Brainwaves

If you give a mouse a cookie, he's going to want at least 4 more doctors to help manage his diabetes. And that is what crowdsourcing provides to the worldwide throng of chronic, complex medical cases. It is the 21st century, and if you are unsatisfied with the medical care you are receiving, why not poll the internet for better ideas? In this episode of BrainWaves, Dr. Adam Rodman (Internist from Botswana) and Dr. David Do (Creator of Symcat) share their experience with automating and crowdsourcing medical diagnoses.   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. Given the absence of available data, BrainWaves can neither endorse nor condemn crowdsourcing in healthcare. Pursue at your own risk!   REFERENCES Dunford E, Trevena H, Goodsell C, Ng KH, Webster J, Millis A, et al. Foodswitch: A mobile phone app to enable consumers to make healthier food choices and crowdsourcing of national food

Distinguishing aphasia from delirium can be INCREDIBLY difficult in the hospital setting, and a missed diagnosis of aphasia can prove disastrous for patients. In this episode, I get a little help from Johnny Depp (yes, that Johnny Depp) in order to illustrate the major differences between these two disease states.   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.  

Last week we talked about caffeine, and this week we've moved onto cosmetics. But not the outward kind, the inward kind. Dr. Anjan Chatterjee joins us in this segment on how the military and other professions may leverage mind-altering substances in order to enhance performance. 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. REFERENCES 1. Chatterjee A. Cosmetic neurology: The controversy over enhancing movement, mentation, and mood. Neurology. 2004;63:968-974 2. Lieberman HR, Tharion WJ, Shukitt-Hale B, Speckman KL, Tulley R. Effects of caffeine, sleep loss, and stress on cognitive performance and mood during u.S. Navy seal training. Sea-air-land. Psychopharmacology. 2002;164:250-261

Quantum (noun, pl. quanta): The amount of neurotransmitter stored within a single vesicle of a neuron. It is quantitatively the smallest amount of information that can be transmitted between nerves in the human body. We have hijacked this concept to describe the smallest amount of information we can share with you on a neurology podcast. In this series, which we have called Quanta, we'll be discussing the most fundamental neurologic principles so that our main episodes won't have to. 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.

Yes! Finally an episode dedicated entirely to caffeine! And just how wonderful it is. ...and how wonderful it may not be. In this installment of BrainWaves, you'll hear about how fantastic and how frightful this chemical can be. 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. Yes, caffeine can be toxic. But so is water. Be smart, do your homework, and remember this is just a podcast--not a guideline for pharmacological management. REFERENCES 1. Nawrot P, Jordan S, Eastwood J, Rotstein J, Hugenholtz A, Feeley M. Effects of caffeine on human health. Food Addit Contam. 2003;20:1-30 2. Ferre S. An update on the mechanisms of the psychostimulant effects of caffeine. J Neurochem. 2008;105:1067-1079 3. Park CA, Kang CK, Son YD, Choi EJ, Kim SH, Oh ST, et al. The effects of caffeine ingestion on cortical areas: Functional imaging study. Magn Reson Imaging. 2014;32:366-371 4. Martin ED, Buno W. Caffeine

If you have sickle cell disease, that means you have a 1 in 10 chance of experiencing a stroke before college. And if you don't think that's going to hold you back, you don't know stroke. This week on BrainWaves, Dr. Erica Jones shares her experience with the neurologic complications of sickle cell anemia, and the latest guidelines for managing patients with this condition. 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. REFERENCES 1. "Data & Statistics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 31 Aug. 2016. Web. 04 Dec. 2016. 2. Wang WC, Dwan K.
Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD003146.
DOI: 10.1002/14651858.CD003146.pub2. 3. Motulsky, Arno G. "Frequency of Sickling Disorders in U.S. Blacks." New England Journal

"Though this be madness, yet there is method in't." Shakespeare didn't know it, but he was already talking about thymectomy in Hamlet. In this week's BrainWaves episode, you'll hear about the pharmacologic fundamentals, and the most recent guidelines for treatment of myasthenia. 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. REFERENCES 1. Schneider-Gold C, Gajdos P, Toyka KV and Hohlfeld RR. Corticosteroids for myasthenia gravis. The Cochrane database of systematic reviews. 2005:CD002828. 2. Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, Marx A, Strobel P, Mazia C, Oger J, Cea JG, Heckmann JM, Evoli A, Nix W, Ciafaloni E, Antonini G, Witoonpanich R, King JO, Beydoun SR, Chalk CH, Barboi AC, Amato AA, Shaibani AI, Katirji B, Lecky BR, Buckley C, Vincent A, Dias-Tosta E, Yoshikawa H, Waddington-Cruz M, Pulley MT, Rivner MH, Kostera-Pruszczyk A, Pascuzzi RM, Jackson CE, Garcia Ramos GS, Vers

