Brainwaves

The asymmetric pupil can be subtle or disturbing, straightforward or perplexing, or even normal or abnormal. But by integrating your eye exam with the neuro exam, you can figure it out. Even if its the eye exam in a dog. Produced by James E. Siegler. Music by Komiku, Lee Rosevere, and Milton Arias. 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, no matter how physiologic you think those pupils are. REFERENCES Liu GT, Volpe NJ, and Galetta SL. Neuro-ophthalmology: Diagnosis and management, 2nd ed., pp. 587-610. Elsevier, 2010.

Fainting spells are surprisingly common. Even among United States Marines. This week we explore the mechanisms underlying loss of consciousness in your every day patient. And your every day soldier. Produced by James E. Siegler. Music by Jason Shaw, Andy Cohen, Kai Engel, and Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Freeman R. Clinical practice. Neurogenic orthostatic hypotension. The New England journal of medicine. 2008;358:615-24. Grubb BP. Neurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation. 2005;111:2997-3006. Wolters FJ, Mattace-Raso FU, Koudstaal PJ, Hofman A, Ikram MA and Heart Brain Connection Collaborative Research G. Orthostatic Hypotension and the Long-Term Risk of Dementia: A Population-Based Study. PLoS Med. 2016;13:e1002143. Sonnesyn H, Nilsen DW, Rongve A, Nore S, Ballard C, Tysnes OB and Aarsland D. High prevalence of orthostatic hypotension

This week's clinical case features Dr. Megha Dhamne, a neuromuscular fellow from the Cleveland Clinic. Two weeks ago, she reviewed some of the antibodies associated with autoimmune myositis. But what happens when you suspect an autoimmune myositis, and antibody testing is negative? Produced by James E. Siegler. Music by Chris Zabriski, The New Valleys, and Hyson. Voiceover by Tuyche Smrstik. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Suresh E and Wimalaratna S. Proximal myopathy: diagnostic approach and initial management. Postgraduate medical journal. 2013;89:470-7. Mammen A. Autoimmune muscle disease. Handbook of clinical neurology. 2016;133:467-84. Hill CL, Zhang Y, Sigurgeirsson B, Pukkala E, Mellemkjaer L, Airio A, Evans SR and Felson DT. Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet. 2001;357:96-100. Choy EH and Isenberg DA. Treatment of dermato

Spinal cord injury can be a devastating problem for patients. There is often significant weakness, loss of sensation and coordination, and some patients may never walk again. Almost everyone knows this. But what about other the other functions of the cord that we don't often talk about? In this week's episode, we review how the spinal cord controls bladder function, and why it's important to know what happens when this circuitry is interrupted. Produced by James E. Siegler. Music by Andy Cohen & 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 Seth JH, Panicker JN, Fowler CJ. The neurological organization of micturition. Handbook of clinical neurology. 2013;117:111-117 Samson G, Cardenas DD. Neurogenic bladder in spinal cord injury. Phys Med Rehabil Clin N Am. 2007;18:255-274, vi de Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physio

Progressive weakness can be terrifying for patients. And even more terrifying for clinicians can be the vast number of potential causes to consider. Among them are disorders of muscle inflammation. In this week's episode of the Quanta series, Dr. Megha Dhamne reviews the clinically relevant antibodies and associated phenotypes we see in patients with autoimmune myositis. Produced by James E. Siegler. Music by Coldnoise and Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Dalakas MC. Inflammatory muscle diseases. The New England journal of medicine. 2015;372:1734-47. Gunawardena H, Betteridge ZE and McHugh NJ. Myositis-specific autoantibodies: their clinical and pathogenic significance in disease expression. Rheumatology (Oxford). 2009;48:607-12. Goyal NA, Cash TM, Alam U, Enam S, Tierney P, Araujo N, Mozaffar FH, Pestronk A and Mozaffar T. Seropositivity for NT5c1A antibody in sporadic inclusion body

The most common primary brain tumor that occurs in adults, glioblastoma multiforme comes with a life expectancy shorter than practically every other form of cancer. But thanks to novel treatment strategies, advanced neuroimaging, and biomarker research, we are learning more and more how to improve the survival and the quality of life with patients who suffer from this terrible illness. Produced by James E. Siegler and Neena Cherayil. Music by Axle, Coldnoise, Josh Woodward, and Kelly Latimer. 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 Grady, D “Glioblastoma, John Mccain’s Form of Brain Cancer, Carries Troubling Prognosis” The New York Times Scutti, S “Sen John McCain has aggressive brain tumor, surgically removed” CNN Gately L, et al. Life beyond a diagnosis of glioblastoma: a systematic review of the literature. J Cancer Surviv (2017). Thakkar JP, et al. Epidemiologic and Molecula

