BrainWaves Podcast

When the heart stops working, the brain stops working. But if the brain stops working, does the heart shut down? In this episode, Dr. David Manly discusses the pathogenesis and management of the reversible syndromes of neurogenic stress cardiomyopathy. 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. Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation. 2008;118:397-409 2. Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008;5:22-29 3. Paur H, Wright PT, Sikkel MB, Tranter MH, Mansfield C, O'Gara P, et al. High levels of circulating epinephrine trigger apical cardiodepression in a beta2-adrenergic receptor/gi-dependent manner: A new model of takotsubo cardiomyopathy. Circulation. 2012;126:697-706 4. Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, et al. Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA : the journal of the American Medical Association. 2011;306:277-286 5. Banki NM, Kopelnik A, Dae MW, Miss J, Tung P, Lawton MT, et al. Acute neurocardiogenic injury after subarachnoid hemorrhage. Circulation. 2005;112:3314-3319 6. Yoshimura S, Toyoda K, Ohara T, Nagasawa H, Ohtani N, Kuwashiro T, et al. Takotsubo cardiomyopathy in acute ischemic stroke. Annals of neurology. 2008;64:547-554 7. Grabowski A, Kilian J, Strank C, Cieslinski G, Meyding-Lamade U. Takotsubo cardiomyopathy--a rare cause of cardioembolic stroke. Cerebrovascular diseases. 2007;24:146-148 8. Finsterer J, Wahbi K. Cns-disease affecting the heart: Brain-heart disorders. Journal of the neurological sciences. 2014;345:8-14

Since its inception in 2002, the FAME clinic has provided the city of Karatu, Tanzania, an unprecedented medical refuge. With over 22,000 clinic visits in 2015 alone, this rural clinic continues to thrive in the region. In this episode of BrainWaves, Dr. Michael Rubenstein ("Dr. Mike") discusses the development of a neurology program within FAME and how it offers patients--as well as resident trainees--an invaluable medical experience. 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.

Although physicians use medications to treat headache, the mind can become tolerant. In fact, many otherwise helpful medications may even aggravate a pre-existing headache syndrome. In this BrainWaves brief, we discuss the concept of medication-overuse headache and its treatment, which may be counterintuitive and is often challenging for patients. 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 Roderick Spears. REFERENCES 1. Dodick DW. Clinical practice. Chronic daily headache. The New England journal of medicine. 2006;354:158-165 2. Diener HC, Limmroth V. Medication-overuse headache: A worldwide problem. The Lancet. Neurology. 2004;3:475-483 3. Tomkins GE, Jackson JL, O'Malley PG, Balden E, Santoro JE. Treatment of chronic headache with antidepressants: A meta-analysis. The American journal of medicine. 2001;111:54-63

Long-term anti-thrombotic treatment of embolic stroke sounds like a tricky field to navigate. Aspirin is the drug of choice in the acute setting for most patients, but when cardioembolic stroke is suspected, aspirin is inferior to anticoagulation for preventing recurrent stroke. In the age of novel oral anticoagulants, why choose warfarin and risk drug interactions, dietary restrictions and bleeding risk? In this episode, we discuss the pros and cons of each of the major NOACs for secondary stroke prevention. 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. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. REFERENCES 1. Connolly SJ, et al. Dabigatran versus warfarin in patients with atrial fibrillation. New Engl J Med 2009; 361:1139-1151. 2. Granger CB, et al. Apixaban versus warfarin in patients with atrial fibrillation. New Engl J Med 2011; 365:981-992. 3. Patel MR, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New Engl J Med 2011; 365:883-891. 4. Giugliano RP, et al. Edoxaban versus warfarin in patients with atrial fibrillation. New Engl J Med 2013; 369:2093-2104.

Diagnostic dilemmas, cryptogenic infarcts account for almost a third of all stroke subtypes. But if you break it down, it's really not so complicated. In our tenth episode, Dr. Noah Levinson gets some insight into the diagnostic approach of this confounding 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. 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 Michael Mullen. REFERENCES 1. Hart RG, Diener HC, Coutts SB, Easton JD, Granger CB, O'Donnell MJ, Sacco RL, Connolly SJ and Cryptogenic Stroke EIWG. Embolic strokes of undetermined source: the case for a new clinical construct. The Lancet Neurology. 2014;13:429-38. 2. Jacobs BS, Boden-Albala B, Lin IF and Sacco RL. Stroke in the young in the northern Manhattan stroke study. Stroke; a journal of cerebral circulation. 2002;33:2789-93. 3. Putaala J, Metso AJ, Metso TM, Konkola N, Kraemer Y, Haapaniemi E, Kaste M and Tatlisumak T. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke; a journal of cerebral circulation. 2009;40:1195-203. 4. Bang OY, Lee PH, Joo SY, Lee JS, Joo IS and Huh K. Frequency and mechanisms of stroke recurrence after cryptogenic stroke. Annals of neurology. 2003;54:227-34.

