Brainwaves

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

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 suici

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

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 Ps

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.

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. 201

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,

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

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 freq

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, Yama

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 Syndr

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,

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,

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

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 tran

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.

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 hemic

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.

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

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