and Caligiuri MP. Tardive dyskinesia. Schizophr Bull. 1993;19:303-15.

#112 Optic neuritis Jun 14, 2018

As a pupil of neurology and medicine, I feel like it is my responsibility to cover this topic at least once on the podcast. This topic came to me in a vision. But not one of phosphenes or impaired stereopsis--both of which we'll cover today. This week, we're discussing inflammation of the optic nerve, from the historical aspects to current concepts. And while you're listening, there's no need to lash out at my puns. You can stop rolling your eyes now.

Produced by James E. Siegler. Music by Lee Rosevere, Kevin McLeod, Steve Combs, and Unheard Music Concepts. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Balcer LJ. Clinical practice. Optic neuritis. The New England journal of medicine. 2006;354:1273-80.
Volpe NJ. Optic neuritis: historical aspects. J Neuroophthalmol. 2001;21:302-9.
Hickman SJ, Dalton CM, Miller DH and Plant GT. Management of acute optic neuritis. Lancet. 2002;360:1953-62.
O'Doherty M and Flitcroft DI. An unusual presentation of optic neuritis and the Pulfrich phenomenon. Journal of neurology, neurosurgery, and psychiatry. 2007;78:906-7.
Liu GT, Volpe NJ and Galetta SL. Neuro-Ophthalmology: Diagnosis and Management, 2nd Ed.: Elsevier; 2010.
Beck RW, Cleary PA, Anderson MM, Jr., Keltner JL, Shults WT, Kaufman DI, Buckley EG, Corbett JJ, Kupersmith MJ, Miller NR and et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. The New England journal of medicine. 1992;326:581-8.
Toosy AT, Mason DF and Miller DH. Optic neuritis. The Lancet Neurology. 2014;13:83-99.

#111 Depression and dementia…and everything in-between Jun 07, 2018

Depression and dementia are unfortunately two very common disorders in mental health. But the fact that they occur together is not explained by their overall prevalence. The relationship is a bit more complicated. Joan Dietz joins Jim Siegler in a discussion on how she counters these common conditions.

Produced by James E. Siegler. Music by Lee Rosevere, Jason Shaw, Chris Zabriskie, Kai Engel, and Scott Holmes. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Byers AL and Yaffe K. Depression and risk of developing dementia. Nature reviews Neurology. 2011;7:323-31.
Korczyn AD and Halperin I. Depression and dementia. Journal of the neurological sciences. 2009;283:139-42.
Alexopoulos GS, Murphy CF, Gunning-Dixon FM, Latoussakis V, Kanellopoulos D, Klimstra S, Lim KO and Hoptman MJ. Microstructural white matter abnormalities and remission of geriatric depression. Am J Psychiatry. 2008;165:238-44.
Dotson VM, Beydoun MA and Zonderman AB. Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment. Neurology. 2010;75:27-34.
Saczynski JS, Beiser A, Seshadri S, Auerbach S, Wolf PA and Au R. Depressive symptoms and risk of dementia: the Framingham Heart Study. Neurology. 2010;75:35-41.
Lee CW, Lin CL, Sung FC, Liang JA and Kao CH. Antidepressant treatment and risk of dementia: a population-based, retrospective case-control study. J Clin Psychiatry. 2016;77:117-22; quiz 122.
Sachdev PS, Smith JS, Angus-Lepan H and Rodriguez P. Pseudodementia twelve years on. Journal of neurology, neurosurgery, and psychiatry. 1990;53:254-9.

#110 Teaching through clinical cases: Hemorrhagic infarction May 31, 2018

Unfortunately, stroke is all too common. Nearly 1 million new strokes are diagnosed in the US each year. And this means that complications of stroke--even if rare--may also be common. One such complication is hemorrhagic transformation. This week, Dr. Ava Liberman reviews a clinical case of hemorrhage following ischemic stroke.

Produced by James E. Siegler. Music by Ghost, Kevin McLeod, and Scott Holmes. Voiceover by David Manly. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jimenez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, American Heart Association Council on E, Prevention Statistics C and Stroke Statistics S. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018;137:e67-e492.
Frontera JA, Lewin JJ, 3rd, Rabinstein AA, Aisiku IP, Alexandrov AW, Cook AM, del Zoppo GJ, Kumar MA, Peerschke EI, Stiefel MF, Teitelbaum JS, Wartenberg KE and Zerfoss CL. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocritical care. 2016;24:6-46.
Prabhakaran S, Gupta R, Ouyang B, John S, Temes RE, Mohammad Y, Lee VH and Bleck TP. Acute brain infarcts after spontaneous intracerebral hemorrhage: a diffusion-weighted imaging study. Stroke; a journal of cerebral circulation. 2010;41:89-94.

#14 Anti-epileptic drug-drug interactions May 24, 2018

Unfortunately, many patients with epilepsy fail their first trial of an anti-seizure medication. A large proportion of these patients are put on a second agent...or a third. But is more necessarily better?

Produced by James E. Siegler. Music by Justin Warren and Lee Rosevere. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol. 2006;61:246-255
Pennell PB, Newport DJ, Stowe ZN, Helmers SL, Montgomery JQ, Henry TR. The impact of pregnancy and childbirth on the metabolism of lamotrigine. Neurology. 2004;62:292-295
Petrenaite V, Sabers A, Hansen-Schwartz J. Individual changes in lamotrigine plasma concentrations during pregnancy. Epilepsy Res. 2005;65:185-188
Pennell PB, Peng L, Newport DJ, Ritchie JC, Koganti A, Holley DK, et al. Lamotrigine in pregnancy: Clearance, therapeutic drug monitoring, and seizure frequency. Neurology. 2008;70:2130-2136

Quanta: TNK-ing to the next level May 20, 2018

It's the age of thrombectomy. The DAWN of a new era. But should we give up on intravenous thrombolysis for acute ischemic stroke? In this installment of the Quanta series (typically shorter episodes, this one happens to be 19 min...), we review the latest data on fibrinolytic agents and anticipate the upcoming paradigm shift in the management of patients with cerebral infarction.

Produced by James E. Siegler. Music by Hyson and Jon Watts. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Assessment of the S, Efficacy of a New Thrombolytic I, Van De Werf F, Adgey J, Ardissino D, Armstrong PW, Aylward P, Barbash G, Betriu A, Binbrek AS, Califf R, Diaz R, Fanebust R, Fox K, Granger C, Heikkila J, Husted S, Jansky P, Langer A, Lupi E, Maseri A, Meyer J, Mlczoch J, Mocceti D, Myburgh D, Oto A, Paolasso E, Pehrsson K, Seabra-Gomes R, Soares-Piegas L, Sugrue D, Tendera M, Topol E, Toutouzas P, Vahanian A, Verheugt F, Wallentin L and White H. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Lancet. 1999;354:716-22.
Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, Yan B, Bush SJ, Dewey HM, Thijs V, Scroop R, Simpson M, Brooks M, Asadi H, Wu TY, Shah DG, Wijeratne T, Ang T, Miteff F, Levi CR, Rodrigues E, Zhao H, Salvaris P, Garcia-Esperon C, Bailey P, Rice H, de Villiers L, Brown H, Redmond K, Leggett D, Fink JN, Collecutt W, Wong AA, Muller C, Coulthard A, Mitchell K, Clouston J, Mahady K, Field D, Ma H, Phan TG, Chong W, Chandra RV, Slater LA, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Bladin CF, Sharma G, Desmond PM, Parsons MW, Donnan GA, Davis SM and Investigators E-IT. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. The New England journal of medicine. 2018;378:1573-1582.
Huang X, Cheripelli BK, Lloyd SM, Kalladka D, Moreton FC, Siddiqui A, Ford I and Muir KW. Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint study. The Lancet Neurology. 2015;14:368-76.
Logallo N, Novotny V, Assmus J, Kvistad CE, Alteheld L, Ronning OM, Thommessen B, Amthor KF, Ihle-Hansen H, Kurz M, Tobro H, Kaur K, Stankiewicz M, Carlsson M, Morsund A, Idicula T, Aamodt AH, Lund C, Naess H, Waje-Andreassen U and Thomassen L. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. The Lancet Neurology. 2017;16:781-788.
Parsons M, Spratt N, Bivard A, Campbell B, Chung K, Miteff F, O'Brien B, Bladin C, McElduff P, Allen C, Bateman G, Donnan G, Davis S and Levi C. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. The New England journal of medicine. 2012;366:1099-107.
Haley EC, Jr., Lyden PD, Johnston KC, Hemmen TM and Investigators TNKiS. A pilot dose-escalation safety study of tenecteplase in acute ischemic stroke. Stroke; a journal of cerebral circulation. 2005;36:607-12.
Haley EC, Jr., Thompson JL, Grotta JC, Lyden PD, Hemmen TG, Brown DL, Fanale C, Libman R, Kwiatkowski TG, Llinas RH, Levine SR, Johnston KC, Buchsbaum R, Levy G, Levin B and Tenecteplase in Stroke I. Phase IIB/III trial of tenecteplase in acute ischemic stroke: results of a prematurely terminated randomized clinical trial. Stroke; a journal of cerebral circulation. 2010;41:707-11.

#109 Misnomers in medicine: Low grade glioma May 17, 2018

The year 2016 marked the transition in an era of neuro-oncology from histologic-based diagnoses of primary brain tumors to a molecular and genetic classification system. Drs. Jorg Dietrich (neuro-oncology) and Brian Nahed (neurosurgery) of Massachusetts General Hospital discuss what the reclassification of primary glial neoplasms means for their patients.

Produced by James E. Siegler. Music by Lee Rosevere, Ian Sutherland, and Lovira. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Schiff D. Low-grade Gliomas. Continuum (Minneap Minn). 2017;23:1564-1579.
Wen PY and Huse JT. 2016 World Health Organization Classification of Central Nervous System Tumors. Continuum (Minneap Minn). 2017;23:1531-1547.
McGirt MJ, Chaichana KL, Attenello FJ, Weingart JD, Than K, Burger PC, Olivi A, Brem H and Quinones-Hinojosa A. Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery. 2008;63:700-7; author reply 707-8.
Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, Tihan T, Vandenberg S, McDermott MW and Berger MS. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008;26:1338-45.
Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR and Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2012;30:3065-70.

#108 Doctors die differently. Part 2: About face May 10, 2018

There is a nationwide epidemic happening right now. And it's not some terrible virus, it's not because of anything we've had to eat or drink. It is an occupational hazard of the hospital environment: Physician suicide. Dr. Pamela Wible, Founder of the Ideal Medical Care Movement, shares her unique approach to this preventable plague.

Produced by James E. Siegler. Music by Andrew Sacco, Damiano Baldoni, Kevin McLeod, Jason Shaw, and Rafael Archangel. Voiceover by Patrick Green. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Kesselheim AS and Austad KE. Residents: workers or students in the eyes of the law? The New England journal of medicine. 2011;364:697-9.
Witte TK, Fitzpatrick KK, Joiner TE, Jr. and Schmidt NB. Variability in suicidal ideation: a better predictor of suicide attempts than intensity or duration of ideation? J Affect Disord. 2005;88:131-6.
Goldman ML, Shah RN and Bernstein CA. Depression and suicide among physician trainees: recommendations for a national response. JAMA Psychiatry. 2015;72:411-2.
Schernhammer E. Taking their own lives -- the high rate of physician suicide. The New England journal of medicine. 2005;352:2473-6.
Schernhammer ES and Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004;161:2295-302.
Sen S, Kranzler HR, Krystal JH, Speller H, Chan G, Gelernter J and Guille C. A prospective cohort study investigating factors associated with depression during medical internship. Archives of general psychiatry. 2010;67:557-65.

#107 Doctors die differently. Part 1: Death be not proud May 03, 2018

It's not a personal goal of mine to live to be 100. I hope to live a long life--don't get me wrong--but I have no intention spending my final days in a hospital or a nursing home. There's nothing wrong with that, if that's what you want. And it turns out, more non-physician patients prefer this pathway toward dying than physician patients. Why is that?

Produced by James E. Siegler. Music by Andy Cohen, Lee Rosevere, Rui, and Unheard Music Concepts. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Matlock DD, Yamashita TE, Min SJ, Smith AK, Kelley AS and S MF. How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life. J Am Geriatr Soc. 2016;64:1061-7.
Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, Abella BS, Kleinman ME, Edelson DP, Berg RA, Aufderheide TP, Menon V, Leary M, Cpr Quality Summit Investigators tAHAECCC, the Council on Cardiopulmonary CCP and Resuscitation. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013;128:417-35.
Periyakoil VS, Neri E, Fong A and Kraemer H. Do unto others: doctors' personal end-of-life resuscitation preferences and their attitudes toward advance directives. PloS one. 2014;9:e98246.
Sandroni C, Nolan J, Cavallaro F and Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive care medicine. 2007;33:237-45.
Blecker S, Johnson NJ, Altekruse S and Horwitz LI. Association of Occupation as a Physician With Likelihood of Dying in a Hospital. JAMA : the journal of the American Medical Association. 2016;315:301-3.
Weissman JS, Cooper Z, Hyder JA, Lipsitz S, Jiang W, Zinner MJ and Prigerson HG. End-of-Life Care Intensity for Physicians, Lawyers, and the General Population. JAMA : the journal of the American Medical Association. 2016;315:303-5.

#106 What just happened? Apr 26, 2018

Forget what you did five minutes ago?

What if this happened every five minutes...for an entire day? In this week's program, Dr. Laura Mainardi shares her family's experience with a day that will never be forgotten. But never remembered.

Produced by James E. Siegler & Laura Mainardi-Villarino. Music by Pablo Pavan, Azevedo Silva, Montplaisir, and Kevin McLeod. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making.

REFERENCES

Arena JE and Rabinstein AA. Transient global amnesia. Mayo Clinic proceedings. 2015;90:264-72.
Hainselin M, Quinette P, Juskenaite A, Desgranges B, Martinaud O, de La Sayette V, Hannequin D, Viader F and Eustache F. Just do it! How performing an action enhances remembering in transient global amnesia. Cortex. 2014;50:192-9.
Noel A, Quinette P, Hainselin M, Dayan J, Viader F, Desgranges B and Eustache F. The Still Enigmatic Syndrome of Transient Global Amnesia: Interactions Between Neurological and Psychopathological Factors. Neuropsychol Rev. 2015;25:125-33.
Quinette P, Guillery-Girard B, Dayan J, de la Sayette V, Marquis S, Viader F, Desgranges B and Eustache F. What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases. Brain. 2006;129:1640-58.

#105 Like the sixth sense…only different: The legacy of Jules Cotard Apr 19, 2018

What do Shel Silverstein, Bruce Willis, and French philosophy have in common? At least one thing. This week on the BrainWaves podcast, the Cotard delusion, and the legacy of the neurologist who described it.

Produced by James E. Siegler. Music by Andrew Sacco, Damiano Baldoni, Squire Tuck, Montplaisir, and Rafael Archangel. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Pearn J and Gardner-Thorpe C. Jules Cotard (1840-1889): his life and the unique syndrome which bears his name. Neurology. 2002;58:1400-3.
Sahoo A and Josephs KA. A Neuropsychiatric Analysis of the Cotard Delusion. J Neuropsychiatry Clin Neurosci. 2018;30:58-65.

#104 Funny bone Apr 12, 2018

Ever hit your elbow in just the wrong spot, and you get that strange shooting sensation down your arm? Yep, that's your ulnar nerve. It's telling you to stop hitting yourself. But the elbow is not the only place where you can injure this particular peripheral nerve. Dr. Noah Levinson returns to the program this week to talk anatomy, pathology, and electrophysiology.

Produced by James E. Siegler. Music by Josh Woodward, Ian Southerland, Lee Rosevere, Milton Arias, and Unheard Music Concepts. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Shehab R and Mirabelli MH. Evaluation and diagnosis of wrist pain: a case-based approach. Am Fam Physician. 2013;87:568-73.
Koo YS, Cho CS and Kim BJ. Pitfalls in using electrophysiological studies to diagnose neuromuscular disorders. J Clin Neurol. 2012;8:1-14.
Landau ME and Campbell WW. Clinical features and electrodiagnosis of ulnar neuropathies. Phys Med Rehabil Clin N Am. 2013;24:49-66.

#103 The Machado-Joseph Disease Apr 05, 2018

The Machado-Joseph Disease, or spinocerebellar ataxia type 3, is one of the few eponyms in medicine whereby the disease is named after the patient and not the physician who originally described it. But someone else's name is missing from the eponym: Thomas. And the alternative title for the condition, "spinocerebellar ataxia," also happens to be a bit of a misnomer. In this week's installment of BrainWaves, we review the history and clinical manifestations of this movement disorder.

Produced by James E. Siegler. Music by Ian Southerland, Mike Durek, and Ondrosik. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Matilla T, McCall A, Subramony SH and Zoghbi HY. Molecular and clinical correlations in spinocerebellar ataxia type 3 and Machado-Joseph disease. Annals of neurology. 1995;38:68-72.
Pedroso JL, Franca MC, Braga-Neto P, D'Abreu A, Saraiva-Pereira ML, Saute JA, Teive HA, Caramelli P, Jardim LB, Lopes-Cendes I and Barsottini OGP. Nonmotor and extracerebellar features in Machado-Joseph disease: A review. Movement Disord. 2013;28:1200-1208.
Shakkottai VG and Fogel BL. Clinical neurogenetics: autosomal dominant spinocerebellar ataxia. Neurol Clin. 2013;31:987-1007.
Paulson HL. Dominantly inherited ataxias: lessons learned from Machado-Joseph disease/spinocerebellar ataxia type 3. Semin Neurol. 2007;27:133-42.
Ashizawa T and Xia G. Ataxia. Continuum (Minneap Minn). 2016;22:1208-26.
Rosenberg RN. Machado-Joseph disease: an autosomal dominant motor system degeneration. Mov Disord. 1992;7:193-203.

#102 April Fool's Day Special: Can't fool a functional MRI Mar 29, 2018

What does a brain look like in a patient with a functional movement disorder? Pretty normal, it turns out. But beneath the normal anatomy is a storm of aberrant signaling. Dr. Mark Hallett, Chief of the Human Motor Control Section of the NIH, describes the underlying neurophysiology in this spectrum of disorders.

Produced by James E. Siegler. Music by Damiano Baldoni, Kevin MacLeod, Ondrosik, and the Philadelphia String Quartet. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Maurer CW, LaFaver K, Ameli R, Epstein SA, Hallett M and Horovitz SG. Impaired self-agency in functional movement disorders: A resting-state fMRI study. Neurology. 2016;87:564-70.
Vuilleumier P, Chicherio C, Assal F, Schwartz S, Slosman D and Landis T. Functional neuroanatomical correlates of hysterical sensorimotor loss. Brain. 2001;124:1077-90.
Nahab FB, Kundu P, Gallea C, Kakareka J, Pursley R, Pohida T, Miletta N, Friedman J and Hallett M. The neural processes underlying self-agency. Cereb Cortex. 2011;21:48-55.

DISCLOSURES

Dr. Hallett receives funding from the Intramural program of the National Institute of Neurological Disorders and Stroke. No relevant conflicts of interest are present. He serves as Chair of the Medical Advisory Board for and receives honoraria and funding for travel from the Neurotoxin Institute. He may accrue revenue on US Patent: Immunotoxin (MAB-Ricin) for the treatment of focal movement disorders, and US Patent: Coil for Magnetic Stimulation and methods for using the same (H-coil); in relation to the latter, he has received license fee payments from the NIH (from Brainsway) for licensing of this patent. Supplemental research funds have been granted by BCN Peptides, S.A., for treatment studies of blepharospasm; Medtronics, Inc., for studies of deep brain stimulation; UniQure for a clinical trial of AAV2-GDNF for Parkinson Disease; Merz for treatment studies of focal hand dystonia; and Allergan for studies of methods to inject botulinum toxins. Jim is lucky enough to have no relevant competing financial interests.

