Brainwaves

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.

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 asp

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 l

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).

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, placeb

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 Menin

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. Infarctio

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'

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 h

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.

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 Eval

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 encephalit

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, Vollme

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.

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.

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.

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

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

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.

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, Walle