BrainWaves: A Neurology Podcast

Latest Episodes:

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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.

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