This week on the program, we have remastered one of our earliest (and most interesting!) episodes on Guillain-Barre syndrome. With an important announcement from Jim Siegler. Produced by James E. Siegler. Music courtesy of Lee Rosevere. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 Dimachkie MM and Saperstein DS. Acquired immune demyelinating neuropathies. Continuum (Minneap Minn). 2014;20:1241-60. Osler W. The principles and practice of medicine. New York: Appleton; 1892. Gray H. History of lumbar puncture (rachicentesis): The operation and the idea. Arch Neurol Psych. 1921;6:61-69. Asbury AK. Guillain-Barre syndrome: historical aspects. Annals of neurology. 1990;27 Suppl:S2-6. Afifi AK. The landry-guillain-barre strohl syndrome 1859 to 1992 a historical perspective. J Family Community Med. 1994;1:30-4. Bril V and Katzberg HD. Acquired immune axonal neuropathies. Continuum (Minneap Minn). 2014;20:1261-73. Iodice V and Sandroni P. Autonomic neuropathies. Continuum (Minneap Minn). 2014;20:1373-97. Lehmann HC, Hartung HP, Kieseier BC and Hughes RA. Guillain-Barre syndrome after exposure to influenza virus. Lancet Infect Dis. 2010;10:643-51. Sivadon-Tardy V, Orlikowski D, Porcher R, Sharshar T, Durand MC, Enouf V, Rozenberg F, Caudie C, Annane D, van der Werf S, Lebon P, Raphael JC, Gaillard JL and Gault E. Guillain-Barre syndrome and influenza virus infection. Clin Infect Dis. 2009;48:48-56. Stowe J, Andrews N, Wise L and Miller E. Investigation of the temporal association of Guillain-Barre syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. American journal of epidemiology. 2009;169:382-8. Tam CC, O'Brien SJ, Petersen I, Islam A, Hayward A and Rodrigues LC. Guillain-Barre syndrome and preceding infection with campylobacter, influenza and Epstein-Barr virus in the general practice research database. PloS one. 2007;2:e344. Tam CC, O'Brien SJ and Rodrigues LC. Influenza, Campylobacter and Mycoplasma infections, and hospital admissions for Guillain-Barre syndrome, England. Emerg Infect Dis. 2006;12:1880-7. Dawood FS, Chaves SS, Perez A, Reingold A, Meek J, Farley MM, Ryan P, Lynfield R, Morin C, Baumbach J, Bennett NM, Zansky S, Thomas A, Lindegren ML, Schaffner W, Finelli L and Emerging Infections Program N. Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010. The Journal of infectious diseases. 2014;209:686-94. McDermott M, Gelb DJ, Wilson K, Pawloski M, Burke JF, Shelgikar AV and London ZN. Sex Differences in Academic Rank and Publication Rate at Top-Ranked US Neurology Programs. JAMA Neurol. 2018;75:956-961. Keddie S, Pakpoor J, Mousele C, Pipis M, Machado PM, Foster M, Record CJ, Keh RYS, Fehmi J, Paterson RW, Bharambe V, Clayton LM, Allen C, Price O, Wall J, Kiss-Csenki A, Rathnasabapathi DP, Geraldes R, Yermakova T, King-Robson J, Zosmer M, Rajakulendran S, Sumaria S, Farmer SF, Nortley R, Marshall CR, Newman EJ, Nirmalananthan N, Kumar G, Pinto AA, Holt J, Lavin TM, Brennan KM, Zandi MS, Jayaseelan DL, Pritchard J, Hadden RDM, Manji H, Willison HJ, Rinaldi S, Carr AS and Lunn MP. Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barre syndrome. Brain. 2021;144:682-693. Lunn MP, Cornblath DR, Jacobs BC, Querol L, van Doorn PA, Hughes RA and Willison HJ. COVID-19 vaccine and Guillain-Barre syndrome: let's not leap to associations. Brain. 2021;144:357-360. 