#9 Teaching through clinical cases: Painless ophthalmoparesis Mar 22, 2018

This throwback Thursday, we revisit a high-yield discussion on diplopia, featuring Dr. Ali Hamedani. Ali navigates us through the orbit, brainstem, and midbrain as we discern the structural and physiological problems that can impede extra-ocular movements.

Produced by James E. Siegler. Music by Little Glass Men and Montplaisir. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

1. Liu GT, Volpe NJ and Galetta SL. Neuro-Ophthalmology: Diagnosis and Management. 2nd ed: Elsevier; 2010.

2. Cornblath WT. Diplopia due to ocular motor cranial neuropathies. Continuum (Minneap Minn). 2014;20:966-80.

3. Chiba A, Kusunoki S, Obata H, Machinami R and Kanazawa I. Serum anti-GQ1b IgG antibody is associated with ophthalmoplegia in Miller Fisher syndrome and Guillain-Barre syndrome: clinical and immunohistochemical studies. Neurology. 1993;43:1911-7.

4. L. DR and G. PS. Approach to orbital disorders and frequency of disease occurence: W. B. Saunders; 1994.

5. Sanders DB and Guptill JT. Myasthenia gravis and Lambert-Eaton myasthenic syndrome. Continuum (Minneap Minn). 2014;20:1413-25.

6. Brent GA. Clinical practice. Graves' disease. The New England journal of medicine. 2008;358:2594-605.

#101 Teaching through clinical cases: Infectious disease consultation Mar 15, 2018

A little fever can go a long way. In this week's installment of the Teaching through Clinical Cases series, Dr. Kathleen Murphy (infectious Disease) manages a healthy young man who presents with fever and his first seizure of life.

Produced by James E. Siegler and Kathleen Murphy. Music by Hyson, Jahzzar, and Josh Woodward. Voiceovers by Erika Mejia and Isa Smrstik. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, Harrison LH, Farley MM, Reingold A, Bennett NM, Craig AS, Schaffner W, Thomas A, Lewis MM, Scallan E, Schuchat A and Emerging Infections Programs N. Bacterial meningitis in the United States, 1998-2007. The New England journal of medicine. 2011;364:2016-25.
Sampathkumar P. West Nile virus: epidemiology, clinical presentation, diagnosis, and prevention. Mayo Clinic proceedings. 2003;78:1137-43; quiz 1144.
Takanashi J, Barkovich AJ, Yamaguchi K and Kohno Y. Influenza-associated encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum: a case report and literature review. AJNR American journal of neuroradiology. 2004;25:798-802.
Haktanir A. MR imaging in novel influenza A(H1N1)-associated meningoencephalitis. AJNR American journal of neuroradiology. 2010;31:394-5.
Iijima H, Wakasugi K, Ayabe M, Shoji H and Abe T. A case of adult influenza A virus-associated encephalitis: magnetic resonance imaging findings. J Neuroimaging. 2002;12:273-5.

#100 Mary Jane in your medicine? The effect of THC on seizure prevention Mar 08, 2018

Cigarettes can offset Parkinson Disease. Alcohol can reduce the risk of heart attack. Can the case be made that marijuana has health benefits too?

Produced by James E. Siegler. Music by Montplaisir and Kevin McLeod. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Or, if you're a patient with seizures, this doesn't mean you should start smoking pot now. Be smart.

REFERENCES

Brodie MJ and Ben-Menachem E. Cannabinoids for epilepsy: What do we know and where do we go? Epilepsia. 2017.
Cunha JM, Carlini EA, Pereira AE, Ramos OL, Pimentel C, Gagliardi R, Sanvito WL, Lander N and Mechoulam R. Chronic administration of cannabidiol to healthy volunteers and epileptic patients. Pharmacology. 1980;21:175-85.
Devinsky O, Cross JH, Laux L, Marsh E, Miller I, Nabbout R, Scheffer IE, Thiele EA, Wright S and Cannabidiol in Dravet Syndrome Study G. Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. The New England journal of medicine. 2017;376:2011-2020.
Maa E and Figi P. The case for medical marijuana in epilepsy. Epilepsia. 2014;55:783-6.

#99 Intro to dystonia Mar 01, 2018

Dystonia refers to a complex spectrum of disturbances in movement, and the differential diagnosis is even more complicated. But Drs. Andres Deik and David Coughlin make it simple. In this week's episode of the BrainWaves podcast, we'll run through the basics of a dystonia differential and approach to managing patients with these complex symptoms.

Produced by James E. Siegler and David Coughlin. Music by Lee Rosevere, Rui, and the Freeharmonic Orchestra. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

1. Skogseid IM. Dystonia–new advances in classification, genetics, pathophysiology and treatment. Acta Neurologica Scandinavica. 2014 Apr 1;129(s198):13-9.

2. Albanese A, Bhatia K, Bressman SB, DeLong MR, Fahn S, Fung VS, Hallett M, Jankovic J, Jinnah HA, Klein C, Lang AE. Phenomenology and classification of dystonia: a consensus update. Movement Disorders. 2013 Jun 15;28(7):863-73.

3. Albanese A, Barnes MP, Bhatia KP, Fernandez‐Alvarez E, Filippini G, Gasser T, Krauss JK, Newton A, Rektor I, Savoiardo M, Valls‐Solè J. A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS‐ES task force. European journal of neurology. 2006 May 1;13(5):433-44.

DISCLOSURES

Andres Deik has received consulting royalties from Adamas therapeutics, Teva pharmaceuticals, ITF Pharma, and Cynapsus Therapeutics. His research has been funded in part by Cynapsus therapeutics and The Dystonia Coalition. David Coughlin, like Jim Siegler, has no competing financial interests to disclose.

#98 ALS and the US military Feb 22, 2018

Risk factors for ALS: Family history, male sex, and serving in the US military? Dr. Colin Quinn shares his experience working with American veterans and summarizes the evidence for this unusual relationship.

Produced by James E. Siegler. Music by Jon Watts, Josh Woodward, Lee Rosevere, Unheard Music Concepts, and The United States Army Old Guard Fife and Drum Corps. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education and entertainment purposes only.

REFERENCES

Haley RW. Excess incidence of ALS in young Gulf War veterans. Neurology. 2003;61:750-6.
Kasarskis EJ, Lindquist JH, Coffman CJ, Grambow SC, Feussner JR, Allen KD, Oddone EZ, Kamins KA, Horner RD and Als Gulf War Clinical Review T. Clinical aspects of ALS in Gulf War veterans. Amyotroph Lateral Scler. 2009;10:35-41.
Al-Chalabi A and Hardiman O. The epidemiology of ALS: a conspiracy of genes, environment and time. Nature reviews Neurology. 2013;9:617-28.
Weisskopf MG, O'Reilly EJ, McCullough ML, Calle EE, Thun MJ, Cudkowicz M and Ascherio A. Prospective study of military service and mortality from ALS. Neurology. 2005;64:32-7.
Horner RD, Kamins KG, Feussner JR, Grambow SC, Hoff-Lindquist J, Harati Y, Mitsumoto H, Pascuzzi R, Spencer PS, Tim R, Howard D, Smith TC, Ryan MA, Coffman CJ and Kasarskis EJ. Occurrence of amyotrophic lateral sclerosis among Gulf War veterans. Neurology. 2003;61:742-9.

Quanta: Exam findings in dystonia Feb 19, 2018

Foot turning in when you walk? Hand cramping up when you write? It could just be you, or it could be a dystonia. History and exam findings in dystonia range from slight abnormalities in posturing to disabling tremors, but there are some clues that can help you identify this movement disorder. Drs. Andres Deik and David Coughlin share their experience in this week's brief episode.

Produced by James E. Siegler. Music by Little Glass Men and the Philadelphia String Quartet. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Albanese A, Bhatia K, Bressman SB, DeLong MR, Fahn S, Fung VS, Hallett M, Jankovic J, Jinnah HA, Klein C, Lang AE. Phenomenology and classification of dystonia: a consensus update. Movement Disorders. 2013 Jun 15;28(7):863-73.
Albanese A, Barnes MP, Bhatia KP, Fernandez‐Alvarez E, Filippini G, Gasser T, Krauss JK, Newton A, Rektor I, Savoiardo M, Valls‐Solè J. A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS‐ES task force. European journal of neurology. 2006 May 1;13(5):433-44.

DISCLOSURES

#97 What is so idiopathic about transverse myelitis? Feb 15, 2018

We've abused the term, 'idiopathic.' Not all clinical conditions have to have an unclear cause. More and more, we are finding out the answers. This week, using transverse myelitis as an example, Dr. Clyde Markowitz shares his experience in working up unknown etiologies of spinal cord inflammation.

Produced by James E. Siegler. Music by Quantum Jazz, Rui, and Steve Combs. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Zalewski NL, Flanagan EP and Keegan BM. Evaluation of idiopathic transverse myelitis revealing specific myelopathy diagnoses. Neurology. 2018;90:e96-e102.
Bevan CJ and Cree BA. Fulminant Demyelinating Diseases of the Central Nervous System. Semin Neurol. 2015;35:656-66.
Greenberg BM and Frohman EM. Immune-mediated myelopathies. Continuum (Minneap Minn). 2015;21:121-31.
Kimbrough DJ, Mealy MA, Simpson A and Levy M. Predictors of recurrence following an initial episode of transverse myelitis. Neurol Neuroimmunol Neuroinflamm. 2014;1:e4.
Cobo Calvo A, Mane Martinez MA, Alentorn-Palau A, Bruna Escuer J, Romero Pinel L and Martinez-Yelamos S. Idiopathic acute transverse myelitis: outcome and conversion to multiple sclerosis in a large series. BMC Neurol. 2013;13:135.
Jacob A and Weinshenker BG. An approach to the diagnosis of acute transverse myelitis. Semin Neurol. 2008;28:105-20.

#96 Teaching through clinical cases: The unconscious patient Feb 08, 2018

Even as a medical professional, it can throw you off to be out in public and find someone acutely unresponsive. It's not like being in the hospital. There are no crash carts, no nursing support, no diagnostic tests. Just you and whatever you have around you. So, what can you do? This week, Dr. Ramani Balu discusses the first 5 minutes of this assessment, with a little twist. You're stuck on an airplane.

Produced by James E. Siegler. Music by Andrew Sacco, Ars Sonor, Chris Zabriskie, Lee Rosevere, and Fabian Measures. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. It's just for fun. Remember fun?

REFERENCES

Gendreau MA and DeJohn C. Responding to medical events during commercial airline flights. The New England journal of medicine. 2002;346:1067-73.
Nable JV, Tupe CL, Gehle BD and Brady WJ. In-Flight Medical Emergencies during Commercial Travel. The New England journal of medicine. 2015;373:939-45.
Silverman D and Gendreau M. Medical issues associated with commercial flights. Lancet. 2009;373:2067-77.

#95 Teaching through clinical cases: A headache that won't give up Feb 01, 2018

Mike Rubenstein, from prior episodes on global health and CSF interpretation, returns to discuss the case of a patient with recurrent headaches. But this time he uses big words. Take a listen.

Produced by James E. Siegler. Music by Mystery Mammal, Lee Rosevere, Unheard Music Concepts, and Greg Atkinson. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making.

REFERENCES

Dodick DW. Clinical practice. Chronic daily headache. The New England journal of medicine. 2006;354:158-65.
Halker RB, Hastriter EV and Dodick DW. Chronic daily headache: an evidence-based and systematic approach to a challenging problem. Neurology. 2011;76:S37-43.
Bigal ME and Lipton RB. The differential diagnosis of chronic daily headaches: an algorithm-based approach. J Headache Pain. 2007;8:263-72.
Silberstein SD and Lipton RB. Chronic daily headache. Curr Opin Neurol. 2000;13:277-83.
Pareja JA, Antonaci F and Vincent M. The hemicrania continua diagnosis. Cephalalgia. 2001;21:940-6.
Prakash S and Patell R. Paroxysmal hemicrania: an update. Curr Pain Headache Rep. 2014;18:407.
Goadsby PJ. Trigeminal autonomic cephalalgias. Continuum (Minneap Minn). 2012;18:883-95.

#94 Resident burnout: Discovering The Cortical Ribbon Jan 25, 2018

We expose our soft spot this week on the show. Lindsay Raab and John Best join Jim Siegler in the studio to discuss their own personal struggles with residency and patient care, and how they've battled hard to overcome them.

Produced by John Best and Lindsay Raab. Senior producer, Jim Siegler. Music by Daniel Birch, Little Glass Men, The New Valleys, Rod Hamilton, Chris Zabriskie, and Jon Watts. Voiceovers by David Manly, Erika Mejia, and Pat Green. BrainWaves' podcasts and online content are intended for medical education only. If you're in healthcare and feeling burnt out, maybe this episode will be insightful. But please do not misconstrue this as advice.

REFERENCES

1. Thomas NK. Resident burnout. JAMA : the journal of the American Medical Association. 2004;292:2880-9.

Quanta: 2017 update to the McDonald criteria for diagnosing MS Jan 22, 2018

Did anyone else catch the recent update to the diagnostic criteria for multiple sclerosis? Me neither. Hopefully this episode will catch you up on it.

Produced by James E. Siegler. Music by Daniel Birch and Chris Zabriskie. The BrainWaves' podcast and online content are intended for medical education and entertainment purposes only.

REFERENCES

Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B and Wolinsky JS. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Annals of neurology. 2011;69:292-302.
Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, Correale J, Fazekas F, Filippi M, Freedman MS, Fujihara K, Galetta SL, Hartung HP, Kappos L, Lublin FD, Marrie RA, Miller AE, Miller DH, Montalban X, Mowry EM, Sorensen PS, Tintore M, Traboulsee AL, Trojano M, Uitdehaag BMJ, Vukusic S, Waubant E, Weinshenker BG, Reingold SC and Cohen JA. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. The Lancet Neurology. 2017.

#93 Aspirin vs. Plavix: The showdown Jan 18, 2018

When it comes to stroke, treatment is dependent on the stroke mechanism. But most patients wind up on aspirin anyway. Or Plavix (clopidogrel). And sometimes both. The question this week is, Why? Hope you're hungry for some fruit. We're comparing a bunch of apples to oranges in this episode of the BrainWaves podcast.

Produced by James E. Siegler. Music by William Ross Chernoff's Nomads, Steve Combs, Rui, Little Glass Men, and Peter Rudenko. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making. Even if this episode is all about choosing aspirin or clopidogrel when you're treating stroke patients. Always talk with your doctor, and if you are a doctor, you should rely on institutional policies and your own clinical judgment when treating patients.

REFERENCES

Jauch EC, Saver JL, Adams HP, Jr., Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW, Jr., Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H, American Heart Association Stroke C, Council on Cardiovascular N, Council on Peripheral Vascular D and Council on Clinical C. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2013;44:870-947.
The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet. 1997;349:1569-81.
CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet. 1997;349:1641-9.
Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM and Investigators F. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. The Lancet Neurology. 2007;6:961-9.
Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC and Investigators C. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. The New England journal of medicine. 2013;369:11-9.
Hong KS, Lee SH, Kim EG, Cho KH, Chang DI, Rha JH, Bae HJ, Lee KB, Kim DE, Park JM, Kim HY, Cha JK, Yu KH, Lee YS, Lee SJ, Choi JC, Cho YJ, Kwon SU, Kim GM, Sohn SI, Park KY, Kang DW, Sohn CH, Lee J, Yoon BW and Investigators C. Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke: Clopidogrel Plus Aspirin Versus Aspirin Alone. Stroke; a journal of cerebral circulation. 2016;47:2323-30.
Liu L, Wong KS, Leng X, Pu Y, Wang Y, Jing J, Zou X, Pan Y, Wang A, Meng X, Wang C, Zhao X, Soo Y, Johnston SC, Wang Y and Investigators C. Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE. Neurology. 2015;85:1154-62.
Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. Bmj. 1994;308:81-106.
Antithrombotic Trialists C. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Bmj. 2002;324:71-86.
Committee CS. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348:1329-39.
Ringleb PA, Bhatt DL, Hirsch AT, Topol EJ, Hacke W and Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events I. Benefit of clopidogrel over aspirin is amplified in patients with a history of ischemic events. Stroke; a journal of cerebral circulation. 2004;35:528-32.
Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ and investigators M. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331-7.
Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, Cacoub P, Cohen EA, Creager MA, Easton JD, Flather MD, Haffner SM, Hamm CW, Hankey GJ, Johnston SC, Mak KH, Mas JL, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Brennan DM, Fabry-Ribaudo L, Booth J, Topol EJ and Investigators C. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. The New England journal of medicine. 2006;354:1706-17.
Rothwell PM, Price JF, Fowkes FG, Zanchetti A, Roncaglioni MC, Tognoni G, Lee R, Belch JF, Wilson M, Mehta Z and Meade TW. Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet. 2012;379:1602-12.

#19 Patients and their pictures Jan 11, 2018

It's a throwback Thursday on the podcast. This week, we revisit an old but familiar topic of neuroimaging. What does it tell you about a person, and how does it compare to a photograph? Featuring Salim Chahin (Washington University) and Ali Mendelson (UCSD).

Produced by James E. Siegler. Music by Ars Sonor, Lee Rosevere, and Kevin McLeod. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

#92 10,000 hours Jan 04, 2018

You've probably heard of the 10,000-hour rule--or maybe the 10-year rule. The time it takes to master a skill. But what is the evidence for this, and was Malcolm Gladwell's interpretation of it (from his book, Outliers) correct? From mindfulness to memory palaces, this week we explore the neuroscience of expertise.

Produced by James E. Siegler. Music by Mozart, Brendan Kinsella, Jon Watts, Mike Durek, and Lee Rosevere. Voiceover by David Manly. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Macnamara BN, Hambrick DZ and Oswald FL. Deliberate practice and performance in music, games, sports, education, and professions: a meta-analysis. Psychol Sci. 2014;25:1608-18.
Ericsson KA, Krampe RT and Teschromer C. The Role of Deliberate Practice in the Acquisition of Expert Performance. Psychol Rev. 1993;100:363-406.
Raskin E. Comparison of scientific and literary ability: A biographical study of eminent scientists and letters of the nineteenth century. Journal of Abnormal & Social Psychology. 1936;31:20-35.

#91 Teaching through clinical cases: A kid with coagulopathy Dec 28, 2017

In this week's clinical case, Dr. John Baird (Stanford) shares the story of a patient he's been following who's experienced a neurologic complication of her hematologic illness. Check it out.

Produced by James E. Siegler. Music by Chris Zabriskie, Ian Southerland, Julie Maxwell, Jason Shaw, and Rafael Archangel. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making.

REFERENCES

George JN. Clinical practice. Thrombotic thrombocytopenic purpura. The New England journal of medicine. 2006;354:1927-35.
George JN and Nester CM. Syndromes of thrombotic microangiopathy. The New England journal of medicine. 2014;371:654-66.
Bakshi R, Shaikh ZA, Bates VE and Kinkel PR. Thrombotic thrombocytopenic purpura: brain CT and MRI findings in 12 patients. Neurology. 1999;52:1285-8.
Goel R, Ness PM, Takemoto CM, Krishnamurti L, King KE and Tobian AA. Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. Blood. 2015;125:1470-6.

#90 Conduction block, and why it confuses me Dec 21, 2017

Nerve conduction testing should not be as puzzling as it's made out to be. This week, we break it down into individual components and use two case examples to explain how you might interpret this commonly implemented electrodiagnostic assessment.

