Brainwaves

It's a throwback Thursday on the podcast. This week, we revisit an old but familiar topic of neuroimaging. What does it tell you about a person, and how does it compare to a photograph? Featuring Salim Chahin (Washington University) and Ali Mendelson (UCSD). Produced by James E. Siegler. Music by Ars Sonor, Lee Rosevere, 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.

You've probably heard of the 10,000-hour rule--or maybe the 10-year rule. The time it takes to master a skill. But what is the evidence for this, and was Malcolm Gladwell's interpretation of it (from his book, Outliers) correct? From mindfulness to memory palaces, this week we explore the neuroscience of expertise. Produced by James E. Siegler. Music by Mozart, Brendan Kinsella, Jon Watts, Mike Durek, and Lee Rosevere. 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 Macnamara BN, Hambrick DZ and Oswald FL. Deliberate practice and performance in music, games, sports, education, and professions: a meta-analysis. Psychol Sci. 2014;25:1608-18. Ericsson KA, Krampe RT and Teschromer C. The Role of Deliberate Practice in the Acquisition of Expert Performance. Psychol Rev. 1993;100:363-406. Raskin E. Comparison of scientific and literary ability: A biographical study of eminent scientists and let

In this week's clinical case, Dr. John Baird (Stanford) shares the story of a patient he's been following who's experienced a neurologic complication of her hematologic illness. Check it out. Produced by James E. Siegler. Music by Chris Zabriskie, Ian Southerland, Julie Maxwell, Jason Shaw, and Rafael Archangel. 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 George JN. Clinical practice. Thrombotic thrombocytopenic purpura. The New England journal of medicine. 2006;354:1927-35. George JN and Nester CM. Syndromes of thrombotic microangiopathy. The New England journal of medicine. 2014;371:654-66. Bakshi R, Shaikh ZA, Bates VE and Kinkel PR. Thrombotic thrombocytopenic purpura: brain CT and MRI findings in 12 patients. Neurology. 1999;52:1285-8. Goel R, Ness PM, Takemoto CM, Krishnamurti L, King KE and Tobian AA. Platelet transfusions in platelet consumptive disorders are associate

Nerve conduction testing should not be as puzzling as it's made out to be. This week, we break it down into individual components and use two case examples to explain how you might interpret this commonly implemented electrodiagnostic assessment. Produced by James E. Siegler. Music by Coldnoise, Jessie Spillane, Loyalty Freak Music, and Yshwa. 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 Allen JA. Chronic Demyelinating Polyneuropathies. Continuum (Minneap Minn). 2017;23:1310-1331. Kincaid JC. Neurophysiologic Studies in the Evaluation of Polyneuropathy. Continuum (Minneap Minn). 2017;23:1263-1275. Preston DC and Shapiro BE. Electromyography and neuromuscular disorders : clinical-electrophysiologic correlations. 3rd ed. London ; New York: Elsevier Saunders; 2013. Pareyson D, Scaioli V and Laura M. Clinical and electrophysiological aspects of Charcot-Marie-Tooth disease. Neuromol

Cerebral vein and dural sinus thrombosis comprises only 0.5% of all strokes, but is one of the most litigated medical diagnoses due to the high rate of underdiagnosis and high probability of neurologic decline without early and aggressive intervention. In this week's installment, Ali Hamedani puts Jim Siegler in the hot seat to go over the clinical and radiographic manifestations of this condition, treatment, and prognosis. Produced by Ali Hamedani and James E. Siegler. Music by Andy Cohen, MMFFF, Loyalty Freak Music, Steve Combs, Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making. REFERENCES Stam J. Thrombosis of the cerebral veins and sinuses. The New England journal of medicine. 2005;352:1791-8. Khandelwal N, Agarwal A, Kochhar R, Bapuraj JR, Singh P, Prabhakar S and Suri S. Comparison of CT venography with MR venography in cerebral sinovenous thrombosis. AJR Am J Roentgenol. 2006;187:1637-43. Ferro JM,

