Can you hear that too? You can’t? Well, that doesn’t mean I’m having auditory hallucinations. It could just be tinnitus, which describes the irritating sound of ringing, buzzing, clicking, or hissing that affect 10-20% of the world's population. But is this a ringing in the ears, or a ringing in the brain? ** IF YOU’RE TAKING YOUR NEUROLOGY BOARDS THIS SUMMER, CHECK OUT THE PENN NEUROLOGY BOARD REVIEW COURSE AT https://upenn.cloud-cme.com/default.aspx?P=5&EID=65373. AND FOR A DISCOUNTED...

It’s 2020, and for the first time in its 72-year history, the American Academy of Neurology has cancelled its annual meeting because of the COVID-19 pandemic. But that does not mean we (BrainWaves producers, not the AAN) can’t provide a few major updates to advances in neurology and neurotherapeutics! This week on the program, Jim Siegler is joined by Dr. Sammita Satyanarayan (Stanford) on a whirlwind tour of some of the latest advances in neurology from this past year. Enjoy! ** IF YOU’RE...

As my wife and I are raising our 9-month old daughter, and she is eating more solid food, I can’t help but think about how important it is she keep an open mind to new food groups. But being open minded is not just a lesson for toddlers. I emphasize it every day on rounds when seeing patients for a “stroke consult”, or a consult for “ICU delirium”. If you reduce yourself to the same anchoring biases that you've grown accustomed to, you’ll never entertain the possibility of other important,...

Perfusion imaging employs concepts that date back to the early 1830s, and it leverages hardware and software that emerged around the same time at multidetector helical CT scans. But it has only become popular in recent years for thrombectomy decision-making. If I'm being honest, I often never use it for this purpose. So what other purposes might it serve? And how does it work? This week, we review the fundamental concepts of perfusion CT, its utility in stroke care, and how it might prove...

Imagine what it would have been like, to have lived in 1918. Spanish influenza killed approximately 3% of the world’s population. Other than the world war, international travel was fairly limited. There was no social media. No flu vaccine. No mechanical ventilators. No World Health Organization. A century later, we’re facing the next great pandemic. And what have we learned? What do we know? From the neurologic complications of SARS-CoV-2, to non-infectious consequences, the environmental...

They say the eyes are the window to the soul. Well, maybe. They also happen to be the first organ we (perhaps, unknowingly) examine whenever we encounter a patient. This week on the program, we build on the prior episode about anisocoria (featuring Dr. Ali Hamedani, episode 74) and discuss the examination of the pupil, and all that these 3-5 millimeters of tissue can teach us. Plus, some Dad jokes at the end... Produced by James E. Siegler. Music courtesy of Chris Haugen, Daniel Birch, and...

Generalized weakness is a common complaint. Much of the time, we as neurologists don’t even see these patients in the hospital or the clinic. But more often than not, “generalized” weakness may be the only way a patient describes difficulty brushing their hair or climbing stairs. In these situations, it’s not exactly generalized weakness. It’s something else. This week on BrainWaves, we review the major patterns of weakness that characterize the most common muscle disorders. With a quick...

This week on BrainWaves, we're revisiting the 2017 episode on recurrent meningitis featuring Dr. Jon Rosenberg (New York Presbyterian-Columbia). While we may not have made much headway in the treatment of these patients since the original show came out, we have made some progress in the neurodiagnostics. Produced by James E. Siegler and Jon Rosenberg. Music courtesy of Coldnoise, Three Chain Links, and Uncanny. Unless otherwise mentioned in the podcast, no competing financial interests exist...

Immune checkpoint inhibitors have revolutionized cancer treatment. Unlike chemotherapy, which essentially includes cellular toxins that can cause widespread and unnecessary tissue damage, checkpoint inhibitors are used to train the body’s natural immune system to fight off the cancer. And while they are extraordinarily effective options for patients with malignant disease, they are not without risk. Every day, we are learning more and more about the autoimmune side effects of these novel...

The sole FDA approved indication for clobazam is as a therapeutic adjunct in Lennox Gastaut Syndrome. But as more and more clinicians publish their experience with the off-label success of certain therapies, we may see new indications for this and other pharmacologic agents in the treatment of neurologic disease. Produced by James E. Siegler. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Music courtesy of Chris Zabriskie,...

In a patient with isolated, progressive hand numbness and weakness, there is a much to be learned about the clinical exam. Often, its all you need. This week, Dr. Aakriti Kothiwal (Cooper University Hospital) presents this week's clinical case and helps localize the lesion. Produced by James E. Siegler and Aakriti Kothiwal. Music courtesy of Jazzar, Lee Rosevere, and Loyalty Freak Music. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for...

The common teaching is that restricted diffusion on MRI indicates stroke—acute cerebral infarction. When, more specifically, the changes on DWI and ADC indicate impairment in the random movement of water molecules in a given tissue. With slower movement, as in energy-depleted tissues with failing ATP-dependent sodium/potassium channels, high cellularity, or a highly viscous extra-cellular space, there is restricted diffusion (of water) and a corresponding bright signal on DWI. These and other...

2019 was a big year. The year of the Mueller report. The American college admissions scandals. Brexit. But it was also the year the US Women's team won the World Cup, and lobbied for the equal pay of women and men in sports. It was the year of NMO, in which several pivotal trials showed benefit of disease modulating therapy in this condition. The year Will Smith played Genie in Aladdin. 2019 was a great year. And as we wrap up 2019, this week's episode includes some of the highlights....