BrainWaves: A Neurology Podcast

#30 GBS: 2021 Update

The field of neurocritical care and traumatic brain injury management is rapidly evolving. We are shifting from older (but not entirely outdated) monitoring techniques to novel diagnostic and therapeutic advances in critical care medicine. Managing intracranial pressure crises involves the careful tiptoeing of a line between maintaining brain circulation and yet reducing intracranial fluid volume. And many of our interventions rely on one simple mathematical construct: CPP = MAP - ICP [Cerebral perfusion pressure = Mean arterial pressure – Intracranial pressure] The importance of this formula cannot be understated. So we are spending 35 minutes today reviewing it, and discussing pearls and pitfalls of ICP monitoring and management. But believe me, it’s worth it. Produced by James E. Siegler and Jon Rosenberg. Music courtesy of Unheard Music Concepts, Rafael Archangel, Milton Arias, and Quincas Moreira. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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  Rosner MJ and Coley IB. Cerebral perfusion pressure, intracranial pressure, and head elevation. Journal of neurosurgery. 1986;65:636-41. Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J, Machamer J, Chaddock K, Celix JM, Cherner M, Hendrix T and Global Neurotrauma Research G. A trial of intracranial-pressure monitoring in traumatic brain injury. The New England journal of medicine. 2012;367:2471-81. Kristiansson H, Nissborg E, Bartek J, Jr., Andresen M, Reinstrup P and Romner B. Measuring elevated intracranial pressure through noninvasive methods: a review of the literature. J Neurosurg Anesthesiol. 2013;25:372-85. Armstead WM. Cerebral Blood Flow Autoregulation and Dysautoregulation. Anesthesiol Clin. 2016;34:465-77. Oddo M, Crippa IA, Mehta S, Menon D, Payen JF, Taccone FS and Citerio G. Optimizing sedation in patients with acute brain injury. Crit Care. 2016;20:128. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW and Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80:6-15. Okonkwo DO, Shutter LA, Moore C, Temkin NR, Puccio AM, Madden CJ, Andaluz N, Chesnut RM, Bullock MR, Grant GA, McGregor J, Weaver M, Jallo J, LeRoux PD, Moberg D, Barber J, Lazaridis C and Diaz-Arrastia RR. Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial. Critical care medicine. 2017;45:1907-1914. Harary M, Dolmans RGF and Gormley WB. Intracranial Pressure Monitoring-Review and Avenues for Development. Sensors (Basel). 2018;18. Koenig MA. Cerebral Edema and Elevated Intracranial Pressure. Continuum (Minneap Minn). 2018;24:1588-1602. Jahns FP, Miroz JP, Messerer M, Daniel RT, Taccone FS, Eckert P and Oddo M. Quantitative pupillometry for the monitoring of intracranial hypertension in patients with severe traumatic brain injury. Crit Care. 2019;23:155. Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K and Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocritical care. 2020;32:647-666. Robba C, Pozzebon S, Moro B, Vincent JL, Creteur J and Taccone FS. Multimodal non-invasive assessment of intracranial hypertension: an observational study. Crit Care. 2020;24:379. 

#181 A primer on ICP management

 What do hip weakness, headache, and neglect have in common? At minimum, they can all be approached with simple neurodiagnostic heuristics. But there's more to neurology and medicine than having an approach to "leg weakness" or an approach to "headache". You have to adapt to new information as it presents itself. You have to know when, and how, to pivot. Produced by James E. Siegler, Minal Patel, and Jesse Thon. Voiceovers by Taryn Hester and Terri Yeager. Music for our program today was courtesy of Lee Rosevere, Rafael Archangel, E’s Jammy Jams, Kai Engel, and Jon Watts under a Creative Commons license. Our theme song was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 Rozen TD. Trigeminal neuralgia and glossopharyngeal neuralgia. Neurol Clin. 2004;22:185-206. Tarulli AW and Raynor EM. Lumbosacral radiculopathy. Neurol Clin. 2007;25:387-405. Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM, American Academy of Neurology S and European Federation of Neurological S. AAN-EFNS guidelines on trigeminal neuralgia management. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2008;15:1013-28. Dyck PJ and Thaisetthawatkul P. Lumbosacral plexopathy. Continuum (Minneap Minn). 2014;20:1343-58. Beume LA, Hieber M, Kaller CP, Nitschke K, Bardutzky J, Urbach H, Weiller C and Rijntjes M. Large Vessel Occlusion in Acute Stroke. Stroke; a journal of cerebral circulation. 2018;49:2323-2329. Menon BK. Neuroimaging in Acute Stroke. Continuum (Minneap Minn). 2020;26:287-309. 