This week on the show, we're discussing the science behind the fiction of George Malley, the protagonist of the 1996 classic, Phenomenon. Specifically, we ask the question, is there a disease out there which incidentally benefits the human organism? Maybe there is... Produced by James E. Siegler. Music by Hyson, Ars Sonor, and Lee Rosevere. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Costanzo JP, Lee RE, Jr. and Lortz PH. Glucose concentration regulates freeze tolerance in the wood frog Rana sylvatica. J Exp Biol. 1993;181:245-55. Moalem S, Weinberg ED and Percy ME. Hemochromatosis and the enigma of misplaced iron: implications for infectious disease and survival. Biometals. 2004;17:135-9. Nagasako EM, Oaklander AL and Dworkin RH. Congenital insensitivity to pain: an update. Pain. 2003;101:213-9. Saloviita T, Ruusila L and Ruusila U. Incidence of Savant Syndrome in Finland. Percept Mot Skills. 2000;91:120-2.

Last week was all about how destroying bad brain can help patients with epilepsy. This week, in a stimulating discussion with Dr. Becker, we're reviewing the ways we can activate the nervous system in order to prevent future seizures: the vagus nerve stimulator, deep brain stimulation, and the responsive neurostimulation system. Produced by James E. Siegler. Music by Chris Zabriskie, Josh Woodward, 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. REFERENCES Penry JK and Dean JC. Prevention of intractable partial seizures by intermittent vagal stimulation in humans: preliminary results. Epilepsia. 1990;31 Suppl 2:S40-3. Yuan H and Silberstein SD. Vagus Nerve and Vagus Nerve Stimulation, a Comprehensive Review: Part II. Headache. 2016;56:259-66. Lanska DJ. J.L. Corning and vagal nerve stimulation for seizures in the 1880s. Neurology. 2002;58:452-9. A randomized controlled trial of chr

This week on BrainWaves, we build on concepts introduced in episode 65 regarding the non-pharmacologic management of drug-resistant epilepsy. In the next two episodes, you'll hear from Dr. Danielle Becker (Penn) and Dr. Myriam Abdennadher (NIH) on the minimally invasive procedures that can drastically impact the lives of patients with refractory seizures. Produced by James E. Siegler. Music by Steve Combs, Jason Shaw, and Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, Moshe SL, Perucca E, Wiebe S and French J. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51:1069-77. Nilsson L, Farahmand BY, Persson PG, Thiblin I and Tomson T. Risk factors for sudden unexpected death in epilepsy: a case-control study. Lancet. 1999;353:888-93. T

Everything doesn't always add up when you're evaluating a patient with a complex array of symptoms. Or maybe it does. Dr. LaFaver (University of Louisville) walks us through this week's Teaching through Clinical Cases. Produced by James E. Siegler & Kathrin LaFaver. Music by Lee Rosevere, Montplaisir, and Coldnoise. 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 Carson A, Hallett M and Stone J. Assessment of patients with functional neurologic disorders. Handbook of clinical neurology. 2017;139:169-188. Carson A, Lehn A, Ludwig L and Stone J. Explaining functional disorders in the neurology clinic: a photo story. Pract Neurol. 2016;16:56-61. Czarnecki K, Thompson JM, Seime R, Geda YE, Duffy JR and Ahlskog JE. Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol. Parkinsonism & related disorders. 2012;18:247-51. Edwards MJ, St

How often do you call the plumber and say, "My faucet is leaking", and then the plumber REMOVES your faucet? Problem solved, right? Ironically, this simplistic approach works extremely well in a variety of epileptic conditions. In this week's show, Dr. Myriam Abdennadher and Danielle Becker comment on the protocol and efficacy for surgery in patients with drug-resistant epilepsy. Produced by James E. Siegler. Music by Little Glass Men, Montplaisir, Three Chain Links, and Squire Tuck. Voiceover by Isa Smrstik. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Jobst BC and Cascino GD. Resective epilepsy surgery for drug-resistant focal epilepsy: a review. JAMA : the journal of the American Medical Association. 2015;313:285-93. Spencer S and Huh L. Outcomes of epilepsy surgery in adults and children. The Lancet Neurology. 2008;7:525-37. Schwartz TH and Spencer DD. Strategies for reoperation after comprehensive epilepsy