Produced by James E. Siegler. Music by Coldnoise, Jessie Spillane, Loyalty Freak Music, and Yshwa. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making.

REFERENCES

Allen JA. Chronic Demyelinating Polyneuropathies. Continuum (Minneap Minn). 2017;23:1310-1331.
Kincaid JC. Neurophysiologic Studies in the Evaluation of Polyneuropathy. Continuum (Minneap Minn). 2017;23:1263-1275.
Preston DC and Shapiro BE. Electromyography and neuromuscular disorders : clinical-electrophysiologic correlations. 3rd ed. London ; New York: Elsevier Saunders; 2013.
Pareyson D, Scaioli V and Laura M. Clinical and electrophysiological aspects of Charcot-Marie-Tooth disease. Neuromolecular Med. 2006;8:3-22.

#89 Cerebral venous sinus thrombosis Dec 14, 2017

Cerebral vein and dural sinus thrombosis comprises only 0.5% of all strokes, but is one of the most litigated medical diagnoses due to the high rate of underdiagnosis and high probability of neurologic decline without early and aggressive intervention. In this week's installment, Ali Hamedani puts Jim Siegler in the hot seat to go over the clinical and radiographic manifestations of this condition, treatment, and prognosis.

Produced by Ali Hamedani and James E. Siegler. Music by Andy Cohen, MMFFF, Loyalty Freak Music, Steve Combs, Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making.

REFERENCES

Stam J. Thrombosis of the cerebral veins and sinuses. The New England journal of medicine. 2005;352:1791-8.
Khandelwal N, Agarwal A, Kochhar R, Bapuraj JR, Singh P, Prabhakar S and Suri S. Comparison of CT venography with MR venography in cerebral sinovenous thrombosis. AJR Am J Roentgenol. 2006;187:1637-43.
Ferro JM, Canhao P, Bousser MG, Stam J, Barinagarrementeria F and Investigators I. Early seizures in cerebral vein and dural sinus thrombosis: risk factors and role of antiepileptics. Stroke; a journal of cerebral circulation. 2008;39:1152-8.
Saposnik G, Barinagarrementeria F, Brown RD, Jr., Bushnell CD, Cucchiara B, Cushman M, deVeber G, Ferro JM, Tsai FY, American Heart Association Stroke C, the Council on E and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2011;42:1158-92.

#88 Phenomenon Dec 07, 2017

This week on the show, we're discussing the science behind the fiction of George Malley, the protagonist of the 1996 classic, Phenomenon. Specifically, we ask the question, is there a disease out there which incidentally benefits the human organism? Maybe there is...

Produced by James E. Siegler. Music by Hyson, Ars Sonor, and Lee Rosevere. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Costanzo JP, Lee RE, Jr. and Lortz PH. Glucose concentration regulates freeze tolerance in the wood frog Rana sylvatica. J Exp Biol. 1993;181:245-55.
Moalem S, Weinberg ED and Percy ME. Hemochromatosis and the enigma of misplaced iron: implications for infectious disease and survival. Biometals. 2004;17:135-9.
Nagasako EM, Oaklander AL and Dworkin RH. Congenital insensitivity to pain: an update. Pain. 2003;101:213-9.
Saloviita T, Ruusila L and Ruusila U. Incidence of Savant Syndrome in Finland. Percept Mot Skills. 2000;91:120-2.

#87 Minimally-invasive surgery for drug-resistant epilepsy: Part 2 Nov 30, 2017

Last week was all about how destroying bad brain can help patients with epilepsy. This week, in a stimulating discussion with Dr. Becker, we're reviewing the ways we can activate the nervous system in order to prevent future seizures: the vagus nerve stimulator, deep brain stimulation, and the responsive neurostimulation system.

Produced by James E. Siegler. Music by Chris Zabriskie, Josh Woodward, and Kevin McLeod. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Penry JK and Dean JC. Prevention of intractable partial seizures by intermittent vagal stimulation in humans: preliminary results. Epilepsia. 1990;31 Suppl 2:S40-3.
Yuan H and Silberstein SD. Vagus Nerve and Vagus Nerve Stimulation, a Comprehensive Review: Part II. Headache. 2016;56:259-66.
Lanska DJ. J.L. Corning and vagal nerve stimulation for seizures in the 1880s. Neurology. 2002;58:452-9.
A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. The Vagus Nerve Stimulation Study Group. Neurology. 1995;45:224-30.
Handforth A, DeGiorgio CM, Schachter SC, Uthman BM, Naritoku DK, Tecoma ES, Henry TR, Collins SD, Vaughn BV, Gilmartin RC, Labar DR, Morris GL, 3rd, Salinsky MC, Osorio I, Ristanovic RK, Labiner DM, Jones JC, Murphy JV, Ney GC and Wheless JW. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology. 1998;51:48-55.
Ben-Menachem E. Vagus-nerve stimulation for the treatment of epilepsy. The Lancet Neurology. 2002;1:477-82.
Morris GL, 3rd, Gloss D, Buchhalter J, Mack KJ, Nickels K and Harden C. Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;81:1453-9.
Fisher R, Salanova V, Witt T, Worth R, Henry T, Gross R, Oommen K, Osorio I, Nazzaro J, Labar D, Kaplitt M, Sperling M, Sandok E, Neal J, Handforth A, Stern J, DeSalles A, Chung S, Shetter A, Bergen D, Bakay R, Henderson J, French J, Baltuch G, Rosenfeld W, Youkilis A, Marks W, Garcia P, Barbaro N, Fountain N, Bazil C, Goodman R, McKhann G, Babu Krishnamurthy K, Papavassiliou S, Epstein C, Pollard J, Tonder L, Grebin J, Coffey R, Graves N and Group SS. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia. 2010;51:899-908.
Morrell MJ and Group RNSSiES. Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology. 2011;77:1295-304.
DeGiorgio CM and Krahl SE. Neurostimulation for drug-resistant epilepsy. Continuum (Minneap Minn). 2013;19:743-55.

#86 Minimally-invasive surgery for drug-resistant epilepsy: Part 1 Nov 23, 2017

This week on BrainWaves, we build on concepts introduced in episode 65 regarding the non-pharmacologic management of drug-resistant epilepsy. In the next two episodes, you'll hear from Dr. Danielle Becker (Penn) and Dr. Myriam Abdennadher (NIH) on the minimally invasive procedures that can drastically impact the lives of patients with refractory seizures.

Produced by James E. Siegler. Music by Steve Combs, Jason Shaw, and Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, Moshe SL, Perucca E, Wiebe S and French J. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51:1069-77.
Nilsson L, Farahmand BY, Persson PG, Thiblin I and Tomson T. Risk factors for sudden unexpected death in epilepsy: a case-control study. Lancet. 1999;353:888-93.
Tomson T, Nashef L and Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions. The Lancet Neurology. 2008;7:1021-31.
Willie JT, Laxpati NG, Drane DL, Gowda A, Appin C, Hao C, Brat DJ, Helmers SL, Saindane A, Nour SG and Gross RE. Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery. 2014;74:569-84; discussion 584-5.

#85 Teaching through clinical cases: A disorder of unusual movements Nov 16, 2017

Everything doesn't always add up when you're evaluating a patient with a complex array of symptoms. Or maybe it does. Dr. LaFaver (University of Louisville) walks us through this week's Teaching through Clinical Cases.

Produced by James E. Siegler & Kathrin LaFaver. Music by Lee Rosevere, Montplaisir, and Coldnoise. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making.

REFERENCES

Carson A, Hallett M and Stone J. Assessment of patients with functional neurologic disorders. Handbook of clinical neurology. 2017;139:169-188.
Carson A, Lehn A, Ludwig L and Stone J. Explaining functional disorders in the neurology clinic: a photo story. Pract Neurol. 2016;16:56-61.
Czarnecki K, Thompson JM, Seime R, Geda YE, Duffy JR and Ahlskog JE. Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol. Parkinsonism & related disorders. 2012;18:247-51.
Edwards MJ, Stone J and Lang AE. From psychogenic movement disorder to functional movement disorder: it's time to change the name. Movement disorders : official journal of the Movement Disorder Society. 2014;29:849-52.
Gelauff J, Stone J, Edwards M and Carson A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. Journal of neurology, neurosurgery, and psychiatry. 2014;85:220-6.
Stone J. Functional neurological disorders: the neurological assessment as treatment. Pract Neurol. 2016;16:7-17.

ACKNOWLEDGEMENTS

Drs. LaFaver and Siegler would like to thank Jason Lindsley for sharing his story on the BrainWaves podcast.

Quanta: Brain surgery for epilepsy Nov 13, 2017

How often do you call the plumber and say, "My faucet is leaking", and then the plumber REMOVES your faucet? Problem solved, right? Ironically, this simplistic approach works extremely well in a variety of epileptic conditions. In this week's show, Dr. Myriam Abdennadher and Danielle Becker comment on the protocol and efficacy for surgery in patients with drug-resistant epilepsy.

Produced by James E. Siegler. Music by Little Glass Men, Montplaisir, Three Chain Links, and Squire Tuck. Voiceover by Isa Smrstik. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Jobst BC and Cascino GD. Resective epilepsy surgery for drug-resistant focal epilepsy: a review. JAMA : the journal of the American Medical Association. 2015;313:285-93.
Spencer S and Huh L. Outcomes of epilepsy surgery in adults and children. The Lancet Neurology. 2008;7:525-37.
Schwartz TH and Spencer DD. Strategies for reoperation after comprehensive epilepsy surgery. Journal of neurosurgery. 2001;95:615-23.
Engel J, Jr., Wiebe S, French J, Sperling M, Williamson P, Spencer D, Gumnit R, Zahn C, Westbrook E, Enos B, Quality Standards Subcommittee of the American Academy of N, American Epilepsy S and American Association of Neurological S. Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology. 2003;60:538-47.
Englot DJ, Wang DD, Rolston JD, Shih TT and Chang EF. Rates and predictors of long-term seizure freedom after frontal lobe epilepsy surgery: a systematic review and meta-analysis. Journal of neurosurgery. 2012;116:1042-8.
DeGiorgio CM and Krahl SE. Neurostimulation for drug-resistant epilepsy. Continuum (Minneap Minn). 2013;19:743-55.

#84 Neonatal abstinence syndrome Nov 09, 2017

With the ongoing opioid crisis, not only those using opiates are affected. There has been an exponential rise in the incidence of neonatal abstinence syndrome--the multi-organ dysfunction experienced by newborns of mothers who are using opioid products and other substances. This week, we discuss the manifestations and ramifications of this disease, with a short commentary on implications of this global epidemic.

Produced by James E. Siegler. Music by Little Glass Men, Jason Shaw, and Chris Zabriskie. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. This is no excuse to give your irritable baby opiates in their applesauce.

REFERENCES

McQueen K and Murphy-Oikonen J. Neonatal Abstinence Syndrome. The New England journal of medicine. 2016;375:2468-2479.
Vlahov D, Des Jarlais DC, Goosby E, Hollinger PC, Lurie PG, Shriver MD and Strathdee SA. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. American journal of epidemiology. 2001;154:S70-7.
Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134:e547-61.
Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S and Alexander ER. Syringe exchange and risk of infection with hepatitis B and C viruses. American journal of epidemiology. 1999;149:203-13.
Wodak A and Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41:777-813.
Jarlenski M, Barry CL, Gollust S, Graves AJ, Kennedy-Hendricks A and Kozhimannil K. Polysubstance Use Among US Women of Reproductive Age Who Use Opioids for Nonmedical Reasons. Am J Public Health. 2017;107:1308-1310.
Hudak ML, Tan RC, Committee On D, Committee On F, Newborn and American Academy of P. Neonatal drug withdrawal. Pediatrics. 2012;129:e540-60.

#83 Halloween Special: Zombies in neurology Oct 31, 2017

If you don't think zombies exist, this episode might convince you otherwise. Two neurologists discuss the history and the neuroscience behind zombie-ism, and the reality of it, in this week's special installment of BrainWaves.

Our zombie producer is Dr. James E. Siegler with the help of zombie expert, Dr. Brian Hanrahan. Our zombie music was courtesy of Andrew Sacco, Ars Sonor, and Little Glass Men. Our studio zombie is Erika Mejia. Content from zombie books, movies, and news events are also included. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making. Not that we know how to treat zombies anyway.

REFERENCES

Smith TC. Zombie infections: Epidemiology, treatment, and prevention. Bmj. 2015;351:h6423
Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R. "Zombie" outbreak caused by the synthetic cannabinoid amb-fubinaca in new york. The New England journal of medicine. 2017;376:235-242
Gilmour SJ, Saito E, Yoneoka D. Importance of survival strategies after a zombie pandemic. Bmj. 2016;532:i259
Hughes DP, Andersen SB, Hywel-Jones NL, Himaman W, Billen J, Boomsma JJ. Behavioral mechanisms and morphological symptoms of zombie ants dying from fungal infection. BMC Ecol. 2011;11:13

#82 Brain death part 2: Limitations of physicians Oct 26, 2017

Last week, we talked about the "why" of brain death. This week, the "how." Again, Jim Siegler is joined by Dr. Joshua Levine and Mike Rubenstein for the second part of the brain death series.

Produced by James E. Siegler and Michael Rubenstein. Music by Chris Zabriskie, Hyson, Kai Engel, and Lee Rosevere. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

1. Wijdicks EF. Brain death. Handbook of clinical neurology. 2013;118:191-203.

2. Wijdicks EF, Varelas PN, Gronseth GS, Greer DM and American Academy of N. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:1911-8.

#81 Brain death part one: The social construct Oct 19, 2017

Brain death, you'd be surprised to know, has its roots in non-neurologic specialties. Specialties like pulmonary critical care, cardiology, and transplant surgery. How the term was conceived, why it was needed, and what it means in our current practice of medicine will be the focus of this week's BrainWaves episode. Featuring Drs. Joshua Levine and Mike Rubenstein.

Produced by James E. Siegler. Music by Chris Zabriskie, Damiano Baldoni, Josh Woodward, and Julie Maxwell. BrainWaves' podcasts and online content are intended for medical education purposes only and should not be used for routine clinical decision making. Please refer to local and regional policies on how brain death is determined at your institution.

REFERENCES

Kacmarek RM. The mechanical ventilator: past, present, and future. Respir Care. 2011;56:1170-80.
De Georgia MA. History of brain death as death: 1968 to the present. J Crit Care. 2014;29:673-8.
West JB. The physiological challenges of the 1952 Copenhagen poliomyelitis epidemic and a renaissance in clinical respiratory physiology. J Appl Physiol (1985). 2005;99:424-32.
A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA : the journal of the American Medical Association. 1968;205:337-40.
Wijdicks EF, Varelas PN, Gronseth GS, Greer DM and American Academy of N. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:1911-8.

#80 The meningitis that keeps coming back Oct 12, 2017

Most people never get meningitis. For those who do, it is rare to experience it more than once. But if it recurs, red flags should be going up. Dr. Jon Rosenberg joins Jim Siegler this week in a discussion about the causes and management of recurrent meningitis.

Produced by James E. Siegler. Music by Lee Rosevere, Fatal Injection, and Coldnoise. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Please don't LP every patient with migraine. That's just mean.

REFERENCES

Rosenberg J and Galen BT. Recurrent Meningitis. Curr Pain Headache Rep. 2017;21:33.
Zunt JR and Baldwin KJ. Chronic and subacute meningitis. Continuum (Minneap Minn). 2012;18:1290-318.

#79 Teaching through clinical cases: Hot & Hyper Oct 05, 2017

Dr. David Coughlin returns for this week's Teaching Through Clinical Cases to discuss the management of a delirious patient with a hyperkinetic movement disorder.

Produced by James E. Siegler. Music by Hyson, Josh Woodward, Komiku and Peter Rudenko. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Mills KC. Serotonin syndrome. American family physician. 1995;52:1475-1482
Radomski J, Dursun S, Reveley M, Kutcher S. An exploratory approach to the serotonin syndrome: An update of clinical phenomenology and revised diagnostic criteria. Medical hypotheses. 2000;55:218-224
Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The hunter serotonin toxicity criteria: Simple and accurate diagnostic decision rules for serotonin toxicity. QJM : monthly journal of the Association of Physicians. 2003;96:635-642
Boyer EW, Shannon M. The serotonin syndrome. The New England journal of medicine. 2005;352:1112-1120
Dosi R, Ambaliya A, Joshi H, Patell R. Serotonin syndrome versus neuroleptic malignant syndrome: A challenging clinical quandary. BMJ case reports. 2014;2014:bcr2014204154
Lappin RI, Auchincloss EL. Treatment of the serotonin syndrome with cyproheptadine. The New England journal of medicine. 1994;331:1021-1022
Pedavally S, Fugate JE, Rabinstein AA. Serotonin syndrome in the intensive care unit: Clinical presentations and precipitating medications. Neurocritical care. 2014;21:108-113
Ables AZ, Nagubilli R. Prevention, recognition, and management of serotonin syndrome. American family physician. 2010;81:1139-1142

#78 Evil spirits in your head: A brief history of trepanation Sep 28, 2017

This week on BrainWaves, we go back in time to explore human's oldest neurosurgical procedure. So carve out some time in your day to learn about the ancient technique of craniotomy.

Produced by James E. Siegler. Music by Chris Zabriskie, Kai Engel, Kevin McLeod, The Philadelphia Orchestra, and Sergey Cheremisinov. Voiceover by John Burnett. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical practice. Please do NOT drill into anyone's head without their full and informed consent.

REFERENCES

Sperati G. Craniotomy through the ages. Acta Otorhinolaryngol Ital. 2007;27:151-6.
Verano JW and Finger S. Chapter 1: ancient trepanation. Handbook of clinical neurology. 2010;95:3-14.
Missios S. Hippocrates, Galen, and the uses of trepanation in the ancient classical world. Neurosurgical focus. 2007;23:E11.
Newman WC, Chivukula S and Grandhi R. From Mystics to Modern Times: A History of Craniotomy & Religion. World Neurosurg. 2016;92:148-50.
Clower WT and Finger S. Discovering trepanation: the contribution of Paul Broca. Neurosurgery. 2001;49:1417-25; discussion 1425-6.
Assina R, Sarris CE and Mammis A. The history of craniotomy for headache treatment. Neurosurgical focus. 2014;36:E9.
Faria MA, Jr. Violence, mental illness, and the brain - A brief history of psychosurgery: Part 1 - From trephination to lobotomy. Surg Neurol Int. 2013;4:49.
Tsermoulas G, Aidonis A and Flint G. The skull of Chios: trepanation in Hippocratic medicine. Journal of neurosurgery. 2014;121:328-32.

#77 Bridging the gap Sep 21, 2017

Atrial fibrillation increases your risk of clotting. Anticoagulation increases your risk of bleeding. Surgery increases your risk of both. Dr. Mike Rubenstein speaks with Dr. Jim Siegler this week about how providers weigh the risks and benefits of anticoagulant bridging in the perioperative setting.