#180 The art of the pivot

Who doesn’t enjoy their sleep? For most of us, it can be the most relaxing escape. And for others, a disturbance of sleep may be the first clue to a neurodenerative condition. Produced by James E. Siegler. Dr. Avidan reports that he receives royalties from Elsevier, is a consultant for Merck, and is a speaker for Eisai and Harmony. Music for our program today was by Andy Cohen, Purple Planet Music, Steve Combs, Yan Terrien, and Shane Ivers, whose music can be found at silvermansound.com. Our theme song was composed by Jimothy Dalton. Voiceover was courtesy of Taryn Hester. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 Boeve BF, Silber MH, Ferman TJ, Lucas JA and Parisi JE. Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Mov Disord. 2001;16:622-30. Gilat M, Coeytaux Jackson A, Marshall NS, Hammond D, Mullins AE, Hall JM, Fang BAM, Yee BJ, Wong KKH, Grunstein RR and Lewis SJG. Melatonin for rapid eye movement sleep behavior disorder in Parkinson's disease: A randomised controlled trial. Mov Disord. 2020;35:344-349. Lloyd R, Tippmann-Peikert M, Slocumb N and Kotagal S. Characteristics of REM sleep behavior disorder in childhood. J Clin Sleep Med. 2012;8:127-31. Malhotra R and Avidan AY. Neurodegenerative Disease and REM Behavior Disorder. Current treatment options in neurology. 2012;14:474-92. McGrane IR, Leung JG, St Louis EK and Boeve BF. Melatonin therapy for REM sleep behavior disorder: a critical review of evidence. Sleep Med. 2015;16:19-26. Porter VR and Avidan AY. Clinical Overview of REM Sleep Behavior Disorder. Semin Neurol. 2017;37:461-470. Shin C, Park H, Lee WW, Kim HJ, Kim HJ and Jeon B. Clonazepam for probable REM sleep behavior disorder in Parkinson's disease: A randomized placebo-controlled trial. Journal of the neurological sciences. 2019;401:81-86. St Louis EK, Boeve AR and Boeve BF. REM Sleep Behavior Disorder in Parkinson's Disease and Other Synucleinopathies. Mov Disord. 2017;32:645-658. St Louis EK and Boeve BF. REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions. Mayo Clinic proceedings. 2017;92:1723-1736. Teigen LN, Sharp RR, Hirsch JR, Campbell E, Timm PC, Sandness DJ, Feemster JC, Gossard TR, Faber SM, Steele TA, Rivera S, Junna MR, Lipford MC, Tippmann-Peikert M, Kotagal S, Ju YE, Howell M, Schenck CH, Videnovic A, Jennum P, Hogl B, Stefani A, Arnulf I, Heidbreder A, Lewis S, McCarter SJ, Boeve BF, Silber MH and St Louis EK. Specialist approaches to prognostic counseling in isolated REM sleep behavior disorder. Sleep Med. 2021;79:107-112. 

#179 RBD and synucleinopathies

 As many as 1% of the world has epilepsy, but far more than will have a seizure in their lifetime. Not everyone needs a seizure medication, some people are even harmed by them. So who warrants treatment, and what do you start with. Consider today’s program an intro to AED decision making. For educational purposes only, of course. Not to guide any healthcare provider’s decision making. Produced by James E. Siegler. Music courtesy of Lee Rosevere, Cellophane Sam, Jon Watts, Josh Woodward, and Rafael Archangel. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 Hauser WA, Rich SS, Annegers JF and Anderson VE. Seizure recurrence after a 1st unprovoked seizure: an extended follow-up. Neurology. 1990;40:1163-70. Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. First Seizure Trial Group (FIR.S.T. Group). Neurology. 1993;43:478-83. Hui AC, Tang A, Wong KS, Mok V and Kay R. Recurrence after a first untreated seizure in the Hong Kong Chinese population. Epilepsia. 2001;42:94-7. Koepp MJ and Woermann FG. Imaging structure and function in refractory focal epilepsy. The Lancet Neurology. 2005;4:42-53. Marson A, Jacoby A, Johnson A, Kim L, Gamble C, Chadwick D and Medical Research Council MSG. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet. 2005;365:2007-13. Manjunath R, Davis KL, Candrilli SD and Ettinger AB. Association of antiepileptic drug nonadherence with risk of seizures in adults with epilepsy. Epilepsy Behav. 2009;14:372-8. Fountain NB. Choosing among antiepileptic drugs. Continuum (Minneap Minn). 2010;16:121-35. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J, Jr., Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Moshe SL, Perucca E, Scheffer IE, Tomson T, Watanabe M and Wiebe S. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55:475-82. Krumholz A, Wiebe S, Gronseth GS, Gloss DS, Sanchez AM, Kabir AA, Liferidge AT, Martello JP, Kanner AM, Shinnar S, Hopp JL and French JA. Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;84:1705-13. Bouma HK, Labos C, Gore GC, Wolfson C and Keezer MR. The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2016;23:455-63. Leone MA, Giussani G, Nolan SJ, Marson AG and Beghi E. Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure. The Cochrane database of systematic reviews. 2016:CD007144. 