With the ongoing opioid crisis, not only those using opiates are affected. There has been an exponential rise in the incidence of neonatal abstinence syndrome--the multi-organ dysfunction experienced by newborns of mothers who are using opioid products and other substances. This week, we discuss the manifestations and ramifications of this disease, with a short commentary on implications of this global epidemic. Produced by James E. Siegler. Music by Little Glass Men, Jason Shaw, and Chris Zabriskie. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. This is no excuse to give your irritable baby opiates in their applesauce. REFERENCES McQueen K and Murphy-Oikonen J. Neonatal Abstinence Syndrome. The New England journal of medicine. 2016;375:2468-2479. Vlahov D, Des Jarlais DC, Goosby E, Hollinger PC, Lurie PG, Shriver MD and Strathdee SA. Needle exchange programs for the prevention of human immunodefic

If you don't think zombies exist, this episode might convince you otherwise. Two neurologists discuss the history and the neuroscience behind zombie-ism, and the reality of it, in this week's special installment of BrainWaves. Our zombie producer is Dr. James E. Siegler with the help of zombie expert, Dr. Brian Hanrahan. Our zombie music was courtesy of Andrew Sacco, Ars Sonor, and Little Glass Men. Our studio zombie is Erika Mejia. Content from zombie books, movies, and news events are also included. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making. Not that we know how to treat zombies anyway. REFERENCES Smith TC. Zombie infections: Epidemiology, treatment, and prevention. Bmj. 2015;351:h6423 Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R. "Zombie" outbreak caused by the synthetic cannabinoid amb-fubinaca in new york. The New England journal of medicine. 2017;376:235-242 Gilmour SJ, Saito E, Yoneok

Last week, we talked about the "why" of brain death. This week, the "how." Again, Jim Siegler is joined by Dr. Joshua Levine and Mike Rubenstein for the second part of the brain death series. Produced by James E. Siegler and Michael Rubenstein. Music by Chris Zabriskie, Hyson, Kai Engel, and Lee Rosevere. 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. Wijdicks EF. Brain death. Handbook of clinical neurology. 2013;118:191-203. 2. Wijdicks EF, Varelas PN, Gronseth GS, Greer DM and American Academy of N. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:1911-8.

Brain death, you'd be surprised to know, has its roots in non-neurologic specialties. Specialties like pulmonary critical care, cardiology, and transplant surgery. How the term was conceived, why it was needed, and what it means in our current practice of medicine will be the focus of this week's BrainWaves episode. Featuring Drs. Joshua Levine and Mike Rubenstein. Produced by James E. Siegler. Music by Chris Zabriskie, Damiano Baldoni, Josh Woodward, and Julie Maxwell. BrainWaves' podcasts and online content are intended for medical education purposes only and should not be used for routine clinical decision making. Please refer to local and regional policies on how brain death is determined at your institution. REFERENCES Kacmarek RM. The mechanical ventilator: past, present, and future. Respir Care. 2011;56:1170-80. De Georgia MA. History of brain death as death: 1968 to the present. J Crit Care. 2014;29:673-8. West JB. The physiological challenges of the 1952 Copenhagen poliomyelitis epidemic and a renai

Most people never get meningitis. For those who do, it is rare to experience it more than once. But if it recurs, red flags should be going up. Dr. Jon Rosenberg joins Jim Siegler this week in a discussion about the causes and management of recurrent meningitis. Produced by James E. Siegler. Music by Lee Rosevere, Fatal Injection, and Coldnoise. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Please don't LP every patient with migraine. That's just mean. REFERENCES Rosenberg J and Galen BT. Recurrent Meningitis. Curr Pain Headache Rep. 2017;21:33. Zunt JR and Baldwin KJ. Chronic and subacute meningitis. Continuum (Minneap Minn). 2012;18:1290-318.

