Brainwaves

This week's BrainWaves episode features a case of a middle-aged woman with progressive headache and cranial neuropathies. The diagnosis of aseptic meningitis is made and a differential diagnosis is illustrated. 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. Nigrovic LE. Aseptic meningitis. Handbook of clinical neurology. 2013;112:1153-6. 2. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB and Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. The New England journal of medicine. 2004;351:1849-59. 3. Hasbun R, Abrahams J, Jekel J and Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. The New England journal of medicine. 2001;345:1727-33. 4. Lee BE, Chawla R, La

This week, I'm handing the mic over to Dr. Laura Mainardi so she can give us some pointers on the evaluation of hand weakness. We're thumbing through a few tips on working up wrist drop in particular. Hoping you give us two thumbs up 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. REFERENCES 1. Preston DC & Shapiro BE. Electromyography and neuromuscular disorders, 3rd ed. Saunders (2013).

Prions are perhaps some of the most terrifying infectious particles known to man. But did you know that patients with some prion diseases actually shed these contagious proteins in their urine? These and other facts about prion diseases are discussed 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. REFERENCES 1. Zabel MD and Reid C. A brief history of prions. Pathog Dis. 2015;73:ftv087. 2. Geschwind MD. Prion Diseases. Continuum (Minneap Minn). 2015;21:1612-38. 3. Rutala WA and Weber DJ. Creutzfeldt-Jakob disease: recommendations for disinfection and sterilization. Clin Infect Dis. 2001;32:1348-56. 4. Glatzel M, Abela E, Maissen M and Aguzzi A. Extraneural pathologic prion protein in sporadic Creutzfeldt-Jakob disease. The New England journal of medicine. 2003;349:1812-20. 5. Moda F, Gambetti P, Notari S, Concha-Marambio L, Catania M, Park KW, Maderna E, Sua

I am not sure there are many more things terrifying than watching your child experience what looks like, just a cold, and then over the course of a few hours becomes paralyzed. In this episode, Drs. Ana Cristancho and Sarah Hopkins describe what we know about this recent polio-like outbreak in the US. 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. This episode was vetted and approved by Dr. Sarah Hopkins. REFERENCES 1. Aliabadi N, Messacar K, Pastula DM, Robinson CC, Leshem E, Sejvar JJ, Nix WA, Oberste MS, Feikin DR and Dominguez SR. Enterovirus D68 Infection in Children with Acute Flaccid Myelitis, Colorado, USA, 2014. Emerg Infect Dis. 2016;22:1387-94. 2. Greninger AL, Naccache SN, Messacar K, Clayton A, Yu G, Somasekar S, Federman S, Stryke D, Anderson C, Yagi S, Messenger S, Wadford D, Xia D, Watt JP, Van Haren K, Dominguez SR, Glaser C, Aldrovandi G and Chiu CY. A novel outbreak enterovi

The acute vestibular syndrome is easy enough to identify, but it can be a challenge to diagnose. In this week's episode of BrainWaves, Dr. Ali Hamedani tries to simplify the approach to acute, intermittent, and chronic complaints of dizziness. Updated and remastered January 2019. Produced by James E. Siegler. Music courtesy of John Bartman and Kevin McLeod. 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 1. Kerber KA. Acute constant dizziness. Continuum (Minneap Minn). 2012;18:1041-59. 2. Lempert T. Vestibular migraine. Semin Neurol. 2013;33:212-8. 3. Kim JS and Zee DS. Clinical practice. Benign paroxysmal positional vertigo. The New England journal of medicine. 2014;370:1138-47. 4. Kattah JC, Talkad AV, Wang DZ, Hsieh YH and Newman-Toker DE. HINTS to diagnose stroke in the acute v

For those of you who've witnessed it, giving levodopa to a patient with idiopathic Parkinson Disease is almost a miracle to watch. Unlike practically every other condition afflicting the nervous system, the unmistakable unrest of PD essentially surrenders to this tiny tablet. But what did we use before levodopa? In this week's episode of BrainWaves, we recount the history (and serendipity) behind the development of this miracle drug. 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. Parkinson J. An essay on the shaking palsy. 1817. J Neuropsychiatry Clin Neurosci. 2002;14:223-36; discussion 222. 2. Glatstein M, Alabdulrazzaq F and Scolnik D. Belladonna Alkaloid Intoxication: The 10-Year Experience of a Large Tertiary Care Pediatric Hospital. Am J Ther. 2016;23:e74-7. 3. Koranyi EK. A preamble on parkinsonism. J Psychiatry Neurosci. 1999;24:296-9. 4. Bucy P and Case T. Tremor: Physio