Produced by Michael Rubenstein and James E. Siegler. Music by Chris Zabriskie, Lee Rosevere, and Jason Shaw. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Rechenmacher SJ, Fang JC. Bridging anticoagulation: Primum non nocere. Journal of the American College of Cardiology. 2015;66:1392-1403
Steinberg BA, Peterson ED, Kim S, Thomas L, Gersh BJ, Fonarow GC, et al. Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: Findings from the outcomes registry for better informed treatment of atrial fibrillation (orbit-af). Circulation. 2015;131:488-494
Stroke prevention in atrial fibrillation study. Final results. Circulation. 1991;84:527-539
Garcia DA, Regan S, Henault LE, Upadhyay A, Baker J, Othman M, et al. Risk of thromboembolism with short-term interruption of warfarin therapy. Archives of internal medicine. 2008;168:63-69
Raval AN, Cigarroa JE, Chung MK, Diaz-Sandoval LJ, Diercks D, Piccini JP, et al. Management of patients on non-vitamin k antagonist oral anticoagulants in the acute care and periprocedural setting: A scientific statement from the american heart association. Circulation. 2017;135:e604-e633
Schulman S, Carrier M, Lee AY, Shivakumar S, Blostein M, Spencer FA, et al. Perioperative management of dabigatran: A prospective cohort study. Circulation. 2015;132:167-173

2017 Update on PFO closure in stroke Sep 14, 2017

Last year, the management of PFO was 'open' for discussion. Now, consider the case closed. Recent data indicates PFOs should be closed in certain patients with cryptogenic strokes. But some questions remain unanswered. This week's episode is an update from last year's review on this frequent topic that troubles stroke units.

Produced by James E. Siegler & Chris Favilla. Music by Lee Rosevere and Marcos H. Bolanos. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education purposes only. Jim is not a cardiac surgeon. Just a guy who's trying to bring you all the latest updates for what smarter doctors are doing.

REFERENCES

Kent DM, Ruthazer R, Weimar C, Mas JL, Serena J, Homma S, Di Angelantonio E, Di Tullio MR, Lutz JS, Elkind MS, Griffith J, Jaigobin C, Mattle HP, Michel P, Mono ML, Nedeltchev K, Papetti F and Thaler DE. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013;81:619-25.
Meier B and Lock JE. Contemporary management of patent foramen ovale. Circulation. 2003;107:5-9.
Kent DM, Dahabreh IJ, Ruthazer R, Furlan AJ, Reisman M, Carroll JD, Saver JL, Smalling RW, Juni P, Mattle HP, Meier B and Thaler DE. Device Closure of Patent Foramen Ovale After Stroke: Pooled Analysis of Completed Randomized Trials. Journal of the American College of Cardiology. 2016;67:907-17.

#76 Fun facts about reflex testing Sep 07, 2017

Reflex testing is an art. And that makes each of us an artist. The nuances of the reflex circuitry and how to interpret reflex testing are the topics of this week's episode, starring medical student Eliana Vasquez, from Texas A&M Health Sciences Center.

Produced by Erika Mejia and James E. Siegler. Music by Komiku, Jahzzar, and Jason Shaw. BrainWaves podcast and online content are intended for medical education only and should not be used in the routine care of patients. I swear, if someone tries to sue me because their doctor said "Well, Jim told me I should hit your knee with a hammer," then I'm coming for you.

REFERENCES

Walker HK. Deep Tendon Reflexes. In: H. K. Walker, W. D. Hall and J. W. Hurst, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston; 1990.
Boes CJ. The history of examination of reflexes. Journal of neurology. 2014;261:2264-74.
Watt D, Lefebvre L. Effects of altered gravity on spinal cord excitability. American Institute of Aeronautics and Astronautics. 2001-4939.

#74 Anisocoria Aug 31, 2017

The asymmetric pupil can be subtle or disturbing, straightforward or perplexing, or even normal or abnormal. But by integrating your eye exam with the neuro exam, you can figure it out. Even if its the eye exam in a dog.

Produced by James E. Siegler. Music by Komiku, Lee Rosevere, and Milton Arias. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making, no matter how physiologic you think those pupils are.

REFERENCES

Liu GT, Volpe NJ, and Galetta SL. Neuro-ophthalmology: Diagnosis and management, 2nd ed., pp. 587-610. Elsevier, 2010.

#73 Things I didn't know about syncope Aug 24, 2017

Fainting spells are surprisingly common. Even among United States Marines. This week we explore the mechanisms underlying loss of consciousness in your every day patient. And your every day soldier.

Produced by James E. Siegler. Music by Jason Shaw, Andy Cohen, Kai Engel, and Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Freeman R. Clinical practice. Neurogenic orthostatic hypotension. The New England journal of medicine. 2008;358:615-24.
Grubb BP. Neurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation. 2005;111:2997-3006.
Wolters FJ, Mattace-Raso FU, Koudstaal PJ, Hofman A, Ikram MA and Heart Brain Connection Collaborative Research G. Orthostatic Hypotension and the Long-Term Risk of Dementia: A Population-Based Study. PLoS Med. 2016;13:e1002143.
Sonnesyn H, Nilsen DW, Rongve A, Nore S, Ballard C, Tysnes OB and Aarsland D. High prevalence of orthostatic hypotension in mild dementia. Dement Geriatr Cogn Disord. 2009;28:307-13.

#72 Teaching through clinical cases: A middle aged woman with proximal weakness Aug 17, 2017

This week's clinical case features Dr. Megha Dhamne, a neuromuscular fellow from the Cleveland Clinic. Two weeks ago, she reviewed some of the antibodies associated with autoimmune myositis. But what happens when you suspect an autoimmune myositis, and antibody testing is negative?

Produced by James E. Siegler. Music by Chris Zabriski, The New Valleys, and Hyson. Voiceover by Tuyche Smrstik. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Suresh E and Wimalaratna S. Proximal myopathy: diagnostic approach and initial management. Postgraduate medical journal. 2013;89:470-7.
Mammen A. Autoimmune muscle disease. Handbook of clinical neurology. 2016;133:467-84.
Hill CL, Zhang Y, Sigurgeirsson B, Pukkala E, Mellemkjaer L, Airio A, Evans SR and Felson DT. Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet. 2001;357:96-100.
Choy EH and Isenberg DA. Treatment of dermatomyositis and polymyositis. Rheumatology (Oxford). 2002;41:7-13.
Gordon PA, Winer JB, Hoogendijk JE and Choy EH. Immunosuppressant and immunomodulatory treatment for dermatomyositis and polymyositis. The Cochrane database of systematic reviews. 2012:CD003643.

#71 Spinal control of bladder function Aug 10, 2017

Spinal cord injury can be a devastating problem for patients. There is often significant weakness, loss of sensation and coordination, and some patients may never walk again. Almost everyone knows this. But what about other the other functions of the cord that we don't often talk about? In this week's episode, we review how the spinal cord controls bladder function, and why it's important to know what happens when this circuitry is interrupted.

Produced by James E. Siegler. Music by Andy Cohen & Steve Combs. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Seth JH, Panicker JN, Fowler CJ. The neurological organization of micturition. Handbook of clinical neurology. 2013;117:111-117
Samson G, Cardenas DD. Neurogenic bladder in spinal cord injury. Phys Med Rehabil Clin N Am. 2007;18:255-274, vi
de Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol. 2015;5:327-396

Quanta: The antibody spectrum of inflammatory muscle disease Aug 07, 2017

Progressive weakness can be terrifying for patients. And even more terrifying for clinicians can be the vast number of potential causes to consider. Among them are disorders of muscle inflammation. In this week's episode of the Quanta series, Dr. Megha Dhamne reviews the clinically relevant antibodies and associated phenotypes we see in patients with autoimmune myositis.

Produced by James E. Siegler. Music by Coldnoise and Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Dalakas MC. Inflammatory muscle diseases. The New England journal of medicine. 2015;372:1734-47.
Gunawardena H, Betteridge ZE and McHugh NJ. Myositis-specific autoantibodies: their clinical and pathogenic significance in disease expression. Rheumatology (Oxford). 2009;48:607-12.
Goyal NA, Cash TM, Alam U, Enam S, Tierney P, Araujo N, Mozaffar FH, Pestronk A and Mozaffar T. Seropositivity for NT5c1A antibody in sporadic inclusion body myositis predicts more severe motor, bulbar and respiratory involvement. Journal of neurology, neurosurgery, and psychiatry. 2016;87:373-8.

#75 Glioblastoma Aug 03, 2017

The most common primary brain tumor that occurs in adults, glioblastoma multiforme comes with a life expectancy shorter than practically every other form of cancer. But thanks to novel treatment strategies, advanced neuroimaging, and biomarker research, we are learning more and more how to improve the survival and the quality of life with patients who suffer from this terrible illness.

Produced by James E. Siegler and Neena Cherayil. Music by Axle, Coldnoise, Josh Woodward, and Kelly Latimer. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Grady, D “Glioblastoma, John Mccain’s Form of Brain Cancer, Carries Troubling Prognosis” The New York Times
Scutti, S “Sen John McCain has aggressive brain tumor, surgically removed” CNN
Gately L, et al. Life beyond a diagnosis of glioblastoma: a systematic review of the literature. J Cancer Surviv (2017).
Thakkar JP, et al. Epidemiologic and Molecular Prognostic Review of Glioblastoma. Cancer epidemiology, biomarkers & prevention (2014).
Louis DN, et al. “The 2016 World Health Organization Classification of Tumors of the Central Nervous System: A Summary” Acta Neuropathologica (2016) 6: 803-820.
Stupp R, et al. MGMT Gene Silencing and Benefit from Temozolomide in Glioblastoma. N Engl J Med (2005).
Stupp R, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. The Lancet Oncology (2009).
Weller M and Wick W. Neuro-oncology in 2013: improving outcome in newly diagnosed malignant glioma. Nature reviews Neurology. 2014;10:68-70.

#70 Teaching through clinical cases: First seizure of life Jul 27, 2017

The first seizure of life is a common presentation requiring a neurology consultation. In this episode, Dr. Brian Hanrahan of the University of Pittsburgh Medical Center, discusses his approach to counseling an adult patient with a first ever seizure, with a particular emphasis on driving safety.

Produced by James E. Siegler. Music by Axletree, Josh Woodward, and Kevin McLeod. Voiceover by Emma Smrstik. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Think responsibly. Podcasts are no excuse NOT to treat a patient who is seizing.

REFERENCES

Maganti RK and Rutecki P. EEG and epilepsy monitoring. Continuum (Minneap Minn). 2013;19:598-622.
Smith SJ. EEG in the diagnosis, classification, and management of patients with epilepsy. Journal of neurology, neurosurgery, and psychiatry. 2005;76 Suppl 2:ii2-7.
Sofat P, Teter B, Kavak KS, Gupta R and Li P. Time interval providing highest yield for initial EEG in patients with new onset seizures. Epilepsy Res. 2016;127:229-232.
Krumholz A, Shinnar S, French J, Gronseth G and Wiebe S. Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;85:1526-7.
Richards KC. Patient page. The risk of fatal car crashes in people with epilepsy. Neurology. 2004;63:E12-3.
Krumholz A. Driving issues in epilepsy: past, present, and future. Epilepsy Curr. 2009;9:31-5.
Temkin NR, Dikmen SS, Wilensky AJ, Keihm J, Chabal S and Winn HR. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. The New England journal of medicine. 1990;323:497-502.
Thompson K, Pohlmann-Eden B, Campbell LA and Abel H. Pharmacological treatments for preventing epilepsy following traumatic head injury. The Cochrane database of systematic reviews. 2015:CD009900.
Deutschman CS and Haines SJ. Anticonvulsant prophylaxis in neurological surgery. Neurosurgery. 1985;17:510-7.
van Breemen MS, Wilms EB and Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. The Lancet Neurology. 2007;6:421-30.
Hemphill JC, 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D, American Heart Association Stroke C, Council on C, Stroke N and Council on Clinical C. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2015;46:2032-60.

#69 "It's not Lyme Disease" Jul 20, 2017

Doctors make the worst patients. Either because we've seen how bad illness can be that we tend to underplay our own symptoms, or because we believe it is more noble to attend to the health of our own patients rather than the health of ourselves. As providers, we refuse to acknowledge weakness until it is much too late. In this episode of BrainWaves, one neurologist describes his interesting, and surprisingly humorous, transition from denial to acceptance of his neurologic condition.

Produced by James E. Siegler, Travis Lewis, & Erika Mejia. Music by Siddhartha, Little Glass Men, and Lee Rosevere. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making. Always talk to your doctor. Especially if you are a doctor yourself.

REFERENCES

Toyry S, Rasanen K, Kujala S, Aarimaa M, Juntunen J, Kalimo R, Luhtala R, Makela P, Myllymaki K, Seuri M and Husman K. Self-reported health, illness, and self-care among finnish physicians: a national survey. Arch Fam Med. 2000;9:1079-85.
McKevitt C, Morgan M, Dundas R and Holland WW. Sickness absence and 'working through' illness: a comparison of two professional groups. J Public Health Med. 1997;19:295-300.

#68 Teaching through clinical cases: A man with falls Jul 13, 2017

People fall for a lot of reasons when they get older, but that doesn't mean they should see a neurologist. A person can fall because of weakness, back or leg pain, instability, clumsiness, vision impairment, a sensory disturbance, and a myriad of other causes. Some of these are neurological, and these require special attention. In this week's Teaching through Clinical Cases episode, Dr. Sneha Mantri discusses a patient who presented to her clinic with falls due to rigidity and ocular dysmotility.

Produced by James E. Siegler. Music by Josh Woodward and Julie Maxwell. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Hess CW and Okun MS. Diagnosing Parkinson Disease. Continuum (Minneap Minn). 2016;22:1047-63.
Garbutt S, Riley DE, Kumar AN, Han Y, Harwood MR and Leigh RJ. Abnormalities of optokinetic nystagmus in progressive supranuclear palsy. Journal of neurology, neurosurgery, and psychiatry. 2004;75:1386-94.
McFarland NR. Diagnostic Approach to Atypical Parkinsonian Syndromes. Continuum (Minneap Minn). 2016;22:1117-42.
PW Brazis, Masdeu JC, Biller J. Localization in Clinical Neurology, 6th ed. 2011 Lippincott Williams and Wilkins.

I wonder: Resident duty hours Jul 09, 2017

As of July 1, 2017, the Accreditation Council of Graduate Medical Education (sorry, in the episode I called in American College--this is wrong) made its first step EVER to extend duty hours for physician trainees. Whereas interns (first year residents) were previously limited to working 16 hour shifts, now they can work as many consecutive hours as senior residents--up to 28 hours at a time! In this episode of the I Wonder series, I ask Ali what he thinks about these new stipulations.

Produced by Erika Mejia and James E. Siegler. Music by Jason Shaw and Jazzhar. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Asch DA, Bilimoria KY and Desai SV. Resident Duty Hours and Medical Education Policy - Raising the Evidence Bar. The New England journal of medicine. 2017;376:1704-1706.
Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW and Czeisler CA. Effect of reducing interns' work hours on serious medical errors in intensive care units. The New England journal of medicine. 2004;351:1838-48.
Lockley SW, Cronin JW, Evans EE, Cade BE, Lee CJ, Landrigan CP, Rothschild JM, Katz JT, Lilly CM, Stone PH, Aeschbach D, Czeisler CA, Harvard Work Hours H and Safety G. Effect of reducing interns' weekly work hours on sleep and attentional failures. The New England journal of medicine. 2004;351:1829-37.

#67 The mind's eye Jul 06, 2017

We rely heavily on our vision to perceive the world around us. (You wouldn't even be able to read this unless your vision were fully intact.) But what happens when that visual information is registered poorly by the eyes, or the information is erroneously translated by a damaged nervous system? Cognitive neuroscientist and visual systems specialist, Dr. Geoff Aguirre joins in this segment on how structural neurologic injury contributes to abnormalities in visual perception.

Produced by James E. Siegler & Erika Mejia. Music by MMFFF, Peter Rudenko, Three Chain Links, and Marcos H. Bolanos. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical purposes.

REFERENCES

Barton JJ. Disorders of higher visual processing. Handbook of clinical neurology. 2011;102:223-61.
Meadows JC and Munro SS. Palinopsia. Journal of neurology, neurosurgery, and psychiatry. 1977;40:5-8.
Radoeva PD, Prasad S, Brainard DH and Aguirre GK. Neural activity within area V1 reflects unconscious visual performance in a case of blindsight. J Cogn Neurosci. 2008;20:1927-39.
Podoll K and Robinson D. Lewis Carroll's migraine experiences. Lancet. 1999;353:1366.

Quanta: Drug-induced Parkinsonism Jul 03, 2017

The second most common cause of Parkinsonism is doctors. No, I am not kidding. It's the medications we choose to prescribe. And the neurologist is not the only one at fault. Psychiatrists, cardiologists, and internists are all responsible. In this episode of the Quanta series, Dr. Sneha Mantri describes her experience as a specialist in movement disorders.

Produced by James E. Siegler and Erika Mejia. Music by Hyson and Jazzhar. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Shin HW and Chung SJ. Drug-induced parkinsonism. J Clin Neurol. 2012;8:15-21.
Lopez-Sendon JL, Mena MA and de Yebenes JG. Drug-induced parkinsonism in the elderly: incidence, management and prevention. Drugs Aging. 2012;29:105-18.
Alvarez MV and Evidente VG. Understanding drug-induced parkinsonism: separating pearls from oy-sters. Neurology. 2008;70:e32-4.

#66 Psychogenic non-epileptic events (or are they seizures?) Jun 29, 2017

Not all that shakes are seizures. Last week, we talked about what it's like to have epilepsy. This week, I am joined by Dr. Taneeta "Mindy" Ganguly to discuss what it's like NOT to have epilepsy--meaning to have non-epileptic seizures. But sometimes, you can have both. And this is where it gets tricky for the neurologist.

Produced by James E. Siegler. Music by Aitua and Kai Engel. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

1. Reuber M and Elger CE. Psychogenic nonepileptic seizures: review and update. Epilepsy Behav. 2003;4:205-16.

Quanta: Agnosia Jun 26, 2017

Seeing is believing. Or so I'm told. But this isn't a hard and fast rule in neurology. Cognitive neuroscientist and neurologist, Dr. Geoffrey Aguirre, joins me in this brief episode to discuss the neuroanatomy of higher order visual processing.

Produced by James E. Siegler & Erika Mejia. Music by Ars Sonor and Nuno Adelaida. Voiceover by Erika Mejia & Jennifer Aniston. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Barton JJ. Disorders of higher visual processing. Handbook of clinical neurology. 2011;102:223-61.
Meadows JC and Munro SS. Palinopsia. Journal of neurology, neurosurgery, and psychiatry. 1977;40:5-8.
Radoeva PD, Prasad S, Brainard DH and Aguirre GK. Neural activity within area V1 reflects unconscious visual performance in a case of blindsight. J Cogn Neurosci. 2008;20:1927-39.

#65 Active recovery Jun 22, 2017

This week I am joined by Torie Robinson, a young woman whose life has been affected by her neurologic disease. She was gracious enough to share her story on the podcast, and it is an incredible tale. Importantly, it illustrates the exhaustion and resilience of a patient who has been forced to deal with all the psychosocial consequences of an incurable condition.

Produced by James E. Siegler. Music by Andy Cohen, Josh Woodward, and Steve Combs. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Nimmo-Smith V, Brugha TS, Kerr MP, McManus S, Rai D. Discrimination, domestic violence, abuse, and other adverse life events in people with epilepsy: Population-based study to assess the burden of these events and their contribution to psychopathology. Epilepsia. 2016;57:1870-1878
Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness, Efficiency of Surgery for Temporal Lobe Epilepsy Study G. A randomized, controlled trial of surgery for temporal-lobe epilepsy. The New England journal of medicine. 2001;345:311-318
Jehi L, Friedman D, Carlson C, Cascino G, Dewar S, Elger C, et al. The evolution of epilepsy surgery between 1991 and 2011 in nine major epilepsy centers across the united states, germany, and australia. Epilepsia. 2015;56:1526-1533
Roberts JI, Hrazdil C, Wiebe S, Sauro K, Vautour M, Wiebe N, et al. Neurologists' knowledge of and attitudes toward epilepsy surgery: A national survey. Neurology. 2015;84:159-166
Burneo JG, Shariff SZ, Liu K, Leonard S, Saposnik G, Garg AX. Disparities in surgery among patients with intractable epilepsy in a universal health system. Neurology. 2016;86:72-78

#64 I wonder: The angry patient Jun 15, 2017

Two weeks ago, Dr. Rubenstein and I talked about one of the difficulties of being a doctor. This week, we're shifting gears and the focus is now on the patient. In particular, the angry patient. Dr. Hamedani shares his experience at being the nicest dude in the world, and how he deals with hard-to-deal-with patients.