Our 9th episode features an evolving case discussion about a patient with eye movement difficulties. Dr. Ali Hamedani navigates us through the orbit, brainstem, and midbrain as we discern the structural and physiological problems that can impede extra-ocular movements. 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 Grant Liu. REFERENCES 1. Liu GT, Volpe NJ and Galetta SL. Neuro-Ophthalmology: Diagnosis and Management. 2nd ed: Elsevier; 2010. 2. Cornblath WT. Diplopia due to ocular motor cranial neuropathies. Continuum (Minneap Minn). 2014;20:966-80. 3. Chiba A, Kusunoki S, Obata H, Machinami R and Kanazawa I. Serum anti-GQ1b IgG antibody is associated with ophthalmoplegia in Miller Fisher syndrome and Guillain-Barre syndrome: clinical and immunohistochemical studies. Neurology. 1993;43:1911-7. 4. L. DR and G. PS. Approach to orbital disorders and frequency of disease occurence: W. B. Saunders; 1994. 5. Sanders DB and Guptill JT. Myasthenia gravis and Lambert-Eaton myasthenic syndrome. Continuum (Minneap Minn). 2014;20:1413-25. 6. Brent GA. Clinical practice. Graves' disease. The New England journal of medicine. 2008;358:2594-605.

Dr. Pouya Khankhanian describes his experience with "worst headache of life." A harbinger of head pathology, thunderclap headache should be quickly and meticulously addressed in order to prevent life-threatening neurologic disease. 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 Roderick Spears. REFERENCES 1. Schwedt TJ, Matharu MS and Dodick DW. Thunderclap headache. The Lancet Neurology. 2006;5:621-31. 2. Linn FH, Wijdicks EF, van der Graaf Y, Weerdesteyn-van Vliet FA, Bartelds AI and van Gijn J. Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage. Lancet. 1994;344:590-3. 3. Sames TA, Storrow AB, Finkelstein JA and Magoon MR. Sensitivity of new-generation computed tomography in subarachnoid hemorrhage. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 1996;3:16-20. 4. van der Wee N, Rinkel GJ, Hasan D and van Gijn J. Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? Journal of neurology, neurosurgery, and psychiatry. 1995;58:357-9. 5. Vergouwen MD and Rinkel GJ. Clinical suspicion of subarachnoid hemorrhage and negative head computed tomographic scan performed within 6 hours of headache onset--no need for lumbar puncture. Ann Emerg Med. 2013;61:503-4. 6. Edlow JA and Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. The New England journal of medicine. 2000;342:29-36. 7. Vermeulen M, Hasan D, Blijenberg BG, Hijdra A and van Gijn J. Xanthochromia after subarachnoid haemorrhage needs no revisitation. Journal of neurology, neurosurgery, and psychiatry. 1989;52:826-8. 8. Muehlschlegel S, Kursun O, Topcuoglu MA, Fok J and Singhal AB. Differentiating reversible cerebral vasoconstriction syndrome with subarachnoid hemorrhage from other causes of subarachnoid hemorrhage. JAMA Neurol. 2013;70:1254-60. 9. Misra UK, Kalita J, Chandra S, Kumar B and Bansal V. Low molecular weight heparin versus unfractionated heparin in cerebral venous sinus thrombosis: a randomized controlled trial. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2012;19:1030-6.

In this BrainWaves brief, we review the major infections of the spinal cord with anatomic localization of disease and clinical management. 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 Colin Quinn. REFERENCES 1. Cho TA, Vaitkevicius H. Infectious myelopathies. Continuum (Minneap Minn). 2012;18(6):1351-1373.