This Thanksgiving, amidst all the turkey, the stuffing, the cranberry sauce, the ham, and the cornucopia of dessert options, you may be inclined to let the food coma sink in. But for those interested in the science behind this fanciful feast, listen to what Dr. Jason Maley has to say about the neurologic complications of some of the common dishes served at your holiday spread. 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. Williams ES. Chronic wasting disease. Veterinary Pathology Online. 2005; 42(5):530-49. 2. Clauss HE, Lorber B. Central nervous system infection with Listeria monocytogenes. Current infectious disease reports. 2008; 10(4):300-6. 3. Garcia HH, Del Brutto OH, Cysticercosis Working Group in Peru. Neurocysticercosis: updated concepts about an old disease. The Lancet Neurology. 2005; 4(10):653-61. 4. Richard DM, Dawes MA, Mathias CW, Acheson A, Hill-Kapturczak N, Dou

Like many other diseases of the nervous system, amyotrophic lateral sclerosis is not a diagnosis you want to receive in the neurology clinic. But once the diagnosis is made, quality of life supersedes quantity of life. Many academic and private hospitals provide a multi-disciplinary ALS clinic to meet the needs of their patients and their loved ones. In this BrainWaves episode, Dr. Lauren Elman discusses her experience with the multidisciplinary ALS clinic at Pennsylvania Hospital. 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. This episode was vetted and approved by Lauren Elman. REFERENCES 1. Miller RG, Jackson CE, Kasarskis EJ, England JD, Forshew D, Johnston W, Kalra S, Katz JS, Mitsumoto H, Rosenfeld J, Shoesmith C, Strong MJ, Woolley SC and Quality Standards Subcommittee of th

Even before the release of the 2015 film, Concussion, there has been a rising concern about mild traumatic brain injury in athletes in recent years. In this week's episode of BrainWaves, we discuss the history of mild TBI and the clinicopathologic concept of chronic traumatic encephalopathy as it pertains to football players. 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. Montenigro PH, Corp DT, Stein TD, Cantu RC and Stern RA. Chronic traumatic encephalopathy: historical origins and current perspective. Annu Rev Clin Psychol. 2015;11:309-30. 2. Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, Gronseth GS, Guskiewicz K, Mandel S, Manley G, McKeag DB, Thurman DJ and Zafonte R. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology.

Idiopathic Parkinson Disease (PD) is the second most common cause of neurodegenerative disease following Alzheimer's. The risk of PD increases to nearly 1 in 100 in the elderly, and although we have been pharmacologically treating this disorder since the early nineteenth century, we have no cure and no definitely therapy to delay disease progression. In this episode of BrainWaves, Dr. David Coughlin illustrates how some of these therapies have evolved and which classes of medications to choose when managing a patient's symptoms--from tremor to dystonia. 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. The content in this episode was vetted and approved by Andres Deik. REFERENCES 1. Elias, W. Jeffrey, et al. "A randomized trial of focused ultrasound thalamotomy for essential tremor." N

This week, we are taking a break from educational neurology and will be stressing the importance of collaboration between patients and physicians. Physicians are critical to healthcare because of their expertise and experience, but medical management is a team sport. It is equally important to incorporate the patient's needs and opinions into the equation. But this leaves us with the concept of "therapeutic privilege," specifically how much does the physician need to tell the patient about his or her own health? In this episode, Jim Siegler steps into the shoes of one of his good friends who has faced a recent cancer diagnosis. 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. Patrick Green, the patient in this episode, has consented to the discussion of his medical care for the purpose of this broadcast and we are sincerely grateful for his contribution. REFERENCES 1. Epstein RM, Korones DN and

The Landry-Guillain-Barre-Strohl Syndrome, aka Guillain-Barre Syndrome, is classically thought of as a painless ascending weakness with areflexia that typically follows an infectious prodrome. But there are a dozen variants with unusual clinical presentations, from back pain to pandysautonomia. And sometimes GBS follows a vaccination rather than viral infection. In this BrainWaves episode, we discuss these and other unique facts regarding the history, clinical manifestations, and treatment of this polyneuropathy. 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. Dimachkie MM and Saperstein DS. Acquired immune demyelinating neuropathies. Continuum (Minneap Minn). 2014;20:1241-60. 2. Asbury AK. Guillain-Barre syndrome: historical aspects. Annals of neurology. 1990;27 Suppl:

Once heralded as "benign" essential tremor, this movement disorder is anything but. And you can see this when you talk with your neurology patients about the difficulties they encounter with dressing, eating, and even speaking. Not to mention the social stigmata and cognitive dysfunction. In this BrainWaves episode, we start by describing the fundamentals of tremor and move on to the clinical features, pharmacology, and prognosis of ET. 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. Deuschl G, Raethjen J, Hellriegel H and Elble R. Treatment of patients with essential tremor. The Lancet Neurology. 2011;10:148-61. 2. Louis ED. Diagnosis and Management of Tremor. Continuum (Minneap Minn). 2016;22:1143-58. 3. Sandvik U, Koskinen LO, Lundquist A and Blomstedt P. Thalamic an