#178 First seizure of life

To quote Donald Rumsfeld, “there are things we know we know…. we know there are some things we do not know... But there are also unknown unknowns—the ones we don't know we don't know…it is the latter category that tends to be the difficult ones.” In neurology, the agnosias are not that dissimilar from Rumsfeld’s 'unknown unknowns.' In this week’s program, we discuss the nosology and nomenclature for the agnosias, the localization, and the importance of recognizing one. Produced by James E. Siegler. Music courtesy of Dr. Turtle, Grossman, Ewell and Grainger, Marco Trovatelli, and Purple Planet Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 Milner AD, Perrett DI, Johnston RS, Benson PJ, Jordan TR, Heeley DW, Bettucci D, Mortara F, Mutani R, Terazzi E and et al. Perception and action in 'visual form agnosia'. Brain. 1991;114 ( Pt 1B):405-28. Zeki S and Ffytche DH. The Riddoch syndrome: insights into the neurobiology of conscious vision. Brain. 1998;121 ( Pt 1):25-45. Biran I and Coslett HB. Visual agnosia. Current neurology and neuroscience reports. 2003;3:508-12. Coslett HB. Apraxia, Neglect, and Agnosia. Continuum (Minneap Minn). 2018;24:768-782. Dhont S, Derom E, Van Braeckel E, Depuydt P and Lambrecht BN. The pathophysiology of 'happy' hypoxemia in COVID-19. Respir Res. 2020;21:198. Li YC, Bai WZ and Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020;92:552-555. Matschke J, Lutgehetmann M, Hagel C, Sperhake JP, Schroder AS, Edler C, Mushumba H, Fitzek A, Allweiss L, Dandri M, Dottermusch M, Heinemann A, Pfefferle S, Schwabenland M, Sumner Magruder D, Bonn S, Prinz M, Gerloff C, Puschel K, Krasemann S, Aepfelbacher M and Glatzel M. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. The Lancet Neurology. 2020;19:919-929. 

#177 Agnosia

Almost 5 years ago, we published a show on chronic traumatic encephalopathy and its relationship to American football. But a lot has happened since 2016. New rules in the NFL. Emerging data on how the developing human brain of a child or adolescent is even more vulnerable to pathologic changes following mild head injury. And a heightened awareness of the disingenuous campaign against contact sports among one of the most outspoken whistleblowers in the medical field. This week on the program, we have remastered and updated the 2016 program. With some additional commentary on how parenthood may yield a new perspective on contact sports. Produced by James E. Siegler. Music courtesy of Chris Haugen, Kevin McLeod, and Meydan. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 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. 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. 2013;80:2250-7. Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Cantu RC, Randolph C and Jordan BD. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005;57:719-26; discussion 719-26. Stamm JM, Bourlas AP, Baugh CM, Fritts NG, Daneshvar DH, Martin BM, McClean MD, Tripodis Y and Stern RA. Age of first exposure to football and later-life cognitive impairment in former NFL players. Neurology. 2015;84:1114-20. Ling H, Morris HR, Neal JW, Lees AJ, Hardy J, Holton JL, Revesz T and Williams DD. Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta Neuropathol. 2017;133:337-352. Alosco ML, Mez J, Tripodis Y, Kiernan PT, Abdolmohammadi B, Murphy L, Kowall NW, Stein TD, Huber BR, Goldstein LE, Cantu RC, Katz DI, Chaisson CE, Martin B, Solomon TM, McClean MD, Daneshvar DH, Nowinski CJ, Stern RA and McKee AC. Age of first exposure to tackle football and chronic traumatic encephalopathy. Annals of neurology. 2018;83:886-901. Hobson W. "From Scientist to Salesman". Available online at https://www.washingtonpost.com/graphics/2020/sports/cte-bennet-omalu/. Accessed 31 December 2020. 