Produced by James E. Siegler and Erika Mejia. Music by Peter Rudenko, Steve Combs, and Lovira. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making. ...But you can probably learn a lot about how to talk with your patients from Dr. Hamedani. So take some notes. He invented the bedside manner.

#63 Linguistics and neural networking Jun 08, 2017

Dr. Chatterjee returns for this sequel to his prior episode on aphasia. This week, we cover the history and the science of neural networking behind language production and comprehension.

Produced by James E. Siegler. Music by Josh Woodward and Andy Cohen. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Pearce JM. Broca's aphasiacs. Eur Neurol. 2009;61:183-9.
Ajax ET, Schenkenberg T and Kosteljanetz M. Alexia without agraphia and the inferior splenium. Neurology. 1977;27:685-8.
Schiff HB, Alexander MP, Naeser MA and Galaburda AM. Aphemia. Clinical-anatomic correlations. Archives of neurology. 1983;40:720-7.

#62 Giving bad news badly May 31, 2017

When it comes to discussions on patient prognosis, it's easy to give bad news. But doing this well, and doing this with tact, is not so easy. It takes poise and preparation, and much more experience than you might have previously thought. Dr. Mike Rubenstein shares his approach in this installment of BrainWaves.

Produced by James E. Siegler. Music by Andy Cohen, Little Glass Men, and Axeltree. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Baile WF, Buckman R, Lenzi R, Glober G, Beale EA and Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5:302-11.
Fallowfield L and Jenkins V. Communicating sad, bad, and difficult news in medicine. Lancet. 2004;363:312-9.
Ptacek JT and Eberhardt TL. Breaking bad news. A review of the literature. JAMA : the journal of the American Medical Association. 1996;276:496-502.

#61 Is tPA dead? May 25, 2017

With the advent of mechanical thrombectomy, some have argued that using intravenous tissue plasminogen activator for stroke is futile. But is it really? Dr. Sheryl Martin-Schild of Dr. Brain, Inc. joins us for today's episode to discuss if the thrombectomy has killed tPA.

The content in this episode was vetted and approved by Sheryl Martin-Schild. Produced by James E. Siegler. Music by Lee Rosevere, Josh Woodward, Kevin McLeod and Little Glass Men. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The european cooperative acute stroke study (ecass). JAMA : the journal of the American Medical Association. 1995;274:1017-1025
Tissue plasminogen activator for acute ischemic stroke. The national institute of neurological disorders and stroke rt-pa stroke study group. The New England journal of medicine. 1995;333:1581-1587
Saver JL, Gornbein J, Grotta J, Liebeskind D, Lutsep H, Schwamm L, et al. Number needed to treat to benefit and to harm for intravenous tissue plasminogen activator therapy in the 3- to 4.5-hour window: Joint outcome table analysis of the ecass 3 trial. Stroke; a journal of cerebral circulation. 2009;40:2433-2437
Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723-1731
Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: A statement for healthcare professionals from the american heart association/american stroke association. Stroke; a journal of cerebral circulation. 2016;47:581-641
Coutinho JM, Liebeskind DS, Slater LA, Nogueira RG, Clark W, Davalos A, et al. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke: A pooled analysis of the swift and star studies. JAMA Neurol. 2017;74:268-274
Rai AT, Boo S, Buseman C, Adcock AK, Tarabishy AR, Miller MM, et al. Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes. J Neurointerv Surg. 2017

Quanta: Lyme disease May 22, 2017

All you need to know about CNS Lyme disease in 10 minutes or less. More to come in a few weeks when Dr. Colin Quinn shares his experience with what was "definitely not Lyme disease." Stay tuned.

Produced by James E. Siegler. Music by Josh Woodward, Chris Zabriskie, Peter Rudenko, Advent Chamber Orchestra. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

Marques A. Chronic Lyme disease: a review. Infect Dis Clin North Am. 2008;22:341-60, vii-viii.
Marques AR. Lyme Neuroborreliosis. Continuum (Minneap Minn). 2015;21:1729-44.
Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, Krupp L, Gronseth G, Bever CT, Jr. and Quality Standards Subcommittee of the American Academy of N. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69:91-102.

#60 Crowdsourcing in medical care May 18, 2017

If you give a mouse a cookie, he's going to want at least 4 more doctors to help manage his diabetes. And that is what crowdsourcing provides to the worldwide throng of chronic, complex medical cases. It is the 21st century, and if you are unsatisfied with the medical care you are receiving, why not poll the internet for better ideas? In this episode of BrainWaves, Dr. Adam Rodman (Internist from Botswana) and Dr. David Do (Creator of Symcat) share their experience with automating and crowdsourcing medical diagnoses.

BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Given the absence of available data, BrainWaves can neither endorse nor condemn crowdsourcing in healthcare. Pursue at your own risk!

REFERENCES

Dunford E, Trevena H, Goodsell C, Ng KH, Webster J, Millis A, et al. Foodswitch: A mobile phone app to enable consumers to make healthier food choices and crowdsourcing of national food composition data. JMIR Mhealth Uhealth. 2014;2:e37
Ranard BL, Ha YP, Meisel ZF, Asch DA, Hill SS, Becker LB, et al. Crowdsourcing--harnessing the masses to advance health and medicine, a systematic review. Journal of general internal medicine. 2014;29:187-203

#59 Speak of the devil: Aphasia vs. delirium May 11, 2017

Distinguishing aphasia from delirium can be INCREDIBLY difficult in the hospital setting, and a missed diagnosis of aphasia can prove disastrous for patients. In this episode, I get a little help from Johnny Depp (yes, that Johnny Depp) in order to illustrate the major differences between these two disease states.

BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice.

#58 Neurostimulants part 2: Cosmetic neurology & the US military May 04, 2017

Last week we talked about caffeine, and this week we've moved onto cosmetics. But not the outward kind, the inward kind. Dr. Anjan Chatterjee joins us in this segment on how the military and other professions may leverage mind-altering substances in order to enhance performance. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Chatterjee A. Cosmetic neurology: The controversy over enhancing movement, mentation, and mood. Neurology. 2004;63:968-974 2. Lieberman HR, Tharion WJ, Shukitt-Hale B, Speckman KL, Tulley R. Effects of caffeine, sleep loss, and stress on cognitive performance and mood during u.S. Navy seal training. Sea-air-land. Psychopharmacology. 2002;164:250-261

Quanta: Aphasiology Apr 30, 2017

Quantum (noun, pl. quanta): The amount of neurotransmitter stored within a single vesicle of a neuron. It is quantitatively the smallest amount of information that can be transmitted between nerves in the human body. We have hijacked this concept to describe the smallest amount of information we can share with you on a neurology podcast. In this series, which we have called Quanta, we'll be discussing the most fundamental neurologic principles so that our main episodes won't have to. Enjoy! BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice.

#57 Neurostimulants part 1: CAFFEINE! Apr 27, 2017

Yes! Finally an episode dedicated entirely to caffeine! And just how wonderful it is. ...and how wonderful it may not be. In this installment of BrainWaves, you'll hear about how fantastic and how frightful this chemical can be. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Yes, caffeine can be toxic. But so is water. Be smart, do your homework, and remember this is just a podcast--not a guideline for pharmacological management. REFERENCES 1. Nawrot P, Jordan S, Eastwood J, Rotstein J, Hugenholtz A, Feeley M. Effects of caffeine on human health. Food Addit Contam. 2003;20:1-30 2. Ferre S. An update on the mechanisms of the psychostimulant effects of caffeine. J Neurochem. 2008;105:1067-1079 3. Park CA, Kang CK, Son YD, Choi EJ, Kim SH, Oh ST, et al. The effects of caffeine ingestion on cortical areas: Functional imaging study. Magn Reson Imaging. 2014;32:366-371 4. Martin ED, Buno W. Caffeine-mediated presynaptic long-term potentiation in hippocampal ca1 pyramidal neurons. J Neurophysiol. 2003;89:3029-3038 5. Ribeiro JA, Sebastiao AM. Caffeine and adenosine. J Alzheimers Dis. 2010;20 Suppl 1:S3-15 6. Pelchovitz DJ, Goldberger JJ. Caffeine and cardiac arrhythmias: A review of the evidence. The American journal of medicine. 2011;124:284-289

#55 The sickle cell-stroke connection Apr 20, 2017

If you have sickle cell disease, that means you have a 1 in 10 chance of experiencing a stroke before college. And if you don't think that's going to hold you back, you don't know stroke. This week on BrainWaves, Dr. Erica Jones shares her experience with the neurologic complications of sickle cell anemia, and the latest guidelines for managing patients with this condition. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. "Data & Statistics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 31 Aug. 2016. Web. 04 Dec. 2016. 2. Wang WC, Dwan K. Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD003146. DOI: 10.1002/14651858.CD003146.pub2. 3. Motulsky, Arno G. "Frequency of Sickling Disorders in U.S. Blacks." New England Journal of Medicine 288.1 (1973): 31-33. Web. Dec. 2016. 4. Lionnet, F., N. Hammoudi, K. S. Stojanovic, V. Avellino, G. Grateau, R. Girot, and J.-P. Haymann. "Hemoglobin sickle cell disease complications: a clinical study of 179 cases." Haematologica 97.8 (2012): 1136-141. Web. Dec. 2016. 5. Ohene-Frempong K, Weiner SJ, Sleeper LA, Miller ST, Embury S, Moohr JW, Wethers DL, Pegelow CH, Gill FM. “Cerebrovascular accidents in sickle cell disease: rates and risk factors.” Blood. 1998;91(1):288 Dec. 2016. 6. Bang, Oh Young, Miki Fujimura, and Seung-Ki Kim. "The Pathophysiology of Moyamoya Disease: An Update." Journal of Stroke 18.1 (2016): 12-20. Web. Dec. 2016. 7. Gueguen, Antoine, Matthieu Mahevas, Ruben Nzouakou, Hassan Hosseini, Anoosha Habibi, Dora Bachir, Pierre Brugière, François Lionnet, Jean-Antoine Ribeil, Bertrand Godeau, Robert Girot, Vahid Ibrahima, David Calvet, Frédéric Galactéros, and Pablo Bartolucci. "Sickle-cell disease stroke throughout life: A retrospective study in an adult referral center." American Journal of Hematology 89.3 (2014): 267-72. Web. Dec. 2016. 8. Scott, R. Michael, and Edward R. Smith. "Moyamoya Disease and Moyamoya Syndrome." New England Journal of Medicine 360.12 (2009): 1226-237. Web. Dec. 2016. 9. Switzer, Jeffrey A., David C. Hess, Fenwick T. Nichols, and Robert J. Adams. "Pathophysiology and treatment of stroke in sickle-cell disease: present and future." The Lancet Neurology 5.6 (2006): 501-12. Web. Dec. 2016. 10. Verduzco, L. A., and D. G. Nathan. "Sickle cell disease and stroke." Blood 114.25 (2009): 5117-125. Web. Dec. 2016. 11. Ware, R. E., and R. W. Helms. "Stroke With Transfusions Changing to Hydroxyurea (SWiTCH)." Blood 119.17 (2012): 3925-932. Web. Dec. 2016. 12. Strouse, John J., Sophie Lanzkron, and Victor Urrutia. "The epidemiology, evaluation and treatment of stroke in adults with sickle cell disease." Expert Review of Hematology 4.6 (2011): 597-606. Web. Dec. 2016.

#54 To thymectomize or Not to thymectomize...That is the question Apr 13, 2017

"Though this be madness, yet there is method in't." Shakespeare didn't know it, but he was already talking about thymectomy in Hamlet. In this week's BrainWaves episode, you'll hear about the pharmacologic fundamentals, and the most recent guidelines for treatment of myasthenia. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Schneider-Gold C, Gajdos P, Toyka KV and Hohlfeld RR. Corticosteroids for myasthenia gravis. The Cochrane database of systematic reviews. 2005:CD002828. 2. Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, Marx A, Strobel P, Mazia C, Oger J, Cea JG, Heckmann JM, Evoli A, Nix W, Ciafaloni E, Antonini G, Witoonpanich R, King JO, Beydoun SR, Chalk CH, Barboi AC, Amato AA, Shaibani AI, Katirji B, Lecky BR, Buckley C, Vincent A, Dias-Tosta E, Yoshikawa H, Waddington-Cruz M, Pulley MT, Rivner MH, Kostera-Pruszczyk A, Pascuzzi RM, Jackson CE, Garcia Ramos GS, Verschuuren JJ, Massey JM, Kissel JT, Werneck LC, Benatar M, Barohn RJ, Tandan R, Mozaffar T, Conwit R, Odenkirchen J, Sonett JR, Jaretzki A, 3rd, Newsom-Davis J, Cutter GR and Group MS. Randomized Trial of Thymectomy in Myasthenia Gravis. The New England journal of medicine. 2016;375:511-22.

#53 Teaching through clinical cases: A young woman with seizures and altered mental status Apr 06, 2017

I have my own methods for conceptualizing altered mental status. But you already heard them in episode 46. This week on BrainWaves, take a wider view of this type of consult from the perspective of an internist. Dr. Fima Macheret takes the mic on this case of a young woman with seizures and encephalopathy. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. The content in this episode was approved by Dr. Fima Macheret. REFERENCES 1. Aagaard-Tillery KM and Belfort MA. Eclampsia: morbidity, mortality, and management. Clin Obstet Gynecol. 2005;48:12-23. 2. Duley L, Henderson-Smart DJ, Walker GJ and Chou D. Magnesium sulphate versus diazepam for eclampsia. The Cochrane database of systematic reviews. 2010:CD000127.

#56 April Fools Day Special Apr 01, 2017

It is April 1st, 2017. Otherwise known as April Fools Day. But it doesn't have to be April 1st for you to be tricked by your neurology patient. In this week's episode of BrainWaves, we go over some of the ways to avoid being fooled the next time around. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice.

#52 Therapeutic uses of botulinum toxin Mar 23, 2017

Yes, we have harnessed the power of paralysis. Botulinum toxin, which is produced by a lethal bacterium, Clostridium botulinum, has been bottled and sold to neurologists for decades. And you know this because you've seen people who received Botox to relax their facial muscles. In this week's installment, Dr. Anh-Thu Vu discusses how neurologists utilize this neurotoxic agent. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. The content in this episode was vetted and approved by Anh-Thu Vu. REFERENCES 1. Arnon SS, Schechter R, Inglesby T V, et al. Botulinum toxin as a biological weapon: medical and public health management. JAMA. 2001;285(8):1059-1070. 2. Thenganatt MA, Fahn S. Botulinum toxin for the treatment of movement disorders. Curr Neurol Neurosci Rep. 2012;12(4):399-409. doi:10.1007/s11910-012-0286-3. 3. Aurora SK, Winner P, Freeman MC, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache. 2011;51(9):1358-1373. doi:10.1111/j.1526-4610.2011.01990.x. 4. Dauer WT, Burke RE, Greene P, Fahn S. Current concepts on the clinical features, aetiology and management of idiopathic cervical dystonia. Brain. 1998;121 (Pt 4):547-560. 5. Karp BI. Botulinum toxin treatment of occupational and focal hand dystonia. Mov Disord. 2004;19 Suppl 8:S116-S119. doi:10.1002/mds.20025. 6. Elia AE, Filippini G, Calandrella D, Albanese A. Botulinum neurotoxins for post-stroke spasticity in adults: a systematic review. Mov Disord. 2009;24(6):801-812. doi:10.1002/mds.22452. 7. Naumann M, Dressler D, Hallett M, et al. Evidence-based review and assessment of botulinum neurotoxin for the treatment of secretory disorders. Toxicon. 2013;67:141-152. doi:10.1016/j.toxicon.2012.10.020. 8. Lotia M, Jankovic J. Botulinum Toxin for the Treatment of Tremor and Tics. Semin Neurol. 2016;36(1):54-63. doi:10.1055/s-0035-1571217.

#51 Teaching through clinical cases: A Hodgkin survivor with progressive ataxia Mar 16, 2017

Clumsiness can be hard to localize. But in a patient with a remote history of cancer, you should be suspicious for a number of things. In this week's clinical case, we discuss a patient who was cured of Hodgkins Lymphoma but returns with progressive dysmetria. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. The content in this episode was vetted and approved by Joseph Berger. REFERENCES 1. Bellizzi A, Anzivino E, Rodio DM, et al. New insights on human polyomavirus JC and pathogenesis of progressive multifocal leukoencephalopathy. Clin Dev Immunol 2013;1-17. 2. Garcia-Suarez J, de Miguel D, Krsnik I, et al. Changes in the natural history of progressive multifocal leukoencephalopathy in HIV-negative lymphoproliferative disorders: Impact of novel therapies. Am J Hematol 2005;80(4):271-81. 3. Felli V, DiSibio A, Anselmi M, et al. Progressive multifocal leukoencephalopathy following treatment with Rituximab in an HIV-negative patient with non-Hodgkin lymphoma: A case report and literature review. Neuroradiol J 2014;27(6):657-64. 4. Van Assche G, Van Ranst M, Sciot R, et al. Progressive multifocal leukoencephalopathy after natalizumab therapy for Crohn’s disease. N Engl J Med 2005;353:362-8. 5. Abate G, Corazzelli G, Ciarmiello A, et al. Neurologic complications of Hodgkin’s disease: A case history. Ann Oncol 1997;8(6):593-600. 6. Hoppe RT, Advani RH, Bierman PJ, et al. Hodgkin disease/lymphoma. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2006;4(3):210-30. 7. Pavlovic D, Patera AC, Nyberg F, et al. Progresive multifocal leukoencephalopathy: current treatment options and future perspectives 2015;8(6):255-73. 8. Cettomai D and McArthur JC. Mirtazapine use in human immunodeficiency virus-infected patients with progressive multifocal leukoencephalopathy. Arch Neurol 2009(2):255-258. 9. Alstadhaug KB, Croughs T, Henriksen S, et al. Treatment of progressive multifocal leukoencephalopathy with interleukin 7. JAMA Neurol 2014;71(8):1030-35.

#50 The large vessel is the best vessel Mar 10, 2017

I can't imagine a better way to celebrate our FIFTIETH episode than to discuss my favorite subject: Large vessel disease. Although we only cover one aspect of this stroke mechanism--atherosclerosis--and technically many of these trials may be somewhat outdated, the matter discussed in this episode remains the most up-to-date in the field. Take a listen. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Chaturvedi S, Bruno A, Feasby T, Holloway R, Benavente O, Cohen SN, Cote R, Hess D, Saver J, Spence JD, Stern B, Wilterdink J, Therapeutics and Technology Assessment Subcommittee of the American Academy of N. Carotid endarterectomy--an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005;65:794-801. 2. Kakkos SK, Nicolaides AN, Charalambous I, Thomas D, Giannopoulos A, Naylor AR, Geroulakos G, Abbott AL, Asymptomatic Carotid S and Risk of Stroke Study G. Predictors and clinical significance of progression or regression of asymptomatic carotid stenosis. J Vasc Surg. 2014;59:956-967 e1. 3. Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, Warlow CP, Barnett HJ and Carotid Endarterectomy Trialists C. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003;361:107-16. 4. Hosseini AA, Kandiyil N, Macsweeney ST, Altaf N and Auer DP. Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke. Annals of neurology. 2013;73:774-84. 5. Lovett JK, Coull AJ and Rothwell PM. Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies. Neurology. 2004;62:569-73. 6. Mantese VA, Timaran CH, Chiu D, Begg RJ, Brott TG and Investigators C. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke; a journal of cerebral circulation. 2010;41:S31-4. 7. Jauch EC, Saver JL, Adams HP, Jr., Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW, Jr., Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H, American Heart Association Stroke C, Council on Cardiovascular N, Council on Peripheral Vascular D and Council on Clinical C. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2013;44:870-947. 8. Chambers BR and Donnan GA. Carotid endarterectomy for asymptomatic carotid stenosis. The Cochrane database of systematic reviews. 2005:CD001923.