In this episode of BrainWaves, Dr. Joseph Berger discusses the complications of HIV literally from head to toe. From neuropathy to myelopathy to neurocognitive disorders as well as the myriad of opportunistic infections. Definitely worth your time. 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 for broadcast. REFERENCES 1. Ellis R, Langford D and Masliah E. HIV and antiretroviral therapy in the brain: neuronal injury and repair. Nat Rev Neurosci. 2007;8:33-44. 2. Boisse L, Gill MJ and Power C. HIV infection of the central nervous system: clinical features and neuropathogenesis. Neurol Clin. 2008;26:799-819, x. 3. Garg RK. HIV infection and seizures. Postgraduate medical journal. 1999;75:387-90. 4. Dore GJ, Law MG and Brew BJ. Prospective analysis of seizures occurring in human immunodeficiency virus type-1 infection. J NeuroAIDS. 1996;1:59-69. 5. Di Rocco A and Simpson DM. AIDS-associated vacuolar myelopathy. AIDS Patient Care STDS. 1998;12:457-61. 6. Murdoch DM, Venter WD, Van Rie A and Feldman C. Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options. AIDS Res Ther. 2007;4:9.

Quick tutorial to help you navigate through the causes of foot drop. Check it out! 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 Colin Quinn for broadcast. REFERENCES Preston DC & Shapiro BE. Electromyography and neuromuscular disorders, 3rd ed. Saunders (2013).

Dr. Clyde Markowitz relays his account of the Radiologically Isolated Syndrome and his approach to managing it. 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 Clyde Markowitz for broadcast. REFERENCES 1. Okuda DT, Mowry EM, Beheshtian A, Waubant E, Baranzini SE, Goodin DS, Hauser SL and Pelletier D. Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome. Neurology. 2009;72:800-5. 2. Barkhof F, Filippi M, Miller DH, Scheltens P, Campi A, Polman CH, Comi G, Ader HJ, Losseff N and Valk J. Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain. 1997;120 ( Pt 11):2059-69. 3. Granberg T, Martola J, Kristoffersen-Wiberg M, Aspelin P and Fredrikson S. Radiologically isolated syndrome--incidental magnetic resonance imaging findings suggestive of multiple sclerosis, a systematic review. Multiple sclerosis. 2013;19:271-80. 4. Okuda DT, Mowry EM, Cree BA, Crabtree EC, Goodin DS, Waubant E and Pelletier D. Asymptomatic spinal cord lesions predict disease progression in radiologically isolated syndrome. Neurology. 2011;76:686-92. 5. Lebrun C, Bensa C, Debouverie M, Wiertlevski S, Brassat D, de Seze J, Rumbach L, Pelletier J, Labauge P, Brochet B, Tourbah A, Clavelou P and Club Francophone de la Sclerose en P. Association between clinical conversion to multiple sclerosis in radiologically isolated syndrome and magnetic resonance imaging, cerebrospinal fluid, and visual evoked potential: follow-up of 70 patients. Archives of neurology. 2009;66:841-6. 6. Giorgio A, Stromillo ML, Rossi F, Battaglini M, Hakiki B, Portaccio E, Federico A, Amato MP and De Stefano N. Cortical lesions in radiologically isolated syndrome. Neurology. 2011;77:1896-9. 7. Amato MP, Hakiki B, Goretti B, Rossi F, Stromillo ML, Giorgio A, Roscio M, Ghezzi A, Guidi L, Bartolozzi ML, Portaccio E, De Stefano N and Italian RISMSSG. Association of MRI metrics and cognitive impairment in radiologically isolated syndromes. Neurology. 2012;78:309-14. 8. Goodin DS and Bates D. Treatment of early multiple sclerosis: the value of treatment initiation after a first clinical episode. Multiple sclerosis. 2009;15:1175-82.

In this episode, resident physician Lauren McCollum discusses how the ICU has influenced her artistic side. 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.

In our first episode with neurology content, we will discuss my research interest in neurologic deterioration after stroke. 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. The case discussed in this episode is fictional and does not contain any patient health identifying information. REFERENCES 1. Siegler JE, Boehme AK, Albright KC, George AJ, Monlezun DJ, Beasley TM and Martin-Schild S. A proposal for the classification of etiologies of neurologic deterioration after acute ischemic stroke. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013;22:e549-56. 2. Thanvi B, Treadwell S and Robinson T. Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management. Postgraduate medical journal. 2008;84:412-7. 3. Balami JS, Chen RL, Grunwald IQ and Buchan AM. Neurological complications of acute ischaemic stroke. The Lancet Neurology. 2011;10:357-71. 4. Kwan J and Hand P. Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM : monthly journal of the Association of Physicians. 2006;99:625-33.

BrainWaves is an open-source audio podcast that was launched in 2016 as a resource for neurology trainees and physicians. Its aim is to provide interested persons with up-to-date clinical and basic science information in general neurology, neurologic subspecialties, and the humanities. 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.