#33 Controversies in chronic traumatic encephalopathy

Happy New Year, and good riddance 2020! Hopefully there is more that you will take away from the past 12 months other than your personal experience with the coronavirus pandemic. Whether you lost a job, a loved one, or an invaluable life experience, I think we can all say BRING ON 2021! So let's welcome the new year with positive mental attitude, a bit more luck, and an unquenchable thirst for knowledge. Produced by James E. Siegler. Music courtesy of Jahzzar, Kevin McLeod, Patches, Montplaisir, Steve Combs, Lee Roosevere, Siddhartha, Soft and Furious, Magic in the Other, and Loyalty Freak Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 EEG Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study G. A randomized, controlled trial of surgery for temporal-lobe epilepsy. The New England journal of medicine. 2001;345:311-8. Cascino GD. Clinical indications and diagnostic yield of video-electroencephalographic monitoring in patients with seizures and spells. Mayo Clinic proceedings. 2002;77:1111-20. Pillai J and Sperling MR. Interictal EEG and the diagnosis of epilepsy. Epilepsia. 2006;47 Suppl 1:14-22. Bouma HK, Labos C, Gore GC, Wolfson C and Keezer MR. The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2016;23:455-63. Debicki DB. Electroencephalography after a single unprovoked seizure. Seizure. 2017;49:69-73. DYSFERLINOPATHY Suresh E and Wimalaratna S. Proximal myopathy: diagnostic approach and initial management. Postgraduate medical journal. 2013;89:470-7. Walter MC, Reilich P, Thiele S, Schessl J, Schreiber H, Reiners K, Kress W, Muller-Reible C, Vorgerd M, Urban P, Schrank B, Deschauer M, Schlotter-Weigel B, Kohnen R and Lochmuller H. Treatment of dysferlinopathy with deflazacort: a double-blind, placebo-controlled clinical trial. Orphanet J Rare Dis. 2013;8:26. Fayssoil A, Ogna A, Chaffaut C, Chevret S, Guimaraes-Costa R, Leturcq F, Wahbi K, Prigent H, Lofaso F, Nardi O, Clair B, Behin A, Stojkovic T, Laforet P, Orlikowski D and Annane D. Natural History of Cardiac and Respiratory Involvement, Prognosis and Predictive Factors for Long-Term Survival in Adult Patients with Limb Girdle Muscular Dystrophies Type 2C and 2D. PloS one. 2016;11:e0153095. Harris E, Bladen CL, Mayhew A, James M, Bettinson K, Moore U, Smith FE, Rufibach L, Cnaan A, Bharucha-Goebel DX, Blamire AM, Bravver E, Carlier PG, Day JW, Diaz-Manera J, Eagle M, Grieben U, Harms M, Jones KJ, Lochmuller H, Mendell JR, Mori-Yoshimura M, Paradas C, Pegoraro E, Pestronk A, Salort-Campana E, Schreiber-Katz O, Semplicini C, Spuler S, Stojkovic T, Straub V, Takeda S, Rocha CT, Walter MC, Bushby K and Jain COSC. The Clinical Outcome Study for dysferlinopathy: An international multicenter study. Neurol Genet. 2016;2:e89. Clark KEN and Isenberg DA. A review of inflammatory idiopathic myopathy focusing on polymyositis. European journal of neurology : the official journal of the European Federation of Neurological Societies. 2018;25:13-23. Wicklund MP. The Limb-Girdle Muscular Dystrophies. Continuum (Minneap Minn). 2019;25:1599-1618. Preston DC and Shapiro BE. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. 3rd ed. London; New York: Elsevier Saunders; 2013. “rAAVrh74.MHCK7.DYSF.DV for Treatment of Dysferlinopathies.” Clinicaltrials.gov. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02710500?cond=dysferlinopathy&draw=2&rank=1 on 22 December 2019. SPINAL DURAL AV FISTULA Jellema K, Tijssen CC, van Rooij WJ, Sluzewski M, Koudstaal PJ, Algra A and van Gijn J. Spinal dural arteriovenous fistulas: long-term follow-up of 44 treated patients. Neurology. 2004;62:1839-41. Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT and Thron A. Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2007;28:1249-58. Krings T and Geibprasert S. Spinal dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2009;30:639-48. Alexander MD, Oliff MC, Olorunsola OG, Brus-Ramer M, Nickoloff EL and Meyers PM. Patient radiation exposure during diagnostic and therapeutic interventional neuroradiology procedures. J Neurointerv Surg. 2010;2:6-10. Cifarelli CP, Kaptain G, Yen CP, Schlesinger D and Sheehan JP. Gamma knife radiosurgery for dural arteriovenous fistulas. Neurosurgery. 2010;67:1230-5; discussion 1235. Kim DJ, Willinsky R, Geibprasert S, Krings T, Wallace C, Gentili F and Terbrugge K. Angiographic characteristics and treatment of cervical spinal dural arteriovenous shunts. AJNR American journal of neuroradiology. 2010;31:1512-5. Chen J and Gailloud P. Safety of spinal angiography: complication rate analysis in 302 diagnostic angiograms. Neurology. 2011;77:1235-40. Manninen AL, Isokangas JM, Karttunen A, Siniluoto T and Nieminen MT. A comparison of radiation exposure between diagnostic CTA and DSA examinations of cerebral and cervicocerebral vessels. AJNR American journal of neuroradiology. 2012;33:2038-42. 