#49 Intro to CSF analysis Mar 02, 2017

It may look like water, but CSF is anything but. In this week's episode of BrainWaves, we discuss the contents of CSF and how to interpret them. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Frederiks JA and Koehler PJ. The first lumbar puncture. J Hist Neurosci. 1997;6:147-53. 2. Seehusen DA, Reeves MM and Fomin DA. Cerebrospinal fluid analysis. Am Fam Physician. 2003;68:1103-8. 3. Shah KH and Edlow JA. Distinguishing traumatic lumbar puncture from true subarachnoid hemorrhage. J Emerg Med. 2002;23:67-74. 4. Deisenhammer F, Bartos A, Egg R, Gilhus NE, Giovannoni G, Rauer S, Sellebjerg F and Force ET. Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2006;13:913-22. 5. Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Hausler M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, Brown WD, Terborg C and Gilden DH. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology. 2008;70:853-60. 6. Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL and Dominguez SR. Acute flaccid myelitis: A clinical review of US cases 2012-2015. Annals of neurology. 2016;80:326-38.

#48 Neuroimaging features of Idiopathic Intracranial Hypertension Feb 23, 2017

Idiopathic intracranial hypertension, also known as the pseudotumor cerebri syndrome, is characterized by elevated intracranial pressure with clinical features of headaches, vision impairment, and occasionally cranial nerve palsies in the absence of a structural lesion on neuroimaging. But that doesn't mean the neuroimaging has to be normal. See what Dr. Anita Kohli has to say about the radiographic correlates of IIH, their relevance, and their prognostic utility in this week's episode. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Friedman DI, Liu GT and Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81:1159-65. 2. Bidot S and Bruce BB. Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension. Semin Neurol. 2015;35:527-38. 3. Agid R, Farb RI, Willinsky RA, Mikulis DJ and Tomlinson G. Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology. 2006;48:521-7. 4. Bidot S, Saindane AM, Peragallo JH, Bruce BB, Newman NJ and Biousse V. Brain Imaging in Idiopathic Intracranial Hypertension. J Neuroophthalmol. 2015;35:400-11. 5. Bidot S, Clough L, Saindane AM, Newman NJ, Biousse V and Bruce BB. The Optic Canal Size Is Associated With the Severity of Papilledema and Poor Visual Function in Idiopathic Intracranial Hypertension. J Neuroophthalmol. 2016;36:120-5. 6. Zagardo MT, Cail WS, Kelman SE and Rothman MI. Reversible empty sella in idiopathic intracranial hypertension: an indicator of successful therapy? AJNR American journal of neuroradiology. 1996;17:1953-6.

#47 Holy osmosis!! Feb 16, 2017

In 1959, Adams and colleagues described a few patients who developed a rapid flaccid quadriparesis following fluid resuscitation for malnutrition and chronic alcoholism. Twenty years later, we learned that this occurs as a consequence of rapid correction of hyponatremia. But this isn't the only cause of the osmotic demyelination syndrome... Hear Dr. Joshua VanDerWerf discuss the history and clinical relevance of this unusual critical care scenario. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Adams RA, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholics and malnourished patients. Arch Neurol Psychiatry 1959;81:154–72. 2. Gocht A, Colmant HJ. Central pontine and extrapontine myelinolysis: a report of 58 cases. Clin Neuropathol. 1987 Nov-Dec;6(6):262-70. 3. Kleinschmidt-Demasters BK, Rojiani AM, Filley CM. Central and extrapontine myelinolysis: then...and now. J Neuropathol Exp Neurol. 2006 Jan;65(1):1-11. 4. Martin RJ. Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry. 2004;75 Suppl 3:iii22-8. 5. Menger H, Jorg J. Outcome of central pontine and extrapontine myelinolysis. J Neurol 1999;246:700–5. 6. Siegler JE, Wang AR, Vanderwerf JD. Normonatremic osmotic demyelination in the setting of acquired immune deficiency syndrome and malnutrition: case report and literature review. J Neurovirol. 2016 Jul 12. 7. Wright DG, Laureno R, Victor M. Pontine and extrapontine myelinolysis. Brain. 1979 Jun;102(2):361-85.

#46 The neuro consult for altered mental status Feb 09, 2017

The request for a consult is like calling in a favor. You shouldn't actually expect the consultant to do it, you should be polite and helpful in all the ways your grandmother expects you to behave. At least that's the courtesy I've seen from really spectacular providers. In this week's episode, we not only review the proper etiquette for calling a consult, but you'll also hear some pearls on the workup for altered mental status. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES None this week. (Sorry!)

#45 Teaching through clinical cases: Status epilepticus Feb 02, 2017

It may come as a surprise to you, but patients who seize...will seize. And in this week's episode, we talk about the fundamentals in working up a patient who presents in status epilepticus. So SEIZE the opportunity to learn from Dr. Chloe Hill as she navigates us through this week's Teaching through Clinical Cases. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. The content in this episode was vetted and approved by Chloe Hill. REFERENCES 1. Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ, Handforth A, Faught E, Calabrese VP, Uthman BM, Ramsay RE and Mamdani MB. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. The New England journal of medicine. 1998;339:792-8. 2. Claassen J, Hirsch LJ, Emerson RG and Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002;43:146-53. 3. Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ and Fitzsimmons BF. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Archives of neurology. 2002;59:205-10.

#44 Transient monocular vision loss Jan 26, 2017

Although you should not confuse this with amaurosis fugax, a transient loss of vision in one eye usually screams vascular event. But not always... Keep an eye out for how the plot thickens in this week's episode of BrainWaves. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. The content in this episode was vetted and approved by Imran Jivraj. REFERENCES 1. Biousse V and Trobe JD. Transient monocular visual loss. Am J Ophthalmol. 2005;140:717-21. 2. Kattah JC, Wang DZ and Reddy C. Intravenous recombinant tissue-type plasminogen activator thrombolysis in treatment of central retinal artery occlusion. Arch Ophthalmol. 2002;120:1234-6. 3. Schumacher M, Schmidt D, Jurklies B, Gall C, Wanke I, Schmoor C, Maier-Lenz H, Solymosi L, Brueckmann H, Neubauer AS, Wolf A, Feltgen N and Group EA-S. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial. Ophthalmology. 2010;117:1367-75 e1. 4. Ravits J and Seybold ME. Transient monocular visual loss from narrow-angle glaucoma. Archives of neurology. 1984;41:991-3.

#43 Stranger causes of intracerebral hemorrhage Jan 19, 2017

Trauma and hypertension account for the overwhelming majority of cases of intracerebral hemorrhage. Today, we address the minority. In this week's episode, Dr. Steven Messe discusses the atypical causes of ICH and how they are managed. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Biffi A and Greenberg SM. Cerebral amyloid angiopathy: a systematic review. J Clin Neurol. 2011;7:1-9. 2. Gilden D, Cohrs RJ, Mahalingam R and Nagel MA. Varicella zoster virus vasculopathies: diverse clinical manifestations, laboratory features, pathogenesis, and treatment. The Lancet Neurology. 2009;8:731-40. 3. Mast H, Young WL, Koennecke HC, Sciacca RR, Osipov A, Pile-Spellman J, Hacein-Bey L, Duong H, Stein BM and Mohr JP. Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet. 1997;350:1065-8. 4. Ruiz-Sandoval JL, Cantu C and Barinagarrementeria F. Intracerebral hemorrhage in young people: analysis of risk factors, location, causes, and prognosis. Stroke; a journal of cerebral circulation. 1999;30:537-41. 5. Siegler JE and Ichord RN. Teaching NeuroImages: Multicompartmental intracranial hemorrhage in a pediatric patient. Neurology. 2016;87:e284.

#42 There's more to the facial nerve than Bell's Palsy Jan 12, 2017

Yeah, we talk about Bell's Palsy here. A lot actually. But there's also hemifacial spasm, blepharospasm, facial myokimia, and pathologic sialorrhea as it pertains to neurodegenerative disease. Not to mention the facial nerve anatomy! Sit down and buckle up, you may want to take notes on this one. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. REFERENCES 1, Gilden DH. Clinical practice. Bell's Palsy. The New England journal of medicine. 2004;351:1323-31. 2. Sweeney CJ and Gilden DH. Ramsay Hunt syndrome. Journal of neurology, neurosurgery, and psychiatry. 2001;71:149-54. 3. Gaio E, Marioni G, de Filippis C, Tregnaghi A, Caltran S and Staffieri A. Facial nerve paralysis secondary to acute otitis media in infants and children. J Paediatr Child Health. 2004;40:483-6.

#41 Teaching through clinical cases: Not-quite-so-septic meningitis Jan 05, 2017

This week's BrainWaves episode features a case of a middle-aged woman with progressive headache and cranial neuropathies. The diagnosis of aseptic meningitis is made and a differential diagnosis is illustrated. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. REFERENCES 1. Nigrovic LE. Aseptic meningitis. Handbook of clinical neurology. 2013;112:1153-6. 2. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB and Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. The New England journal of medicine. 2004;351:1849-59. 3. Hasbun R, Abrahams J, Jekel J and Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. The New England journal of medicine. 2001;345:1727-33. 4. Lee BE, Chawla R, Langley JM, Forgie SE, Al-Hosni M, Baerg K, Husain E, Strong J, Robinson JL, Allen U, Law BJ, Dobson S and Davies HD. Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of aseptic meningitis. BMC Infect Dis. 2006;6:68. 5. Negrini B, Kelleher KJ and Wald ER. Cerebrospinal fluid findings in aseptic versus bacterial meningitis. Pediatrics. 2000;105:316-9. 6. Logan SA and MacMahon E. Viral meningitis. Bmj. 2008;336:36-40. 7. Ginsberg L and Kidd D. Chronic and recurrent meningitis. Pract Neurol. 2008;8:348-61. 8. Jolles S, Sewell WA and Leighton C. Drug-induced aseptic meningitis: diagnosis and management. Drug Saf. 2000;22:215-26. 9. Chamberlain MC and Glantz M. Myelomatous meningitis. Cancer. 2008;112:1562-7. 10. Nieuwenhuizen L and Biesma DH. Central nervous system myelomatosis: review of the literature. Eur J Haematol. 2008;80:1-9. 11. Sobol U and Stiff P. Neurologic aspects of plasma cell disorders. Handbook of clinical neurology. 2014;120:1083-99.

#40 Teaching through clinical cases: Wrist drop Dec 29, 2016

This week, I'm handing the mic over to Dr. Laura Mainardi so she can give us some pointers on the evaluation of hand weakness. We're thumbing through a few tips on working up wrist drop in particular. Hoping you give us two thumbs up on this one! ;-) BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Preston DC & Shapiro BE. Electromyography and neuromuscular disorders, 3rd ed. Saunders (2013).

#39 What doesn't scare you about prions makes you stronger Dec 22, 2016

Prions are perhaps some of the most terrifying infectious particles known to man. But did you know that patients with some prion diseases actually shed these contagious proteins in their urine? These and other facts about prion diseases are discussed in this week's episode of BrainWaves. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Zabel MD and Reid C. A brief history of prions. Pathog Dis. 2015;73:ftv087. 2. Geschwind MD. Prion Diseases. Continuum (Minneap Minn). 2015;21:1612-38. 3. Rutala WA and Weber DJ. Creutzfeldt-Jakob disease: recommendations for disinfection and sterilization. Clin Infect Dis. 2001;32:1348-56. 4. Glatzel M, Abela E, Maissen M and Aguzzi A. Extraneural pathologic prion protein in sporadic Creutzfeldt-Jakob disease. The New England journal of medicine. 2003;349:1812-20. 5. Moda F, Gambetti P, Notari S, Concha-Marambio L, Catania M, Park KW, Maderna E, Suardi S, Haik S, Brandel JP, Ironside J, Knight R, Tagliavini F and Soto C. Prions in the urine of patients with variant Creutzfeldt-Jakob disease. The New England journal of medicine. 2014;371:530-9. 6. Wieser HG, Schindler K and Zumsteg D. EEG in Creutzfeldt-Jakob disease. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2006;117:935-51. 7. Lapergue B, Demeret S, Denys V, Laplanche JL, Galanaud D, Verny M, Sazdovitch V, Baulac M, Haik S, Hauw JJ, Bolgert F, Brandel JP and Navarro V. Sporadic Creutzfeldt-Jakob disease mimicking nonconvulsive status epilepticus. Neurology. 2010;74:1995-9. 8. Siegler JE, Jacobs DA, Amado D, Adams JL and Berger JR. Rapidly progressive dementia with hypoglycorrhachia. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2015;22:1685-7.

#38 Acute flaccid myelitis Dec 15, 2016

I am not sure there are many more things terrifying than watching your child experience what looks like, just a cold, and then over the course of a few hours becomes paralyzed. In this episode, Drs. Ana Cristancho and Sarah Hopkins describe what we know about this recent polio-like outbreak in the US. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. This episode was vetted and approved by Dr. Sarah Hopkins. REFERENCES 1. Aliabadi N, Messacar K, Pastula DM, Robinson CC, Leshem E, Sejvar JJ, Nix WA, Oberste MS, Feikin DR and Dominguez SR. Enterovirus D68 Infection in Children with Acute Flaccid Myelitis, Colorado, USA, 2014. Emerg Infect Dis. 2016;22:1387-94. 2. Greninger AL, Naccache SN, Messacar K, Clayton A, Yu G, Somasekar S, Federman S, Stryke D, Anderson C, Yagi S, Messenger S, Wadford D, Xia D, Watt JP, Van Haren K, Dominguez SR, Glaser C, Aldrovandi G and Chiu CY. A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012-14): a retrospective cohort study. Lancet Infect Dis. 2015;15:671-82. 3. Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL and Dominguez SR. Acute flaccid myelitis: A clinical review of US cases 2012-2015. Annals of neurology. 2016;80:326-38.

#36 Teaching through clinical cases: Acute vestibular syndrome Dec 08, 2016

The acute vestibular syndrome is easy enough to identify, but it can be a challenge to diagnose. In this week's episode of BrainWaves, Dr. Ali Hamedani tries to simplify the approach to acute, intermittent, and chronic complaints of dizziness. Updated and remastered January 2019.

REFERENCES

1. Kerber KA. Acute constant dizziness. Continuum (Minneap Minn). 2012;18:1041-59.

2. Lempert T. Vestibular migraine. Semin Neurol. 2013;33:212-8.

3. Kim JS and Zee DS. Clinical practice. Benign paroxysmal positional vertigo. The New England journal of medicine. 2014;370:1138-47.

#35 Levodopa: A history Dec 01, 2016

For those of you who've witnessed it, giving levodopa to a patient with idiopathic Parkinson Disease is almost a miracle to watch. Unlike practically every other condition afflicting the nervous system, the unmistakable unrest of PD essentially surrenders to this tiny tablet. But what did we use before levodopa? In this week's episode of BrainWaves, we recount the history (and serendipity) behind the development of this miracle drug. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Parkinson J. An essay on the shaking palsy. 1817. J Neuropsychiatry Clin Neurosci. 2002;14:223-36; discussion 222. 2. Glatstein M, Alabdulrazzaq F and Scolnik D. Belladonna Alkaloid Intoxication: The 10-Year Experience of a Large Tertiary Care Pediatric Hospital. Am J Ther. 2016;23:e74-7. 3. Koranyi EK. A preamble on parkinsonism. J Psychiatry Neurosci. 1999;24:296-9. 4. Bucy P and Case T. Tremor: Physiologic mechanism and abolition by surgical means. Arch Neurol Psych. 1939;41:721-746. 5. Walter BL, Abosch A and Vitek JL. From Neuroscience to Neurology: Molecular Medicine, and the Therapeutic Transformation of Neurology 2004. 6. Hornykiewicz O. A brief history of levodopa. Journal of neurology. 2010;257:S249-52. 7. Tolosa E, Marti MJ, Valldeoriola F and Molinuevo JL. History of levodopa and dopamine agonists in Parkinson's disease treatment. Neurology. 1998;50:S2-10; discussion S44-8. 8. Birkmayer W and Hornykiewicz O. [The L-3,4-dioxyphenylalanine (DOPA)-effect in Parkinson-akinesia]. Wien Klin Wochenschr. 1961;73:787-8. 9. Cotzias GC, Van Woert MH and Schiffer LM. Aromatic amino acids and modification of parkinsonism. The New England journal of medicine. 1967;276:374-9. 10. Willis AW, Schootman M, Kung N, Wang XY, Perlmutter JS and Racette BA. Disparities in deep brain stimulation surgery among insured elders with Parkinson disease. Neurology. 2014;82:163-71.

#37 You are what you eat/Happy Thanksgiving Nov 24, 2016

This Thanksgiving, amidst all the turkey, the stuffing, the cranberry sauce, the ham, and the cornucopia of dessert options, you may be inclined to let the food coma sink in. But for those interested in the science behind this fanciful feast, listen to what Dr. Jason Maley has to say about the neurologic complications of some of the common dishes served at your holiday spread. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Williams ES. Chronic wasting disease. Veterinary Pathology Online. 2005; 42(5):530-49. 2. Clauss HE, Lorber B. Central nervous system infection with Listeria monocytogenes. Current infectious disease reports. 2008; 10(4):300-6. 3. Garcia HH, Del Brutto OH, Cysticercosis Working Group in Peru. Neurocysticercosis: updated concepts about an old disease. The Lancet Neurology. 2005; 4(10):653-61. 4. Richard DM, Dawes MA, Mathias CW, Acheson A, Hill-Kapturczak N, Dougherty DM. L-tryptophan: basic metabolic functions, behavioral research and therapeutic indications. International journal of tryptophan research: IJTR. 2009; 23(2):45. 5. Sobel J. Botulism. Clinical Infectious Diseases. 2005; 41(8):1167-73. 6. Caruana M, Cauchi R, Vassallo N. Putative role of red wine polyphenols against brain pathology in Alzheimer’s and Parkinson’s disease. Frontiers in Nutrition. 2016; 3. 7. Hillbom M, Saloheimo P, Fujioka S, Wszolek ZK, Juvela S, Leone MA. Diagnosis and management of Marchiafava–Bignami disease: a review of CT/MRI confirmed cases. Journal of Neurology, Neurosurgery & Psychiatry. 2013.

#34 The ALS multi-disciplinary clinic Nov 17, 2016

Like many other diseases of the nervous system, amyotrophic lateral sclerosis is not a diagnosis you want to receive in the neurology clinic. But once the diagnosis is made, quality of life supersedes quantity of life. Many academic and private hospitals provide a multi-disciplinary ALS clinic to meet the needs of their patients and their loved ones. In this BrainWaves episode, Dr. Lauren Elman discusses her experience with the multidisciplinary ALS clinic at Pennsylvania Hospital. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. This episode was vetted and approved by Lauren Elman. REFERENCES 1. Miller RG, Jackson CE, Kasarskis EJ, England JD, Forshew D, Johnston W, Kalra S, Katz JS, Mitsumoto H, Rosenfeld J, Shoesmith C, Strong MJ, Woolley SC and Quality Standards Subcommittee of the American Academy of N. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009;73:1227-33. 2. Miller RG, Jackson CE, Kasarskis EJ, England JD, Forshew D, Johnston W, Kalra S, Katz JS, Mitsumoto H, Rosenfeld J, Shoesmith C, Strong MJ, Woolley SC and Quality Standards Subcommittee of the American Academy of N. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009;73:1218-26.

