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    Education

    BrainWaves: A Neurology Podcast

    BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology and medicine. Follow us on Twitter @brainwavesaudio, or just tune in every Thursday for the latest shows! **NOT FOR CLINICAL DECISION MAKING**

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    Copyright: © All rights reserved

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

    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

    1. Suresh E and Wimalaratna S. Proximal myopathy: diagnostic approach and initial management. Postgraduate medical journal. 2013;89:470-7.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. Wicklund MP. The Limb-Girdle Muscular Dystrophies. Continuum (Minneap Minn). 2019;25:1599-1618.
    7. Preston DC and Shapiro BE. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. 3rd ed. London; New York: Elsevier Saunders; 2013.
    8. "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
    Show notes

    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

    1. Zunt JR and Baldwin KJ. Chronic and subacute meningitis. Continuum (Minneap Minn). 2012;18:1290-318.
    2. Ginsberg L and Kidd D. Chronic and recurrent meningitis. Pract Neurol. 2008;8:348-61.
    3. Rosenberg J and Galen BT. Recurrent Meningitis. Curr Pain Headache Rep. 2017;21:33.
    4. Baldwin KJ and Avila JD. Diagnostic Approach to Chronic Meningitis. Neurol Clin. 2018;36:831-849.
    5. 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.
    6. 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
    Show notes

    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

    1. Bhatia S, Tykodi SS and Thompson JA. Treatment of metastatic melanoma: an overview. Oncology (Williston Park). 2009;23:488-96.
    2. Hottinger AF. Neurologic complications of immune checkpoint inhibitors. Curr Opin Neurol. 2016;29:806-812.
    3. Wick W, Hertenstein A and Platten M. Neurological sequelae of cancer immunotherapies and targeted therapies. Lancet Oncol. 2016;17:e529-e541.
    4. Cohen JV and Buchbinder EI. The Evolution of Adjuvant Therapy for Melanoma. Curr Oncol Rep. 2019;21:106.
    5. 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.
    6. Graus F and Dalmau J. Paraneoplastic neurological syndromes in the era of immune-checkpoint inhibitors. Nat Rev Clin Oncol. 2019;16:535-548.
    7. Zekeridou A and Lennon VA. Neurologic Autoimmunity in the Era of Checkpoint Inhibitor Cancer Immunotherapy. Mayo Clinic proceedings. 2019;94:1865-1878.
    8. 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
    Show notes

    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

    1. 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.
    2. 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.
    3. Remy C. Clobazam in the treatment of epilepsy: a review of the literature. Epilepsia. 1994;35 Suppl 5:S88-91.
    4. 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.
    5. Ng YT and Collins SD. Clobazam. Neurotherapeutics. 2007;4:138-44.
    6. 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.
    7. Mahmoud SH and Rans C. Systematic review of clobazam use in patients with status epilepticus. Epilepsia Open. 2018;3:323-330.
    8. 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
    Show notes

    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

    1. Gross PT and Jones HR, Jr. Proximal median neuropathies: electromyographic and clinical correlation. Muscle Nerve. 1992;15:390-5.
    2. Gross PT and Tolomeo EA. Proximal median neuropathies. Neurol Clin. 1999;17:425-45, v.
    3. 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.
    4. Bouche P. Compression and entrapment neuropathies. Handbook of clinical neurology. 2013;115:311-66.
    5. 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.
    6. 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.
    7. 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
    Show notes

    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

    1. 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.
    2. 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.
    3. Roberts TP and Rowley HA. Diffusion weighted magnetic resonance imaging in stroke. Eur J Radiol. 2003;45:185-94.
    4. 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.
    5. Maier SE, Sun Y and Mulkern RV. Diffusion imaging of brain tumors. NMR Biomed. 2010;23:849-64.
    6. 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.
    7. 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.
    8. Aliaga ES and Barkhof F. MRI mimics of multiple sclerosis. Handbook of clinical neurology. 2014;122:291-316.
    9. 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
    Show notes

    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]

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
    10. 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.
    11. 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.
    12. 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]

    1. 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.
    2. Perry RT and Halsey NA. The clinical significance of measles: a review. The Journal of infectious diseases. 2004;189 Suppl 1:S4-16.
    3. 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.
    4. Poland GA and Jacobson RM. The age-old struggle against the antivaccinationists. The New England journal of medicine. 2011;364:97-9.
    5. 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.
    6. Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016;170:1209-1215.
    7. Bester JC. Not a matter of parental choice but of social justice obligation: Children are owed measles vaccination. Bioethics. 2018;32:611-619.
    8. 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]

    1. Senzolo M, Ferronato C and Burra P. Neurologic complications after solid organ transplantation. Transpl Int. 2009;22:269-78.
    2. Dhar R. Neurologic complications of transplantation. Handbook of clinical neurology. 2017;141:545-572.
    3. 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.
    4. 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.
    5. 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.
    6. 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
    Show notes

    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

    1. 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.
    2. Agnihotri SP, Singhal T, Stern BJ and Cho TA. Neurosarcoidosis. Semin Neurol. 2014;34:386-94.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. Agbogu BN, Stern BJ, Sewell C and Yang G. Therapeutic considerations in patients with refractory neurosarcoidosis. Archives of neurology. 1995;52:875-9.
    8. Baughman RP and Lower EE. Infliximab for refractory sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2001;18:70-4.
    9. 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.
    10. 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
    Show notes

    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

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. Overell JR, Bone I and Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology. 2000;55:1172-9.
    7. 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.
    8. 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.
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. Fonseca AC and Ferro JM. Drug abuse and stroke. Current neurology and neuroscience reports. 2013;13:325.
    14. 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.
    15. 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
    Show notes

    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

    1. Bingham C. Peer review on the Internet: A better class of conversation. Lancet. 1998;351:S10-14.
    2. 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.
    3. 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.
    4. 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.
    5. Ware M. Peer review: Benefits, perspectives, and alternatives: Publishing Research Consortium; 2008.
    6. Mandavilli A. Peer review: Trial by Twitter. Nature. 2011;469:286-7.
    7. Haffar S, Bazerbachi F and Murad MH. Peer Review Bias: A Critical Review. Mayo Clinic proceedings. 2019;94:670-676.
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