Best of BrainWaves 2020

I shouldn’t have to tell you that traumatic brain injury is a major cause of morbidity and mortality. I shouldn’t have to. But I will. And it is. In severe cases of head injury, there can be delayed and irreversible deterioration in the nervous system for which there is no treatment and the prognosis is grim. This week on the program, Dr. Monisha Kumar (University of Pennsylvania) discusses the worst of the worst of these scenarios, what to look out for, and expert recommendations on what to do when it happens. Produced by James E. Siegler and Monisha Kumar. Music courtesy of Rui, Swelling, Unheard Music Concepts, Jahzzar, Ian Southerland, and TRG Banks. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 Strich SJ. Diffuse degeneration of the cerebral white matter in severe dementia following head injury. Journal of neurology, neurosurgery, and psychiatry. 1956;19:163-85. Adams JH, Graham DI, Murray LS and Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Annals of neurology. 1982;12:557-63. Povlishock JT, Becker DP, Cheng CL and Vaughan GW. Axonal change in minor head injury. J Neuropathol Exp Neurol. 1983;42:225-42. Gentry LR. Imaging of closed head injury. Radiology. 1994;191:1-17. Meythaler JM, Peduzzi JD, Eleftheriou E and Novack TA. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil. 2001;82:1461-71. Arfanakis K, Haughton VM, Carew JD, Rogers BP, Dempsey RJ and Meyerand ME. Diffusion tensor MR imaging in diffuse axonal injury. AJNR American journal of neuroradiology. 2002;23:794-802. Scheid R, Preul C, Gruber O, Wiggins C and von Cramon DY. Diffuse axonal injury associated with chronic traumatic brain injury: evidence from T2*-weighted gradient-echo imaging at 3 T. AJNR American journal of neuroradiology. 2003;24:1049-56. DeKosky ST, Ikonomovic MD and Gandy S. Traumatic brain injury--football, warfare, and long-term effects. The New England journal of medicine. 2010;363:1293-6. Johnson VE, Stewart W and Smith DH. Widespread tau and amyloid-beta pathology many years after a single traumatic brain injury in humans. Brain Pathol. 2012;22:142-9. Schrag M and Greer DM. Clinical associations of cerebral microbleeds on magnetic resonance neuroimaging. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2014;23:2489-2497. Haghbayan H, Boutin A, Laflamme M, Lauzier F, Shemilt M, Moore L, Zarychanski R, Douville V, Fergusson D and Turgeon AF. The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Critical care medicine. 2017;45:e1280-e1288. Izzy S, Mazwi NL, Martinez S, Spencer CA, Klein JP, Parikh G, Glenn MB, Greenberg SM, Greer DM, Wu O and Edlow BL. Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal. Neurocritical care. 2017;27:199-207. van Eijck MM, Schoonman GG, van der Naalt J, de Vries J and Roks G. Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis. Brain Inj. 2018;32:395-402. 