#33 Controversies in chronic traumatic encephalopathy Nov 10, 2016

Even before the release of the 2015 film, Concussion, there has been a rising concern about mild traumatic brain injury in athletes in recent years. In this week's episode of BrainWaves, we discuss the history of mild TBI and the clinicopathologic concept of chronic traumatic encephalopathy as it pertains to football players. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Montenigro PH, Corp DT, Stein TD, Cantu RC and Stern RA. Chronic traumatic encephalopathy: historical origins and current perspective. Annu Rev Clin Psychol. 2015;11:309-30. 2. Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, Gronseth GS, Guskiewicz K, Mandel S, Manley G, McKeag DB, Thurman DJ and Zafonte R. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80:2250-7. 3. Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Cantu RC, Randolph C and Jordan BD. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005;57:719-26; discussion 719-26. 4. Stamm JM, Bourlas AP, Baugh CM, Fritts NG, Daneshvar DH, Martin BM, McClean MD, Tripodis Y and Stern RA. Age of first exposure to football and later-life cognitive impairment in former NFL players. Neurology. 2015;84:1114-20.

#32 Oral therapies for idiopathic Parkinson Disease Nov 03, 2016

Idiopathic Parkinson Disease (PD) is the second most common cause of neurodegenerative disease following Alzheimer's. The risk of PD increases to nearly 1 in 100 in the elderly, and although we have been pharmacologically treating this disorder since the early nineteenth century, we have no cure and no definitely therapy to delay disease progression. In this episode of BrainWaves, Dr. David Coughlin illustrates how some of these therapies have evolved and which classes of medications to choose when managing a patient's symptoms--from tremor to dystonia. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was vetted and approved by Andres Deik. REFERENCES 1. Elias, W. Jeffrey, et al. "A randomized trial of focused ultrasound thalamotomy for essential tremor." New England Journal of Medicine 375.8 (2016): 730-739. 2. Hoehn, Margaret M., and Melvin D. Yahr. "Parkinsonism: onset, progression, and mortality." Neurology 50.2 (1998): 318-318. Hely, Mariese A., et al. "The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years." Movement Disorders 23.6 (2008): 837-844. 3. McIntyre, Cameron C., et al. "Uncovering the mechanism (s) of action of deep brain stimulation: activation, inhibition, or both." Clinical neurophysiology 115.6 (2004): 1239-1248. 4. Olanow, C. Warren. "Levodopa: effect on cell death and the natural history of Parkinson's disease." Movement Disorders 30.1 (2015): 37-44. 5. Parkinson Study Group. "Levodopa and the progression of Parkinson's disease." N Engl J Med 2004.351 (2004): 2498-2508. 6. Parkinson Study Group. "A randomized controlled trial comparing pramipexole with levodopa in early Parkinson's disease: design and methods of the CALM-PD Study." Clinical neuropharmacology 23.1 (2000): 34-44. 7. PD Med Collaborative Group. "Long-term effectiveness of dopamine agonists and monoamine oxidase B inhibitors compared with levodopa as initial treatment for Parkinson's disease (PD MED): a large, open-label, pragmatic randomised trial." The Lancet 384.9949 (2014): 1196-1205. 8. Weaver, Frances M., et al. "Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial." Jama 301.1 (2009): 63-73.

#31 Patient-provider interactions Oct 27, 2016

This week, we are taking a break from educational neurology and will be stressing the importance of collaboration between patients and physicians. Physicians are critical to healthcare because of their expertise and experience, but medical management is a team sport. It is equally important to incorporate the patient's needs and opinions into the equation. But this leaves us with the concept of "therapeutic privilege," specifically how much does the physician need to tell the patient about his or her own health? In this episode, Jim Siegler steps into the shoes of one of his good friends who has faced a recent cancer diagnosis. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Patrick Green, the patient in this episode, has consented to the discussion of his medical care for the purpose of this broadcast and we are sincerely grateful for his contribution. REFERENCES 1. Epstein RM, Korones DN and Quill TE. Withholding information from patients--when less is more. The New England journal of medicine. 2010;362:380-1.

#30 GBS: From variants to vaccines Oct 20, 2016

The Landry-Guillain-Barre-Strohl Syndrome, aka Guillain-Barre Syndrome, is classically thought of as a painless ascending weakness with areflexia that typically follows an infectious prodrome. But there are a dozen variants with unusual clinical presentations, from back pain to pandysautonomia. And sometimes GBS follows a vaccination rather than viral infection. In this BrainWaves episode, we discuss these and other unique facts regarding the history, clinical manifestations, and treatment of this polyneuropathy. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. REFERENCES 1. Dimachkie MM and Saperstein DS. Acquired immune demyelinating neuropathies. Continuum (Minneap Minn). 2014;20:1241-60. 2. Asbury AK. Guillain-Barre syndrome: historical aspects. Annals of neurology. 1990;27 Suppl:S2-6. 3. Afifi AK. The landry-guillain-barre strohl syndrome 1859 to 1992 a historical perspective. J Family Community Med. 1994;1:30-4. 4. Bril V and Katzberg HD. Acquired immune axonal neuropathies. Continuum (Minneap Minn). 2014;20:1261-73. 5. Iodice V and Sandroni P. Autonomic neuropathies. Continuum (Minneap Minn). 2014;20:1373-97. 6. Lehmann HC, Hartung HP, Kieseier BC and Hughes RA. Guillain-Barre syndrome after exposure to influenza virus. Lancet Infect Dis. 2010;10:643-51. 7. Tam CC, O'Brien SJ, Petersen I, Islam A, Hayward A and Rodrigues LC. Guillain-Barre syndrome and preceding infection with campylobacter, influenza and Epstein-Barr virus in the general practice research database. PloS one. 2007;2:e344.

#29 Not-so-benign essential tremor Oct 13, 2016

Once heralded as "benign" essential tremor, this movement disorder is anything but. And you can see this when you talk with your neurology patients about the difficulties they encounter with dressing, eating, and even speaking. Not to mention the social stigmata and cognitive dysfunction. In this BrainWaves episode, we start by describing the fundamentals of tremor and move on to the clinical features, pharmacology, and prognosis of ET. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. REFERENCES 1. Deuschl G, Raethjen J, Hellriegel H and Elble R. Treatment of patients with essential tremor. The Lancet Neurology. 2011;10:148-61. 2. Louis ED. Diagnosis and Management of Tremor. Continuum (Minneap Minn). 2016;22:1143-58. 3. Sandvik U, Koskinen LO, Lundquist A and Blomstedt P. Thalamic and subthalamic deep brain stimulation for essential tremor: where is the optimal target? Neurosurgery. 2012;70:840-5; discussion 845-6. 4. Zesiewicz TA, Elble R, Louis ED, Hauser RA, Sullivan KL, Dewey RB, Jr., Ondo WG, Gronseth GS, Weiner WJ and Quality Standards Subcommittee of the American Academy of N. Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2005;64:2008-20.

#28 How American neurology was born Oct 06, 2016

From the "gilded age" to the "germ theory", Dr. Joshua VanDerWerf (physician, historian, humanitarian), illustrates the birth of American neurology. You may recognize the names Chiari, Wernicke, and Broca, but what about William Alexander Hammond or Silas Weir Mitchell? These figures, among others, and their contributions to neurology are the subject of this week's BrainWaves episode. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Goetz CG, Chmura TA, Lanska D. Part 1: the history of 19th century neurology and the American Neurological Association. Ann Neurol. 2003;53 Suppl 4:S2-S26. 2. Koehler PJ1, Lanska DJ. Mitchell's influence on European studies of peripheral nerve injuries during World War I. J Hist Neurosci. 2004 Dec;13(4):326-35. 3. Lanska DJ1. Characteristics and lasting contributions of 19th-century American neurologists. J Hist Neurosci. 2001 Aug;10(2):202-16.

#27 Heavy metal poisoning Sep 29, 2016

Heavy metal poisoning is increasingly rare in the US, but in patients with multi-organ dysfunction and unclear exposure history, you should be suspicious. In this episode of BrainWaves, we discuss the most common metals associated with central and peripheral nerve dysfunction, the symptoms they produce, imaging features, and treatment. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. This episode was vetted and approved by Francis DeRoos. REFERENCES 1. Staff NP and Windebank AJ. Peripheral neuropathy due to vitamin deficiency, toxins, and medications. Continuum (Minneap Minn). 2014;20:1293-306. 2. Cao Y, Skaug MA, Andersen O and Aaseth J. Chelation therapy in intoxications with mercury, lead and copper. J Trace Elem Med Biol. 2015;31:188-92. 3. Sun TW, Xu QY, Zhang XJ, Wu Q, Liu ZS, Kan QC, Sun CY and Wang L. Management of thallium poisoning in patients with delayed hospital admission. Clin Toxicol (Phila). 2012;50:65-9.

#26 Considerations in the management of women with epilepsy Sep 22, 2016

There's more to epilepsy than AED titration. (Shocking, I know.) Especially in women, management is undeniably complex. For example, the same enzymatic machinery used to metabolize AEDs is also used to break down estrogen-containing oral contraceptives--an interaction that could literally open a Pandora's box of complications. These and other issues affecting the management of women with epilepsy are addressed by Dr. Danielle Becker in this week's BrainWaves podcast. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. This episode was vetted and approved by Danielle Becker. REFERENCES 1. Meador K, Reynolds MW, Crean S, Fahrbach K and Probst C. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008;81:1-13. 2. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW and Neurodevelopmental Effects of Antiepileptic Drugs Study G. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014;168:729-36. 3. Veliskova J and Desantis KA. Sex and hormonal influences on seizures and epilepsy. Horm Behav. 2013;63:267-77. 4. Herzog AG, Fowler KM, Smithson SD, Kalayjian LA, Heck CN, Sperling MR, Liporace JD, Harden CL, Dworetzky BA, Pennell PB, Massaro JM and Progesterone Trial Study G. Progesterone vs placebo therapy for women with epilepsy: A randomized clinical trial. Neurology. 2012;78:1959-66. 5. Tauboll E, Sveberg L and Svalheim S. Interactions between hormones and epilepsy. Seizure. 2015;28:3-11. 6. Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia. 2005;46 Suppl 9:117-24. 7. Reiter SF, Bjork MH, Daltveit AK, Veiby G, Kolstad E, Engelsen BA and Gilhus NE. Life satisfaction in women with epilepsy during and after pregnancy. Epilepsy Behav. 2016;62:251-257. 8. Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Hauser WA, Wiebe S, Gronseth GS, Thurman D, Meador KJ, Koppel BS, Kaplan PW, Robinson JN, Gidal B, Hovinga CA, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Le Guen C, American Academy of N and American Epilepsy S. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73:126-32.

#25 Introduction to nystagmus Sep 15, 2016

Abnormal eye movements can be...abnormal. We have already briefly covered efferent dysfunction in an earlier episode ("#9 Teaching through clinical cases: Painless ophthalmoparesis"), but now Dr. Ali Hamedani is back and excited to discuss how we characterize and localize nystagmus in the central nervous system. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. This episode was vetted and approved by Robert Avery. REFERENCES Liu GT, Volpe NJ, and Galetta SL. Neuro-ophthalmology: Diagnosis and management, 2nd ed., pp. 587-610. Elsevier, 2010.

#24 Teaching through clinical cases: Progressive paresthesias and ataxia in a young patient Sep 08, 2016

In this week's episode of Teaching through Clinical Cases, Dr. Michael Rubenstein (episode 17, "The FAME clinic in Tanzania") leads a discussion on the evaluation of a young patient with a rapidly progressive gait difficulty with numbness and paresthesias. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. This episode was vetted and approved by Michael Rubenstein. REFERENCES 1. Kumar N, Elliott MA, Hoyer JD, Harper CM, Jr., Ahlskog JE and Phyliky RL. "Myelodysplasia," myeloneuropathy, and copper deficiency. Mayo Clinic proceedings. 2005;80:943-6. 2. Stabler SP. Vitamin B12 deficiency. The New England journal of medicine. 2013;368:2041-2. 3. Goodman BP. Metabolic and toxic causes of myelopathy. Continuum (Minneap Minn). 2015;21:84-99. 4. Kriegstein AR, Shungu DC, Millar WS, Armitage BA, Brust JC, Chillrud S, Goldman J and Lynch T. Leukoencephalopathy and raised brain lactate from heroin vapor inhalation ("chasing the dragon"). Neurology. 1999;53:1765-73. 5. Pema PJ, Horak HA and Wyatt RH. Myelopathy caused by nitrous oxide toxicity. AJNR American journal of neuroradiology. 1998;19:894-6.

#23 Autoimmune and paraneoplastic limbic encephalitis Sep 01, 2016

A relatively recent discovery in the history of neurology, autoimmune and paraneoplastic encephalitides encompass a wide spectrum of immunologic phenomena that affect the nervous system. In this episode, which focuses on limbic encephalitis, Dr. Ramani Balu outlines his experience with these unusual conditions. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was vetted and approved by Ramani Balu. REFERENCES 1. Anderson NE and Barber PA. Limbic encephalitis - a review. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2008;15:961-71. 2. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J and Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012;79:1094-100. 3. Lancaster E, Martinez-Hernandez E and Dalmau J. Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology. 2011;77:179-89. 4. Rosenfeld MR and Dalmau JO. Paraneoplastic disorders of the CNS and autoimmune synaptic encephalitis. Continuum (Minneap Minn). 2012;18:366-83. 5. Titulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F and Dalmau J. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. The Lancet Neurology. 2013;12:157-65. 6. Irani SR, Michell AW, Lang B, Pettingill P, Waters P, Johnson MR, Schott JM, Armstrong RJ, A SZ, Bleasel A, Somerville ER, Smith SM and Vincent A. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Annals of neurology. 2011;69:892-900.

(Updated 15 June 2018)

#22 The many faces of PRES Aug 25, 2016

Posterior reversible encephalopathy syndrome: Not always posterior, or reversible, or with associated encephalopathy. These and other clinical and neuroimaging factoids are reviewed in this week's edition of BrainWaves where we discuss the various--and often disparate--features of PRES. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was vetted and approved by Amy Pruitt. REFERENCES 1. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL and Caplan LR. A reversible posterior leukoencephalopathy syndrome. The New England journal of medicine. 1996;334:494-500. 2. Casey SO, Sampaio RC, Michel E and Truwit CL. Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR American journal of neuroradiology. 2000;21:1199-206. 3. Fugate JE and Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. The Lancet Neurology. 2015;14:914-25. 4. Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR American journal of neuroradiology. 2008;29:1043-9. 5. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR American journal of neuroradiology. 2008;29:1036-42. 6. Hefzy HM, Bartynski WS, Boardman JF and Lacomis D. Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR American journal of neuroradiology. 2009;30:1371-9.

#20 PFO closure in cryptogenic stroke Aug 17, 2016

A patent foramen ovale (PFO) may increase your risk of stroke, but does surgical correction reverse this risk? These and other important questions about secondary stroke prevention in patients with PFO are addressed in this week's BrainWaves podcast starring Dr. Christopher Favilla. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was approved and vetted by Steven Messe. REFERENCES 1. Di Tullio M, Sacco RL, Gopal A, Mohr JP, Homma S. Patent foramen ovale as a risk factor for cryptogenic stroke. Annals of internal medicine. 1992;117:461-465. 2. Kent DM, Dahabreh IJ, Ruthazer R, Furlan AJ, Reisman M, Carroll JD, et al. Device closure of patent foramen ovale after stroke: Pooled analysis of completed randomized trials. Journal of the American College of Cardiology. 2016;67:907-917. 3. Carroll JD, Saver JL, Thaler DE, Smalling RW, Berry S, MacDonald LA, et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. The New England journal of medicine. 2013;368:1092-1100.

#21 Zika: What you need to know Aug 11, 2016

Rio is front and center of the world right now, not just because of the 2016 Olympic games, but also because it harbors the Zika virus. In this episode, infectious disease specialist Dr. Jennifer McGuire speaks with Dr. Ana Cristancho about the things every neurologist needs to know about this worldwide outbreak. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was approved and vetted by Jennifer McGuire. REFERENCES 1. Bogoch, II, Brady OJ, Kraemer MU, German M, Creatore MI, Kulkarni MA, Brownstein JS, Mekaru SR, Hay SI, Groot E, Watts A and Khan K. Anticipating the international spread of Zika virus from Brazil. Lancet. 2016;387:335-6. 2. Campos GS, Bandeira AC and Sardi SI. Zika Virus Outbreak, Bahia, Brazil. Emerg Infect Dis. 2015;21:1885-6. 3. Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, Pretrick M, Marfel M, Holzbauer S, Dubray C, Guillaumot L, Griggs A, Bel M, Lambert AJ, Laven J, Kosoy O, Panella A, Biggerstaff BJ, Fischer M and Hayes EB. Zika virus outbreak on Yap Island, Federated States of Micronesia. The New England journal of medicine. 2009;360:2536-43. 4. Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009;15:1347-50. 5. Mlakar J, Korva M, Tul N, Popovic M, Poljsak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodusek V, Vizjak A, Pizem J, Petrovec M and Avsic Zupanc T. Zika Virus Associated with Microcephaly. The New England journal of medicine. 2016;374:951-8.

#16 Choosing a DMT in Multiple Sclerosis Aug 05, 2016

With so many disease modifying therapies out there, how do you decide which drug to use in your MS patient? BrainWaves makes it simple. In this interview with Dr. Christopher Perrone, we review the US FDA-approved therapies for relapsing-remitting MS, their mechanisms of action, side effects, and benefits. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was approved and vetted by Salim Chahin. REFERENCES 1. Wingerchuk DM and Carter JL. Multiple sclerosis: current and emerging disease-modifying therapies and treatment strategies. Mayo Clinic proceedings. 2014;89:225-40. 2. Torkildsen O, Myhr KM and Bo L. Disease-modifying treatments for multiple sclerosis - a review of approved medications. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2016;23 Suppl 1:18-27.

#15 Wernicke's Encephalopathy Jul 28, 2016

The human body only has enough thiamine to last 2-3 weeks, so what happens when we run out? In this BrainWaves brief, we review the consequences of acute thiamine deficiency on the nervous system. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was approved and vetted by Michael Rubenstein. REFERENCES 1. Caine D, Halliday GM, Kril JJ and Harper CG. Operational criteria for the classification of chronic alcoholics: identification of Wernicke's encephalopathy. Journal of neurology, neurosurgery, and psychiatry. 1997;62:51-60. 2. Sechi G and Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. The Lancet Neurology. 2007;6:442-55. 3. Zuccoli G and Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature. AJR Am J Roentgenol. 2009;192:501-8. 4. Galvin R, Brathen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA and Efns. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2010;17:1408-18.

#19 Patients and their pictures Jul 21, 2016

How much can a picture mean to a patient? How much can it mean to a provider? And what if that picture is an MRI, instead of a photograph? In this episode of our Humanities section, we deliver 2 perspectives on imaging in patient care. On the one hand, MRI and CT scan can tell you a lot about a patient's medical history and active medical disease. On the other, a personal photograph may illuminate the social history in a way words may fail to capture.

The content in this episode was approved and vetted by Salim Chahin. BrainWaves podcasts and online content are intended for medical education purposes only and should not be used for routine clinical decision making.

*Remastered for release on 11 January 2018.