I have my own methods for conceptualizing altered mental status. But you already heard them in episode 46. This week on BrainWaves, take a wider view of this type of consult from the perspective of an internist. Dr. Fima Macheret takes the mic on this case of a young woman with seizures and encephalopathy. 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 approved by Dr. Fima Macheret. REFERENCES 1. Aagaard-Tillery KM and Belfort MA. Eclampsia: morbidity, mortality, and management. Clin Obstet Gynecol. 2005;48:12-23. 2. Duley L, Henderson-Smart DJ, Walker GJ and Chou D. Magnesium sulphate versus diazepam for eclampsia. The Cochrane database of systematic reviews. 2010:CD000127.

It is April 1st, 2017. Otherwise known as April Fools Day. But it doesn't have to be April 1st for you to be tricked by your neurology patient. In this week's episode of BrainWaves, we go over some of the ways to avoid being fooled the next time around. 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.

Yes, we have harnessed the power of paralysis. Botulinum toxin, which is produced by a lethal bacterium, Clostridium botulinum, has been bottled and sold to neurologists for decades. And you know this because you've seen people who received Botox to relax their facial muscles. In this week's installment, Dr. Anh-Thu Vu discusses how neurologists utilize this neurotoxic agent. 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 Anh-Thu Vu. REFERENCES 1. Arnon SS, Schechter R, Inglesby T V, et al. Botulinum toxin as a biological weapon: medical and public health management. JAMA. 2001;285(8):1059-1070. 2. Thenganatt MA, Fahn S. Botulinum toxin for the treatment of movement disorders. Curr Neurol Neurosci Rep. 2012;12(4):399-409. doi:10.1007/s11910-012-0286-3. 3. Aurora SK, Winner P, Freeman MC, et al. OnabotulinumtoxinA for treatment of chronic m

Clumsiness can be hard to localize. But in a patient with a remote history of cancer, you should be suspicious for a number of things. In this week's clinical case, we discuss a patient who was cured of Hodgkins Lymphoma but returns with progressive dysmetria. 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. REFERENCES 1. Bellizzi A, Anzivino E, Rodio DM, et al. New insights on human polyomavirus JC and pathogenesis of progressive multifocal leukoencephalopathy. Clin Dev Immunol 2013;1-17. 2. Garcia-Suarez J, de Miguel D, Krsnik I, et al. Changes in the natural history of progressive multifocal leukoencephalopathy in HIV-negative lymphoproliferative disorders: Impact of novel therapies. Am J Hematol 2005;80(4):271-81. 3. Felli V, DiSibio A, Anselmi M, et al. Progressive multifocal leukoencephalopathy following treatment with R

I can't imagine a better way to celebrate our FIFTIETH episode than to discuss my favorite subject: Large vessel disease. Although we only cover one aspect of this stroke mechanism--atherosclerosis--and technically many of these trials may be somewhat outdated, the matter discussed in this episode remains the most up-to-date in the field. Take a listen. 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. REFERENCES 1. Chaturvedi S, Bruno A, Feasby T, Holloway R, Benavente O, Cohen SN, Cote R, Hess D, Saver J, Spence JD, Stern B, Wilterdink J, Therapeutics and Technology Assessment Subcommittee of the American Academy of N. Carotid endarterectomy--an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005;65:794-801. 2. Kakkos SK, Nicolaides AN, Charalambous I, Thomas D, Giannopoulos A, Naylor AR, Geroulakos G, Ab

It may look like water, but CSF is anything but. In this week's episode of BrainWaves, we discuss the contents of CSF and how to interpret them. 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. 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 lumbar puncture from true subarachnoid hemorrhage. J Emerg Med. 2002;23:67-74. 4. Deisenhammer F, Bartos A, Egg R, Gilhus NE, Giovannoni G, Rauer S, Sellebjerg F and Force ET. Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2006;13:913-22. 5. Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Sa

Idiopathic intracranial hypertension, also known as the pseudotumor cerebri syndrome, is characterized by elevated intracranial pressure with clinical features of headaches, vision impairment, and occasionally cranial nerve palsies in the absence of a structural lesion on neuroimaging. But that doesn't mean the neuroimaging has to be normal. See what Dr. Anita Kohli has to say about the radiographic correlates of IIH, their relevance, and their prognostic utility in this week's episode. 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. REFERENCES 1. Friedman DI, Liu GT and Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81:1159-65. 2. Bidot S and Bruce BB. Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension. Semin Neurol. 2015;35:527-38. 3. Agid R, Farb RI, Willinsky RA, Mikulis DJ and Tomlinson G. Idiopa