From the "gilded age" to the "germ theory", Dr. Joshua VanDerWerf (physician, historian, humanitarian), illustrates the birth of American neurology. You may recognize the names Chiari, Wernicke, and Broca, but what about William Alexander Hammond or Silas Weir Mitchell? These figures, among others, and their contributions to neurology are the subject of this week's BrainWaves 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. Goetz CG, Chmura TA, Lanska D. Part 1: the history of 19th century neurology and the American Neurological Association. Ann Neurol. 2003;53 Suppl 4:S2-S26. 2. Koehler PJ1, Lanska DJ. Mitchell's influence on European studies of peripheral nerve injuries during World War I. J Hist Neurosci. 2004 Dec;13(4):326-35. 3. Lanska DJ1. Characteristics and lasting contributions of 19th-century American neurologists. J Hist Neurosci. 2001 Aug;10(2):202-16.

Heavy metal poisoning is increasingly rare in the US, but in patients with multi-organ dysfunction and unclear exposure history, you should be suspicious. In this episode of BrainWaves, we discuss the most common metals associated with central and peripheral nerve dysfunction, the symptoms they produce, imaging features, and treatment. 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. This episode was vetted and approved by Francis DeRoos. REFERENCES 1. Staff NP and Windebank AJ. Peripheral neuropathy due to vitamin deficiency, toxins, and medications. Continuum (Minneap Minn). 2014;20:1293-306. 2. Cao Y, Skaug MA, Andersen O and Aaseth J. Chelation therapy in intoxications with mercury, lead and copper. J Trace Elem Med Biol. 2015;31:188-92. 3. Sun TW, Xu QY, Zhang XJ, Wu Q, Liu ZS, K

There's more to epilepsy than AED titration. (Shocking, I know.) Especially in women, management is undeniably complex. For example, the same enzymatic machinery used to metabolize AEDs is also used to break down estrogen-containing oral contraceptives--an interaction that could literally open a Pandora's box of complications. These and other issues affecting the management of women with epilepsy are addressed by Dr. Danielle Becker in this week's BrainWaves podcast. 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. This episode was vetted and approved by Danielle Becker. REFERENCES 1. Meador K, Reynolds MW, Crean S, Fahrbach K and Probst C. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008

Abnormal eye movements can be...abnormal. We have already briefly covered efferent dysfunction in an earlier episode ("#9 Teaching through clinical cases: Painless ophthalmoparesis"), but now Dr. Ali Hamedani is back and excited to discuss how we characterize and localize nystagmus in the central nervous system. 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. This episode was vetted and approved by Robert Avery. REFERENCES Liu GT, Volpe NJ, and Galetta SL. Neuro-ophthalmology: Diagnosis and management, 2nd ed., pp. 587-610. Elsevier, 2010.

In this week's episode of Teaching through Clinical Cases, Dr. Michael Rubenstein (episode 17, "The FAME clinic in Tanzania") leads a discussion on the evaluation of a young patient with a rapidly progressive gait difficulty with numbness and paresthesias. 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. This episode was vetted and approved by Michael Rubenstein. REFERENCES 1. Kumar N, Elliott MA, Hoyer JD, Harper CM, Jr., Ahlskog JE and Phyliky RL. "Myelodysplasia," myeloneuropathy, and copper deficiency. Mayo Clinic proceedings. 2005;80:943-6. 2. Stabler SP. Vitamin B12 deficiency. The New England journal of medicine. 2013;368:2041-2. 3. Goodman BP. Metabolic and toxic causes of myelopathy. Continuum (Minneap Minn). 2015;21:84-99. 4. Kriegstein AR, Shungu DC, Millar WS, Armitage BA,

A relatively recent discovery in the history of neurology, autoimmune and paraneoplastic encephalitides encompass a wide spectrum of immunologic phenomena that affect the nervous system. In this episode, which focuses on limbic encephalitis, Dr. Ramani Balu outlines his experience with these unusual conditions. 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. The content in this episode was vetted and approved by Ramani Balu. 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 encephalitis. Neurology. 20

Posterior reversible encephalopathy syndrome: Not always posterior, or reversible, or with associated encephalopathy. These and other clinical and neuroimaging factoids are reviewed in this week's edition of BrainWaves where we discuss the various--and often disparate--features of PRES. 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. The content in this episode was vetted and approved by Amy Pruitt. REFERENCES 1. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL and Caplan LR. A reversible posterior leukoencephalopathy syndrome. The New England journal of medicine. 1996;334:494-500. 2. Casey SO, Sampaio RC, Michel E and Truwit CL. Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection