Brainwaves

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 Cardio

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,

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 Europea

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 enceph

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.

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. 201

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

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. 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-

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.

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 heada

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

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. E

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 immu

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.

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.

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 NeuroA

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).

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 o

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.

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 stro