In 1959, Adams and colleagues described a few patients who developed a rapid flaccid quadriparesis following fluid resuscitation for malnutrition and chronic alcoholism. Twenty years later, we learned that this occurs as a consequence of rapid correction of hyponatremia. But this isn't the only cause of the osmotic demyelination syndrome... Hear Dr. Joshua VanDerWerf discuss the history and clinical relevance of this unusual critical care scenario. 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. REFERENCES 1. Adams RA, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholics and malnourished patients. Arch Neurol Psychiatry 1959;81:154–72. 2. Gocht A, Colmant HJ. Central pontine and extrapontine myelinolysis: a report of 58 cases. Clin Neuropathol. 1987 Nov-Dec;6(6):262-70. 3. Kleinschmidt-Demasters BK, Rojiani AM, Filley CM. Central and extrapo

The request for a consult is like calling in a favor. You shouldn't actually expect the consultant to do it, you should be polite and helpful in all the ways your grandmother expects you to behave. At least that's the courtesy I've seen from really spectacular providers. In this week's episode, we not only review the proper etiquette for calling a consult, but you'll also hear some pearls on the workup for altered mental status. 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. REFERENCES None this week. (Sorry!)

It may come as a surprise to you, but patients who seize...will seize. And in this week's episode, we talk about the fundamentals in working up a patient who presents in status epilepticus. So SEIZE the opportunity to learn from Dr. Chloe Hill as she navigates us through this week's Teaching through Clinical Cases. 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 Chloe Hill. REFERENCES 1. Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ, Handforth A, Faught E, Calabrese VP, Uthman BM, Ramsay RE and Mamdani MB. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. The New England journal of medicine. 1998;339:792-8. 2. Claassen J, Hirsch LJ, Emerson RG and Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or

Although you should not confuse this with amaurosis fugax, a transient loss of vision in one eye usually screams vascular event. But not always... Keep an eye out for how the plot thickens in this week's episode of BrainWaves. 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 Imran Jivraj. REFERENCES 1. Biousse V and Trobe JD. Transient monocular visual loss. Am J Ophthalmol. 2005;140:717-21. 2. Kattah JC, Wang DZ and Reddy C. Intravenous recombinant tissue-type plasminogen activator thrombolysis in treatment of central retinal artery occlusion. Arch Ophthalmol. 2002;120:1234-6. 3. Schumacher M, Schmidt D, Jurklies B, Gall C, Wanke I, Schmoor C, Maier-Lenz H, Solymosi L, Brueckmann H, Neubauer AS, Wolf A, Feltgen N and Group EA-S. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter

Trauma and hypertension account for the overwhelming majority of cases of intracerebral hemorrhage. Today, we address the minority. In this week's episode, Dr. Steven Messe discusses the atypical causes of ICH and how they are managed. 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. REFERENCES 1. Biffi A and Greenberg SM. Cerebral amyloid angiopathy: a systematic review. J Clin Neurol. 2011;7:1-9. 2. Gilden D, Cohrs RJ, Mahalingam R and Nagel MA. Varicella zoster virus vasculopathies: diverse clinical manifestations, laboratory features, pathogenesis, and treatment. The Lancet Neurology. 2009;8:731-40. 3. Mast H, Young WL, Koennecke HC, Sciacca RR, Osipov A, Pile-Spellman J, Hacein-Bey L, Duong H, Stein BM and Mohr JP. Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet. 1997;350:1065-8. 4. Ruiz-Sandoval JL, Cantu C and Barinagarrementeria F. Intracere

Yeah, we talk about Bell's Palsy here. A lot actually. But there's also hemifacial spasm, blepharospasm, facial myokimia, and pathologic sialorrhea as it pertains to neurodegenerative disease. Not to mention the facial nerve anatomy! Sit down and buckle up, you may want to take notes on this one. 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, Gilden DH. Clinical practice. Bell's Palsy. The New England journal of medicine. 2004;351:1323-31. 2. Sweeney CJ and Gilden DH. Ramsay Hunt syndrome. Journal of neurology, neurosurgery, and psychiatry. 2001;71:149-54. 3. Gaio E, Marioni G, de Filippis C, Tregnaghi A, Caltran S and Staffieri A. Facial nerve paralysis secondary to acute otitis media in infants and children. J Paediatr Child Health. 2004;40:483-6.