#18 Autoantibodies in acquired myasthenia Jul 14, 2016

Myasthenia gravis is a disorder characterized by proximal weakness, ptosis, and antibody formation against proteins at the neuromuscular junction. Most commonly, the protein targeted by antibodies is the nicotinic acetylcholine receptor. However, research in the last 2 decades has identified a number of other antibody targets, which we have reviewed here in this BrainWaves brief. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was vetted and approved by Grant T. Liu. REFERENCES 1. Gilhus NE and Verschuuren JJ. Myasthenia gravis: subgroup classification and therapeutic strategies. The Lancet Neurology. 2015;14:1023-36. 2. Hurst RL and Gooch CL. Muscle-Specific Receptor Tyrosine Kinase (MuSK) Myasthenia Gravis. Current neurology and neuroscience reports. 2016;16:61. 3. Koneczny I, Cossins J and Vincent A. The role of muscle-specific tyrosine kinase (MuSK) and mystery of MuSK myasthenia gravis. J Anat. 2014;224:29-35. 4. Dalmau J and Rosenfeld MR. Paraneoplastic syndromes of the CNS. The Lancet Neurology. 2008;7:327-40. 5. Evoli A and Lancaster E. Paraneoplastic disorders in thymoma patients. J Thorac Oncol. 2014;9:S143-7.

#14 Anti-epileptic drug-drug interactions Jul 07, 2016

Things you need to know about the way anti-epileptic drugs affect each other, all in one podcast. Take a few minutes here to familiarize yourself with these common and critical complications of seizure management. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was vetted and approved by Danielle Becker. REFERENCES 1. Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol. 2006;61:246-255 2. Pennell PB, Newport DJ, Stowe ZN, Helmers SL, Montgomery JQ, Henry TR. The impact of pregnancy and childbirth on the metabolism of lamotrigine. Neurology. 2004;62:292-295 3. Petrenaite V, Sabers A, Hansen-Schwartz J. Individual changes in lamotrigine plasma concentrations during pregnancy. Epilepsy Res. 2005;65:185-188 4. Pennell PB, Peng L, Newport DJ, Ritchie JC, Koganti A, Holley DK, et al. Lamotrigine in pregnancy: Clearance, therapeutic drug monitoring, and seizure frequency. Neurology. 2008;70:2130-2136

#13 The broken heart syndrome Jun 29, 2016

REFERENCES

1. Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation. 2008;118:397-409

5. Banki NM, Kopelnik A, Dae MW, Miss J, Tung P, Lawton MT, et al. Acute neurocardiogenic injury after subarachnoid hemorrhage. Circulation. 2005;112:3314-3319

6. Yoshimura S, Toyoda K, Ohara T, Nagasawa H, Ohtani N, Kuwashiro T, et al. Takotsubo cardiomyopathy in acute ischemic stroke. Annals of neurology. 2008;64:547-554

7. Grabowski A, Kilian J, Strank C, Cieslinski G, Meyding-Lamade U. Takotsubo cardiomyopathy--a rare cause of cardioembolic stroke. Cerebrovascular diseases. 2007;24:146-148

8. Finsterer J, Wahbi K. Cns-disease affecting the heart: Brain-heart disorders. Journal of the neurological sciences. 2014;345:8-14

#17 The FAME clinic in Tanzania Jun 23, 2016

Since its inception in 2002, the FAME clinic has provided the city of Karatu, Tanzania, an unprecedented medical refuge. With over 22,000 clinic visits in 2015 alone, this rural clinic continues to thrive in the region. In this episode of BrainWaves, Dr. Michael Rubenstein ("Dr. Mike") discusses the development of a neurology program within FAME and how it offers patients--as well as resident trainees--an invaluable medical experience. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice.

#12 Headache meds giving you a headache? Jun 16, 2016

Although physicians use medications to treat headache, the mind can become tolerant. In fact, many otherwise helpful medications may even aggravate a pre-existing headache syndrome. In this BrainWaves brief, we discuss the concept of medication-overuse headache and its treatment, which may be counterintuitive and is often challenging for patients. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was vetted and approved by Roderick Spears. REFERENCES 1. Dodick DW. Clinical practice. Chronic daily headache. The New England journal of medicine. 2006;354:158-165 2. Diener HC, Limmroth V. Medication-overuse headache: A worldwide problem. The Lancet. Neurology. 2004;3:475-483 3. Tomkins GE, Jackson JL, O'Malley PG, Balden E, Santoro JE. Treatment of chronic headache with antidepressants: A meta-analysis. The American journal of medicine. 2001;111:54-63

#11 Which NOAC is best for secondary stroke prevention? Jun 07, 2016

Long-term anti-thrombotic treatment of embolic stroke sounds like a tricky field to navigate. Aspirin is the drug of choice in the acute setting for most patients, but when cardioembolic stroke is suspected, aspirin is inferior to anticoagulation for preventing recurrent stroke. In the age of novel oral anticoagulants, why choose warfarin and risk drug interactions, dietary restrictions and bleeding risk? In this episode, we discuss the pros and cons of each of the major NOACs for secondary stroke prevention. Enjoy! BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. REFERENCES 1. Connolly SJ, et al. Dabigatran versus warfarin in patients with atrial fibrillation. New Engl J Med 2009; 361:1139-1151. 2. Granger CB, et al. Apixaban versus warfarin in patients with atrial fibrillation. New Engl J Med 2011; 365:981-992. 3. Patel MR, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New Engl J Med 2011; 365:883-891. 4. Giugliano RP, et al. Edoxaban versus warfarin in patients with atrial fibrillation. New Engl J Med 2013; 369:2093-2104.

#10 Cryptogenic stroke: Solving the unsolved Jun 01, 2016

Diagnostic dilemmas, cryptogenic infarcts account for almost a third of all stroke subtypes. But if you break it down, it's really not so complicated.

Except, it may complicated enough that we had to entirely rewrite and re-produce this episode of the podcast. To ensure the accuracy of the content that is distributed, we have also replaced this original episode with the 2019 update.

Produced by James E. Siegler. Music courtesy of Josh Woodward, Julie Maxwell, Dan Lebowitz, and this group called E’s Jammy Jams. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

Siegler JE, Swaminathan B, Giruparajah M, Bosch J, Perera KS, Hart RG, Kasner SE and Investigators EGR. Age disparity in diagnostic evaluation of stroke patients: Embolic Stroke of Undetermined Source Global Registry Project. Eur Stroke J. 2016;1:130-138.
Jacobs BS, Boden-Albala B, Lin IF and Sacco RL. Stroke in the young in the northern Manhattan stroke study. Stroke; a journal of cerebral circulation. 2002;33:2789-93.
Hart RG, Sharma M, Mundl H, Kasner SE, Bangdiwala SI, Berkowitz SD, Swaminathan B, Lavados P, Wang Y, Wang Y, Davalos A, Shamalov N, Mikulik R, Cunha L, Lindgren A, Arauz A, Lang W, Czlonkowska A, Eckstein J, Gagliardi RJ, Amarenco P, Ameriso SF, Tatlisumak T, Veltkamp R, Hankey GJ, Toni D, Bereczki D, Uchiyama S, Ntaios G, Yoon BW, Brouns R, Endres M, Muir KW, Bornstein N, Ozturk S, O'Donnell MJ, De Vries Basson MM, Pare G, Pater C, Kirsch B, Sheridan P, Peters G, Weitz JI, Peacock WF, Shoamanesh A, Benavente OR, Joyner C, Themeles E, Connolly SJ and Investigators NE. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. The New England journal of medicine. 2018;378:2191-2201.
Diener HC, Sacco RL, Easton JD, Granger CB, Bernstein RA, Uchiyama S, Kreuzer J, Cronin L, Cotton D, Grauer C, Brueckmann M, Chernyatina M, Donnan G, Ferro JM, Grond M, Kallmunzer B, Krupinski J, Lee BC, Lemmens R, Masjuan J, Odinak M, Saver JL, Schellinger PD, Toni D, Toyoda K, Committee R-SES and Investigators. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. The New England journal of medicine. 2019;380:1906-1917.
Di Tullio M, Sacco RL, Gopal A, Mohr JP and Homma S. Patent foramen ovale as a risk factor for cryptogenic stroke. Annals of internal medicine. 1992;117:461-5.
Overell JR, Bone I and Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology. 2000;55:1172-9.
Li J, Liu J, Liu M, Zhang S, Hao Z, Zhang J and Zhang C. Closure versus medical therapy for preventing recurrent stroke in patients with patent foramen ovale and a history of cryptogenic stroke or transient ischemic attack. The Cochrane database of systematic reviews. 2015;9:CD009938.
Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, Arquizan C, Bejot Y, Vuillier F, Detante O, Guidoux C, Canaple S, Vaduva C, Dequatre-Ponchelle N, Sibon I, Garnier P, Ferrier A, Timsit S, Robinet-Borgomano E, Sablot D, Lacour JC, Zuber M, Favrole P, Pinel JF, Apoil M, Reiner P, Lefebvre C, Guerin P, Piot C, Rossi R, Dubois-Rande JL, Eicher JC, Meneveau N, Lusson JR, Bertrand B, Schleich JM, Godart F, Thambo JB, Leborgne L, Michel P, Pierard L, Turc G, Barthelet M, Charles-Nelson A, Weimar C, Moulin T, Juliard JM, Chatellier G and Investigators C. Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke. The New England journal of medicine. 2017;377:1011-1021.
Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS, Tirschwell DL and Investigators R. Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke. The New England journal of medicine. 2017;377:1022-1032.
Sondergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen-Kudsk JE, Settergren M, Sjostrand C, Roine RO, Hildick-Smith D, Spence JD, Thomassen L and Gore RCSI. Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. The New England journal of medicine. 2017;377:1033-1042.
Juul K, Tybjaerg-Hansen A, Steffensen R, Kofoed S, Jensen G and Nordestgaard BG. Factor V Leiden: The Copenhagen City Heart Study and 2 meta-analyses. Blood. 2002;100:3-10.
Kaku DA and Lowenstein DH. Emergence of recreational drug abuse as a major risk factor for stroke in young adults. Annals of internal medicine. 1990;113:821-7.
Fonseca AC and Ferro JM. Drug abuse and stroke. Current neurology and neuroscience reports. 2013;13:325.
Susac JO, Egan RA, Rennebohm RM and Lubow M. Susac's syndrome: 1975-2005 microangiopathy/autoimmune endotheliopathy. Journal of the neurological sciences. 2007;257:270-2.
Perera KS, Ng KKH, Nayar S, Catanese L, Dyal L, Sharma M, Connolly SJ, Yusuf S, Bosch J, Eikelboom JW and Hart RG. Association Between Low-Dose Rivaroxaban With or Without Aspirin and Ischemic Stroke Subtypes: A Secondary Analysis of the COMPASS Trial. JAMA Neurol. 2019. Epub ahead of print.

#9 Teaching through clinical cases: Painless ophthalmoparesis May 26, 2016

Our 9th episode features an evolving case discussion about a patient with eye movement difficulties. Dr. Ali Hamedani navigates us through the orbit, brainstem, and midbrain as we discern the structural and physiological problems that can impede extra-ocular movements. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. This episode was vetted and approved by Grant Liu. REFERENCES 1. Liu GT, Volpe NJ and Galetta SL. Neuro-Ophthalmology: Diagnosis and Management. 2nd ed: Elsevier; 2010. 2. Cornblath WT. Diplopia due to ocular motor cranial neuropathies. Continuum (Minneap Minn). 2014;20:966-80. 3. Chiba A, Kusunoki S, Obata H, Machinami R and Kanazawa I. Serum anti-GQ1b IgG antibody is associated with ophthalmoplegia in Miller Fisher syndrome and Guillain-Barre syndrome: clinical and immunohistochemical studies. Neurology. 1993;43:1911-7. 4. L. DR and G. PS. Approach to orbital disorders and frequency of disease occurence: W. B. Saunders; 1994. 5. Sanders DB and Guptill JT. Myasthenia gravis and Lambert-Eaton myasthenic syndrome. Continuum (Minneap Minn). 2014;20:1413-25. 6. Brent GA. Clinical practice. Graves' disease. The New England journal of medicine. 2008;358:2594-605.

#8 Headache like a clap of thunder May 21, 2016

Dr. Pouya Khankhanian describes his experience with "worst headache of life." A harbinger of head pathology, thunderclap headache should be quickly and meticulously addressed in order to prevent life-threatening neurologic disease. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was vetted and approved by Roderick Spears. REFERENCES 1. Schwedt TJ, Matharu MS and Dodick DW. Thunderclap headache. The Lancet Neurology. 2006;5:621-31. 2. Linn FH, Wijdicks EF, van der Graaf Y, Weerdesteyn-van Vliet FA, Bartelds AI and van Gijn J. Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage. Lancet. 1994;344:590-3. 3. Sames TA, Storrow AB, Finkelstein JA and Magoon MR. Sensitivity of new-generation computed tomography in subarachnoid hemorrhage. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 1996;3:16-20. 4. van der Wee N, Rinkel GJ, Hasan D and van Gijn J. Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? Journal of neurology, neurosurgery, and psychiatry. 1995;58:357-9. 5. Vergouwen MD and Rinkel GJ. Clinical suspicion of subarachnoid hemorrhage and negative head computed tomographic scan performed within 6 hours of headache onset--no need for lumbar puncture. Ann Emerg Med. 2013;61:503-4. 6. Edlow JA and Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. The New England journal of medicine. 2000;342:29-36. 7. Vermeulen M, Hasan D, Blijenberg BG, Hijdra A and van Gijn J. Xanthochromia after subarachnoid haemorrhage needs no revisitation. Journal of neurology, neurosurgery, and psychiatry. 1989;52:826-8. 8. Muehlschlegel S, Kursun O, Topcuoglu MA, Fok J and Singhal AB. Differentiating reversible cerebral vasoconstriction syndrome with subarachnoid hemorrhage from other causes of subarachnoid hemorrhage. JAMA Neurol. 2013;70:1254-60. 9. Misra UK, Kalita J, Chandra S, Kumar B and Bansal V. Low molecular weight heparin versus unfractionated heparin in cerebral venous sinus thrombosis: a randomized controlled trial. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2012;19:1030-6.

#7 Infectious causes of myelopathy May 18, 2016

In this BrainWaves brief, we review the major infections of the spinal cord with anatomic localization of disease and clinical management. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. This episode was vetted and approved by Colin Quinn. REFERENCES 1. Cho TA, Vaitkevicius H. Infectious myelopathies. Continuum (Minneap Minn). 2012;18(6):1351-1373.

#6 HIV on your mind? May 12, 2016

In this episode of BrainWaves, Dr. Joseph Berger discusses the complications of HIV literally from head to toe. From neuropathy to myelopathy to neurocognitive disorders as well as the myriad of opportunistic infections. Definitely worth your time. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. The content in this episode was vetted and approved by Joseph Berger for broadcast. REFERENCES 1. Ellis R, Langford D and Masliah E. HIV and antiretroviral therapy in the brain: neuronal injury and repair. Nat Rev Neurosci. 2007;8:33-44. 2. Boisse L, Gill MJ and Power C. HIV infection of the central nervous system: clinical features and neuropathogenesis. Neurol Clin. 2008;26:799-819, x. 3. Garg RK. HIV infection and seizures. Postgraduate medical journal. 1999;75:387-90. 4. Dore GJ, Law MG and Brew BJ. Prospective analysis of seizures occurring in human immunodeficiency virus type-1 infection. J NeuroAIDS. 1996;1:59-69. 5. Di Rocco A and Simpson DM. AIDS-associated vacuolar myelopathy. AIDS Patient Care STDS. 1998;12:457-61. 6. Murdoch DM, Venter WD, Van Rie A and Feldman C. Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options. AIDS Res Ther. 2007;4:9.

#3 Foot Drop May 05, 2016

Quick tutorial to help you navigate through the causes of foot drop. Check it out! BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information.

REFERENCES

Preston DC & Shapiro BE. Electromyography and neuromuscular disorders, 3rd ed. Saunders (2013).

#4 The Radiologically isolated syndrome May 01, 2016

Dr. Clyde Markowitz relays his account of the Radiologically Isolated Syndrome and his approach to managing it. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. The content in this episode was vetted and approved by Clyde Markowitz for broadcast. REFERENCES 1. Okuda DT, Mowry EM, Beheshtian A, Waubant E, Baranzini SE, Goodin DS, Hauser SL and Pelletier D. Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome. Neurology. 2009;72:800-5. 2. Barkhof F, Filippi M, Miller DH, Scheltens P, Campi A, Polman CH, Comi G, Ader HJ, Losseff N and Valk J. Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain. 1997;120 ( Pt 11):2059-69. 3. Granberg T, Martola J, Kristoffersen-Wiberg M, Aspelin P and Fredrikson S. Radiologically isolated syndrome--incidental magnetic resonance imaging findings suggestive of multiple sclerosis, a systematic review. Multiple sclerosis. 2013;19:271-80. 4. Okuda DT, Mowry EM, Cree BA, Crabtree EC, Goodin DS, Waubant E and Pelletier D. Asymptomatic spinal cord lesions predict disease progression in radiologically isolated syndrome. Neurology. 2011;76:686-92. 5. Lebrun C, Bensa C, Debouverie M, Wiertlevski S, Brassat D, de Seze J, Rumbach L, Pelletier J, Labauge P, Brochet B, Tourbah A, Clavelou P and Club Francophone de la Sclerose en P. Association between clinical conversion to multiple sclerosis in radiologically isolated syndrome and magnetic resonance imaging, cerebrospinal fluid, and visual evoked potential: follow-up of 70 patients. Archives of neurology. 2009;66:841-6. 6. Giorgio A, Stromillo ML, Rossi F, Battaglini M, Hakiki B, Portaccio E, Federico A, Amato MP and De Stefano N. Cortical lesions in radiologically isolated syndrome. Neurology. 2011;77:1896-9. 7. Amato MP, Hakiki B, Goretti B, Rossi F, Stromillo ML, Giorgio A, Roscio M, Ghezzi A, Guidi L, Bartolozzi ML, Portaccio E, De Stefano N and Italian RISMSSG. Association of MRI metrics and cognitive impairment in radiologically isolated syndromes. Neurology. 2012;78:309-14. 8. Goodin DS and Bates D. Treatment of early multiple sclerosis: the value of treatment initiation after a first clinical episode. Multiple sclerosis. 2009;15:1175-82.

#5 Apoptosis, an original poem May 01, 2016

In this episode, resident physician Lauren McCollum discusses how the ICU has influenced her artistic side. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice.

#2 Teaching through cinical cases: Neurologic deterioration after stroke May 01, 2016

In our first episode with neurology content, we will discuss my research interest in neurologic deterioration after stroke. Enjoy! BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. The case discussed in this episode is fictional and does not contain any patient health identifying information. REFERENCES 1. Siegler JE, Boehme AK, Albright KC, George AJ, Monlezun DJ, Beasley TM and Martin-Schild S. A proposal for the classification of etiologies of neurologic deterioration after acute ischemic stroke. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013;22:e549-56. 2. Thanvi B, Treadwell S and Robinson T. Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management. Postgraduate medical journal. 2008;84:412-7. 3. Balami JS, Chen RL, Grunwald IQ and Buchan AM. Neurological complications of acute ischaemic stroke. The Lancet Neurology. 2011;10:357-71. 4. Kwan J and Hand P. Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM : monthly journal of the Association of Physicians. 2006;99:625-33.

#1 Mission & Purpose Apr 02, 2016

BrainWaves is an open-source audio podcast that was launched in 2016 as a resource for neurology trainees and physicians. Its aim is to provide interested persons with up-to-date clinical and basic science information in general neurology, neurologic subspecialties, and the humanities. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice.

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