#176 Mind blown

COVID-19 is more than just a threat to your physical health. Even if you are never infected, you may not be free of it. In today's program, we take lessons from prior pandemics and consider the sociocultural effects of a global infectious disease. Be advised, this one is of the "sentimental" variety. Produced by James E. Siegler. Music courtesy of Purple Planet Music, Meydn, Kevin MacLeod and Shane Ivers, which you can find at Silvermansound.com. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095-128. Fineberg HV. Pandemic preparedness and response--lessons from the H1N1 influenza of 2009. The New England journal of medicine. 2014;370:1335-42. Shanks GD. Insights from unusual aspects of the 1918 influenza pandemic. Travel Med Infect Dis. 2015;13:217-22. Armitage R and Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020;5:e256. Bonaccorsi G, Pierri F, Cinelli M, Flori A, Galeazzi A, Porcelli F, Schmidt AL, Valensise CM, Scala A, Quattrociocchi W and Pammolli F. Economic and social consequences of human mobility restrictions under COVID-19. Proc Natl Acad Sci U S A. 2020;117:15530-15535. Dinmohamed AG, Visser O, Verhoeven RHA, Louwman MWJ, van Nederveen FH, Willems SM, Merkx MAW, Lemmens V, Nagtegaal ID and Siesling S. Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands. Lancet Oncol. 2020;21:750-751. Jeffery MM, D'Onofrio G, Paek H, Platts-Mills TF, Soares WE, 3rd, Hoppe JA, Genes N, Nath B and Melnick ER. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA internal medicine. 2020;180:1328-1333. Rabinovitz B, Jaywant A and Fridman CB. Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: implications for the current COVID-19 pandemic. Clin Neuropsychol. 2020:1-27. Santini ZI, Jose PE, York Cornwell E, Koyanagi A, Nielsen L, Hinrichsen C, Meilstrup C, Madsen KR and Koushede V. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020;5:e62-e70. Wong LE, et al. Where are all the patients? New Eng J Med (2020): Published online 14 May 2020. Available at https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0193. 

#175 Call your Mom

The mental status exam is a keystone of the neurologic assessment. Dr. Andrea Casher (Cooper University Hospital) builds upon this metaphor in our program this week. Making a special appearance is US President Donald Trump, who underwent a mental status exam and recounts his experience. Produced by James E. Siegler and Andrea Casher. Music courtesy of Unheard Music Concepts, Purple Planet Music, Lee Rosevere, and Scott Holmes. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 Tombaugh TN and McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40:922-35. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL and Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695-9. Dong Y, Sharma VK, Chan BP, Venketasubramanian N, Teoh HL, Seet RC, Tanicala S, Chan YH and Chen C. The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. Journal of the neurological sciences. 2010;299:15-8. Gorno-Tempini ML, Hillis AE, Weintraub S, Kertesz A, Mendez M, Cappa SF, Ogar JM, Rohrer JD, Black S, Boeve BF, Manes F, Dronkers NF, Vandenberghe R, Rascovsky K, Patterson K, Miller BL, Knopman DS, Hodges JR, Mesulam MM and Grossman M. Classification of primary progressive aphasia and its variants. Neurology. 2011;76:1006-14. Ng KP, Chiew HJ, Lim L, Rosa-Neto P, Kandiah N and Gauthier S. The influence of language and culture on cognitive assessment tools in the diagnosis of early cognitive impairment and dementia. Expert review of neurotherapeutics. 2018;18:859-869. Rabinovitz B, Jaywant A and Fridman CB. Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: implications for the current COVID-19 pandemic. Clin Neuropsychol. 2020:1-27. 