Dr. David Coughlin returns for this week's Teaching Through Clinical Cases to discuss the management of a delirious patient with a hyperkinetic movement disorder. Produced by James E. Siegler. Music by Hyson, Josh Woodward, Komiku and Peter Rudenko. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Mills KC. Serotonin syndrome. American family physician. 1995;52:1475-1482 Radomski J, Dursun S, Reveley M, Kutcher S. An exploratory approach to the serotonin syndrome: An update of clinical phenomenology and revised diagnostic criteria. Medical hypotheses. 2000;55:218-224 Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The hunter serotonin toxicity criteria: Simple and accurate diagnostic decision rules for serotonin toxicity. QJM : monthly journal of the Association of Physicians. 2003;96:635-642 Boyer EW, Shannon M. The serotonin syndrome. The New England journal of medicine. 2005;352:1112-1120 Dosi R, Ambal

This week on BrainWaves, we go back in time to explore human's oldest neurosurgical procedure. So carve out some time in your day to learn about the ancient technique of craniotomy. Produced by James E. Siegler. Music by Chris Zabriskie, Kai Engel, Kevin McLeod, The Philadelphia Orchestra, and Sergey Cheremisinov. Voiceover by John Burnett. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical practice. Please do NOT drill into anyone's head without their full and informed consent. REFERENCES Sperati G. Craniotomy through the ages. Acta Otorhinolaryngol Ital. 2007;27:151-6. Verano JW and Finger S. Chapter 1: ancient trepanation. Handbook of clinical neurology. 2010;95:3-14. Missios S. Hippocrates, Galen, and the uses of trepanation in the ancient classical world. Neurosurgical focus. 2007;23:E11. Newman WC, Chivukula S and Grandhi R. From Mystics to Modern Times: A History of Craniotomy & Religion. World Neurosurg. 2016;92:148-50. Clow

Atrial fibrillation increases your risk of clotting. Anticoagulation increases your risk of bleeding. Surgery increases your risk of both. Dr. Mike Rubenstein speaks with Dr. Jim Siegler this week about how providers weigh the risks and benefits of anticoagulant bridging in the perioperative setting. Produced by Michael Rubenstein and James E. Siegler. Music by Chris Zabriskie, Lee Rosevere, and Jason Shaw. 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 Rechenmacher SJ, Fang JC. Bridging anticoagulation: Primum non nocere. Journal of the American College of Cardiology. 2015;66:1392-1403 Steinberg BA, Peterson ED, Kim S, Thomas L, Gersh BJ, Fonarow GC, et al. Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: Findings from the outcomes registry for better informed treatment of atrial fibrillation (orbit-af). Circulation. 20

Last year, the management of PFO was 'open' for discussion. Now, consider the case closed. Recent data indicates PFOs should be closed in certain patients with cryptogenic strokes. But some questions remain unanswered. This week's episode is an update from last year's review on this frequent topic that troubles stroke units.   Produced by James E. Siegler & Chris Favilla. Music by Lee Rosevere and Marcos H. Bolanos. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education purposes only. Jim is not a cardiac surgeon. Just a guy who's trying to bring you all the latest updates for what smarter doctors are doing. REFERENCES Kent DM, Ruthazer R, Weimar C, Mas JL, Serena J, Homma S, Di Angelantonio E, Di Tullio MR, Lutz JS, Elkind MS, Griffith J, Jaigobin C, Mattle HP, Michel P, Mono ML, Nedeltchev K, Papetti F and Thaler DE. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013;81:619-25. Meier B and Lock JE.

Reflex testing is an art. And that makes each of us an artist. The nuances of the reflex circuitry and how to interpret reflex testing are the topics of this week's episode, starring medical student Eliana Vasquez, from Texas A&M Health Sciences Center. Produced by Erika Mejia and James E. Siegler. Music by Komiku, Jahzzar, and Jason Shaw. BrainWaves podcast and online content are intended for medical education only and should not be used in the routine care of patients. I swear, if someone tries to sue me because their doctor said "Well, Jim told me I should hit your knee with a hammer," then I'm coming for you. REFERENCES Walker HK. Deep Tendon Reflexes. In: H. K. Walker, W. D. Hall and J. W. Hurst, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston; 1990. Boes CJ. The history of examination of reflexes. Journal of neurology. 2014;261:2264-74. Watt D, Lefebvre L. Effects of altered gravity on spinal cord excitability. American Institute of Aeronautics and Astronau