In the TV show, HOUSE, it's either lupus or its sarcoidosis. Only, it's never sarcoidosis. That's because sarcoidosis is such a heterogeneous condition and can affect practically any age group. In some patients, this idiopathic inflammatory disorder can also involve the nervous system. Also causing a variety of signs and symptoms ranging from mild headache to a proximal myopathy or even a CNS vasculitis. This week on the BrainWaves podcast, Dr. Jesse Thon reflects on the literature and shares...

In 2016, when we first launched the BrainWaves podcast, cryptogenic stroke was a poorly understood concept. 3 years later, it remains poorly understood. But we are making progress. In this week's update of episode 10, we review the progress that has been made in the pathogenesis, diagnosis, and management of these patients. Produced by James E. Siegler. The original 2016 version of this show was also produced by Dr. Noah Levinson. Music courtesy of Josh Woodward, Julie Maxwell, Dan Lebowitz,...

Peer review prior to publication of medical data dates back to the 9th century CE, but has only really gained steam in the past 70 or 80 years. Ideally, peer review would serve as an initial filter for data that enters a permanent public scientific record. But peer review is not without flaws. In the second installment of the BrainWaves segment, “It’s not over yet…”, we discuss publication as a potential source of bias, and highlight the reasons why it should not be the final step of the peer...

The FDA label for ACTEMRA (tocilizumab)--the first medication approved for use in giant cell arteritis in 2017--is 40 pages long. Of the information provided in this document, which includes important dosing information, dose adjustments based on leukocyte count, clinical trial and epidemiologic data, there is a box of text on the first page of the insert. "WARNING: RISK OF SERIOUS INFECTIONS" it reads. What do you make of this warning? And with such a clear and broad-sweeping statement...

This year, Halloween falls on a Thursday. So we've put together a special episode to celebrate it! But first...a question: What do Frankenstein's monster, Spock, and Rick Deckard all have in common? Find out in this week's episode of BrainWaves. Produced by James E. Siegler. Special guest, Scott Kasner (Hospital of the University of Pennsylvania) with fair use of material from Young Frankenstein (1974), Star Trek: The Original Series (1966-1969), and Blade Runner (1982). Music courtesy...

College is a tough time for any kid. But it should also be exciting. Then to experience the freedoms of young adulthood, only later to face the horrifying reality of a progressive neurodegenerative condition...it's not something anyone should experience. In this week's continuation of the patient narrative series, Dr. Paul McIntosh (Duke) shares his life-changing story, and his optimism, about surviving a chronic neurological illness. Produced by James E. Siegler with the help of Paul...

Sara Henya would have you recognize her for her music, not her malady. While she may have Tourette Syndrome, she refuses to let it define her. In this week's episode of BrainWaves, we're launching a two part series featuring people who are living with a chronic neurologic illness--how they were diagnosed, how they cope with it, and of course, the neurobiology that underlies it. Produced by James E. Siegler with Dr. Michael Rubenstein and Sara Henya. Music courtesy of Sara Henya (find her...

This week on the program, our earlier episode on the multidisciplinary care of ALS patients gets a face lift. Since it originally aired in 2016, there have been several important advances in the treatment of these patients--including the first FDA approved therapy for this condition in more than 2 decades. But many of the core management strategies remain the same. Dr. Lauren Elman, Associate Professor of Neurology, Director of Research Operations and Associate Director of clinical care at...

In this week's clinical case, Dr. Mike Bradshaw (Chicago Medical School and Billings Clinic) walks us through the case of a young woman with HSV encephalitis. With a twist. SPOILER ALERT: If you don't want to know the answer, DON'T LOOK AT THE SHOWNOTES! Produced by James E. Siegler and Mike Bradshaw. Music courtesy of Yan Terrien, Unheard Music Concepts, Steve Combs, and Montplaisir. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for...

We just used clinical trial data regarding eculizumab in myasthenia gravis as an example of how to critically appraise the literature, and in this week's program...MORE data on the efficacy of eculizumab in another neurological condition. This week on BrainWaves, the exciting results of the PREVENT trial and the future treatment of NMO spectrum disorder! Produced by James E. Siegler. Special thanks to Dr. Olga Rosenveld Thon. Music courtesy of Unheard Music Concepts, TRG Banks, and Aitua....

One study shows that 30 minutes of exercise 5 times a week can reduce your risk of squamous cell carcinoma of the skin, p=0.001. (Let's pretend this is true). What does this mean? Well, let's start by asking the question, how IMPORTANT is it that you reduce your risk of SCC of the skin, and how MUCH does exercise reduce that risk? If the effect of exercise is associated with a relative risk reduction of 1% in your lifetime risk of SCC, is that enough to get you to spend 1 week of your life...

This week on the BrainWaves podcast, finally...a REAL show about BRAINWAVES! Dr. Carolina Maciel, of the University of Florida, schools Jim Siegler on how to read EEG and interpret abnormal patterns across the ictal-interictal continuum. Produced by James E. Siegler and Carolina Maciel. Music courtesy of Chris Zabriskie, Montplaisir, Rafael Archangel, Steve Combs, Unheard Music Concepts, and Siddhartha. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content...