The first seizure of life is a common presentation requiring a neurology consultation. In this episode, Dr. Brian Hanrahan of the University of Pittsburgh Medical Center, discusses his approach to counseling an adult patient with a first ever seizure, with a particular emphasis on driving safety. Produced by James E. Siegler. Music by Axletree, Josh Woodward, and Kevin McLeod. Voiceover by Emma Smrstik. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Think responsibly. Podcasts are no excuse NOT to treat a patient who is seizing. REFERENCES Maganti RK and Rutecki P. EEG and epilepsy monitoring. Continuum (Minneap Minn). 2013;19:598-622. Smith SJ. EEG in the diagnosis, classification, and management of patients with epilepsy. Journal of neurology, neurosurgery, and psychiatry. 2005;76 Suppl 2:ii2-7. Sofat P, Teter B, Kavak KS, Gupta R and Li P. Time interval providing highest yield for initial EEG in patients with new onset s

Doctors make the worst patients. Either because we've seen how bad illness can be that we tend to underplay our own symptoms, or because we believe it is more noble to attend to the health of our own patients rather than the health of ourselves. As providers, we refuse to acknowledge weakness until it is much too late. In this episode of BrainWaves, one neurologist describes his interesting, and surprisingly humorous, transition from denial to acceptance of his neurologic condition. Produced by James E. Siegler, Travis Lewis, & Erika Mejia. Music by Siddhartha, Little Glass Men, and Lee Rosevere. 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. Always talk to your doctor. Especially if you are a doctor yourself. REFERENCES Toyry S, Rasanen K, Kujala S, Aarimaa M, Juntunen J, Kalimo R, Luhtala R, Makela P, Myllymaki K, Seuri M and Husman K. Self-reported health, illness, and self-care amon

People fall for a lot of reasons when they get older, but that doesn't mean they should see a neurologist. A person can fall because of weakness, back or leg pain, instability, clumsiness, vision impairment, a sensory disturbance, and a myriad of other causes. Some of these are neurological, and these require special attention. In this week's Teaching through Clinical Cases episode, Dr. Sneha Mantri discusses a patient who presented to her clinic with falls due to rigidity and ocular dysmotility. Produced by James E. Siegler. Music by Josh Woodward and Julie Maxwell. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Hess CW and Okun MS. Diagnosing Parkinson Disease. Continuum (Minneap Minn). 2016;22:1047-63. Garbutt S, Riley DE, Kumar AN, Han Y, Harwood MR and Leigh RJ. Abnormalities of optokinetic nystagmus in progressive supranuclear palsy. Journal of neurology, neurosurgery, and psychiatry. 2004;75:1386-94. McFar

As of July 1, 2017, the Accreditation Council of Graduate Medical Education (sorry, in the episode I called in American College--this is wrong) made its first step EVER to extend duty hours for physician trainees. Whereas interns (first year residents) were previously limited to working 16 hour shifts, now they can work as many consecutive hours as senior residents--up to 28 hours at a time! In this episode of the I Wonder series, I ask Ali what he thinks about these new stipulations. Produced by Erika Mejia and James E. Siegler. Music by Jason Shaw and Jazzhar. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Asch DA, Bilimoria KY and Desai SV. Resident Duty Hours and Medical Education Policy - Raising the Evidence Bar. The New England journal of medicine. 2017;376:1704-1706. Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW and Czeisler CA. Effect of r

We rely heavily on our vision to perceive the world around us. (You wouldn't even be able to read this unless your vision were fully intact.) But what happens when that visual information is registered poorly by the eyes, or the information is erroneously translated by a damaged nervous system? Cognitive neuroscientist and visual systems specialist, Dr. Geoff Aguirre joins in this segment on how structural neurologic injury contributes to abnormalities in visual perception. Produced by James E. Siegler & Erika Mejia. Music by MMFFF, Peter Rudenko, Three Chain Links, and Marcos H. Bolanos. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical purposes. REFERENCES Barton JJ. Disorders of higher visual processing. Handbook of clinical neurology. 2011;102:223-61. Meadows JC and Munro SS. Palinopsia. Journal of neurology, neurosurgery, and psychiatry. 1977;40:5-8. Radoeva PD, Prasad S, Brainard DH and Aguirre GK. N

The second most common cause of Parkinsonism is doctors. No, I am not kidding. It's the medications we choose to prescribe. And the neurologist is not the only one at fault. Psychiatrists, cardiologists, and internists are all responsible. In this episode of the Quanta series, Dr. Sneha Mantri describes her experience as a specialist in movement disorders. Produced by James E. Siegler and Erika Mejia. Music by Hyson and Jazzhar. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Shin HW and Chung SJ. Drug-induced parkinsonism. J Clin Neurol. 2012;8:15-21. Lopez-Sendon JL, Mena MA and de Yebenes JG. Drug-induced parkinsonism in the elderly: incidence, management and prevention. Drugs Aging. 2012;29:105-18. Alvarez MV and Evidente VG. Understanding drug-induced parkinsonism: separating pearls from oy-sters. Neurology. 2008;70:e32-4.

Not all that shakes are seizures. Last week, we talked about what it's like to have epilepsy. This week, I am joined by Dr. Taneeta "Mindy" Ganguly to discuss what it's like NOT to have epilepsy--meaning to have non-epileptic seizures. But sometimes, you can have both. And this is where it gets tricky for the neurologist. Produced by James E. Siegler. Music by Aitua and Kai Engel. 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. Reuber M and Elger CE. Psychogenic nonepileptic seizures: review and update. Epilepsy Behav. 2003;4:205-16.

Seeing is believing. Or so I'm told. But this isn't a hard and fast rule in neurology. Cognitive neuroscientist and neurologist, Dr. Geoffrey Aguirre, joins me in this brief episode to discuss the neuroanatomy of higher order visual processing. Produced by James E. Siegler & Erika Mejia. Music by Ars Sonor and Nuno Adelaida. Voiceover by Erika Mejia & Jennifer Aniston. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Barton JJ. Disorders of higher visual processing. Handbook of clinical neurology. 2011;102:223-61. Meadows JC and Munro SS. Palinopsia. Journal of neurology, neurosurgery, and psychiatry. 1977;40:5-8. Radoeva PD, Prasad S, Brainard DH and Aguirre GK. Neural activity within area V1 reflects unconscious visual performance in a case of blindsight. J Cogn Neurosci. 2008;20:1927-39.

This week I am joined by Torie Robinson, a young woman whose life has been affected by her neurologic disease. She was gracious enough to share her story on the podcast, and it is an incredible tale. Importantly, it illustrates the exhaustion and resilience of a patient who has been forced to deal with all the psychosocial consequences of an incurable condition. Produced by James E. Siegler. Music by Andy Cohen, Josh Woodward, 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 Nimmo-Smith V, Brugha TS, Kerr MP, McManus S, Rai D. Discrimination, domestic violence, abuse, and other adverse life events in people with epilepsy: Population-based study to assess the burden of these events and their contribution to psychopathology. Epilepsia. 2016;57:1870-1878 Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness, Efficiency of Surgery for Temporal Lobe Epilepsy Study G. A random

Two weeks ago, Dr. Rubenstein and I talked about one of the difficulties of being a doctor. This week, we're shifting gears and the focus is now on the patient. In particular, the angry patient. Dr. Hamedani shares his experience at being the nicest dude in the world, and how he deals with hard-to-deal-with patients.   Produced by James E. Siegler and Erika Mejia. Music by Peter Rudenko, Steve Combs, and Lovira. 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. ...But you can probably learn a lot about how to talk with your patients from Dr. Hamedani. So take some notes. He invented the bedside manner.

Dr. Chatterjee returns for this sequel to his prior episode on aphasia. This week, we cover the history and the science of neural networking behind language production and comprehension.   Produced by James E. Siegler. Music by Josh Woodward and Andy Cohen. 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 Pearce JM. Broca's aphasiacs. Eur Neurol. 2009;61:183-9. Ajax ET, Schenkenberg T and Kosteljanetz M. Alexia without agraphia and the inferior splenium. Neurology. 1977;27:685-8. Schiff HB, Alexander MP, Naeser MA and Galaburda AM. Aphemia. Clinical-anatomic correlations. Archives of neurology. 1983;40:720-7.

When it comes to discussions on patient prognosis, it's easy to give bad news. But doing this well, and doing this with tact, is not so easy. It takes poise and preparation, and much more experience than you might have previously thought. Dr. Mike Rubenstein shares his approach in this installment of BrainWaves.   Produced by James E. Siegler. Music by Andy Cohen, Little Glass Men, and Axeltree. 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 Baile WF, Buckman R, Lenzi R, Glober G, Beale EA and Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5:302-11. Fallowfield L and Jenkins V. Communicating sad, bad, and difficult news in medicine. Lancet. 2004;363:312-9. Ptacek JT and Eberhardt TL. Breaking bad news. A review of the literature. JAMA : the journal of the American Medical Association. 1996;276:496-502.

With the advent of mechanical thrombectomy, some have argued that using intravenous tissue plasminogen activator for stroke is futile. But is it really? Dr. Sheryl Martin-Schild of Dr. Brain, Inc. joins us for today's episode to discuss if the thrombectomy has killed tPA.   The content in this episode was vetted and approved by Sheryl Martin-Schild. Produced by James E. Siegler. Music by Lee Rosevere, Josh Woodward, Kevin McLeod and Little Glass Men. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.   REFERENCES Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The european cooperative acute stroke study (ecass). JAMA : the journal of the American Medical Association. 1995;274:1017-1025 Tissue plasminogen activator for acute ischemic stroke. The national institute of neurological disorders and stroke rt-pa s

All you need to know about CNS Lyme disease in 10 minutes or less. More to come in a few weeks when Dr. Colin Quinn shares his experience with what was "definitely not Lyme disease." Stay tuned.   Produced by James E. Siegler. Music by Josh Woodward, Chris Zabriskie, Peter Rudenko, Advent Chamber Orchestra. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.   REFERENCES Marques A. Chronic Lyme disease: a review. Infect Dis Clin North Am. 2008;22:341-60, vii-viii. Marques AR. Lyme Neuroborreliosis. Continuum (Minneap Minn). 2015;21:1729-44. Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, Krupp L, Gronseth G, Bever CT, Jr. and Quality Standards Subcommittee of the American Academy of N. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69:91-102.