#174 The mental status

October 29 is World Stroke Day! Might as well know how it is best treated. This week, Jim Siegler revisits a 2017 episode on the differences between two of the most commonly prescribed post-stroke treatments, with some key updates, recent trial results, and practice-changing paradigms. Produced by James E. Siegler. Music courtesy of William Ross Chernoff’s Nomads, Steve Combs, Rui, Little Glass Men, and Peter Rudenko. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 Jauch EC, Saver JL, Adams HP, Jr., Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW, Jr., Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H, American Heart Association Stroke C, Council on Cardiovascular N, Council on Peripheral Vascular D and Council on Clinical C. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2013;44:870-947. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet. 1997;349:1569-81. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet. 1997;349:1641-9. Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM and Investigators F. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. The Lancet Neurology. 2007;6:961-9. Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC and Investigators C. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. The New England journal of medicine. 2013;369:11-9. Hong KS, Lee SH, Kim EG, Cho KH, Chang DI, Rha JH, Bae HJ, Lee KB, Kim DE, Park JM, Kim HY, Cha JK, Yu KH, Lee YS, Lee SJ, Choi JC, Cho YJ, Kwon SU, Kim GM, Sohn SI, Park KY, Kang DW, Sohn CH, Lee J, Yoon BW and Investigators C. Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke: Clopidogrel Plus Aspirin Versus Aspirin Alone. Stroke; a journal of cerebral circulation. 2016;47:2323-30. Liu L, Wong KS, Leng X, Pu Y, Wang Y, Jing J, Zou X, Pan Y, Wang A, Meng X, Wang C, Zhao X, Soo Y, Johnston SC, Wang Y and Investigators C. Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE. Neurology. 2015;85:1154-62. Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. Bmj. 1994;308:81-106. Antithrombotic Trialists C. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Bmj. 2002;324:71-86. Committee CS. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348:1329-39. Ringleb PA, Bhatt DL, Hirsch AT, Topol EJ, Hacke W and Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events I. Benefit of clopidogrel over aspirin is amplified in patients with a history of ischemic events. Stroke; a journal of cerebral circulation. 2004;35:528-32. Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ and investigators M. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331-7. Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, Cacoub P, Cohen EA, Creager MA, Easton JD, Flather MD, Haffner SM, Hamm CW, Hankey GJ, Johnston SC, Mak KH, Mas JL, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Brennan DM, Fabry-Ribaudo L, Booth J, Topol EJ and Investigators C. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. The New England journal of medicine. 2006;354:1706-17. Rothwell PM, Price JF, Fowkes FG, Zanchetti A, Roncaglioni MC, Tognoni G, Lee R, Belch JF, Wilson M, Mehta Z and Meade TW. Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet. 2012;379:1602-12. Sahlen A, Varenhorst C, Lagerqvist B, Renlund H, Omerovic E, Erlinge D, Wallentin L, James SK and Jernberg T. Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction: experiences from SWEDEHEART registry. European heart journal. 2016;37:3335-3342. Bath PM, Woodhouse LJ, Appleton JP, Beridze M, Christensen H, Dineen RA, Duley L, England TJ, Flaherty K, Havard D, Heptinstall S, James M, Krishnan K, Markus HS, Montgomery AA, Pocock SJ, Randall M, Ranta A, Robinson TG, Scutt P, Venables GS, Sprigg N and Investigators T. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial. Lancet. 2018;391:850-859. Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R, Goodman SG, Windecker S, Darius H, Li J, Averkov O, Bahit MC, Berwanger O, Budaj A, Hijazi Z, Parkhomenko A, Sinnaeve P, Storey RF, Thiele H, Vinereanu D, Granger CB, Alexander JH and Investigators A. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. The New England journal of medicine. 2019;380:1509-1524. Wang Y, Chen W, Lin Y, Meng X, Chen G, Wang Z, Wu J, Wang D, Li J, Cao Y, Xu Y, Zhang G, Li X, Pan Y, Li H, Zhao X, Liu L, Lin J, Dong K, Jing J, Johnston SC, Wang D, Wang Y and Group PPS. Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. Bmj. 2019;365:l2211. 

#93 Aspirin vs. Plavix: The showdown

This week on the program, we bring to you a special episode on the impact of the COVID-19 pandemic on the neurology 2021 match--and potentially MANY subsequent matches. Jim Siegler is joined by the Assistant Program Director of the Cooper Neurology Residency Program, Olga Thon, and the creators of the @NMatch2021 Twitter account (who you should DEFINITELY follow after listening to our episode). If you are an applicant for the 2021 cycle, this show is MANDATORY. (only kidding, this is just a podcast) Produced by James E. Siegler, with assistance by Olga Thon, Adriana Romirez, Dylan Del Papa, Justine Ker, and Alvin Singh. Music courtesy of Akash Gandi, Little Glass Men, Kevin MacLeod, Josh Woodward, Julie Maxwell, and Kai Engel. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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.

#173 Matching during the COVID-19 pandemic

Halloween is one of the most exciting and festive holidays, but this year I imagine many of us are going to spend it indoors. To help pass the time, enjoy this seasonal special about the neurologic manifestations of zombie-ism. Today's program is a re-run from 2017, featuring Dr. Brian Hanrahan, and has been remastered and updated with some recent additions in light of the coronavirus pandemic. Produced by James E. Siegler. Music courtesy of Andrew Sacco, Ars Sonor, Yan Terrien, and Unheard Music Concepts. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig, with some original recordings out of Studio 3. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 Smith TC. Zombie infections: Epidemiology, treatment, and prevention. Bmj. 2015;351:h6423 Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R. "Zombie" outbreak caused by the synthetic cannabinoid amb-fubinaca in new york. The New England journal of medicine. 2017;376:235-242 Rabinovitz B, Jaywant A, Fridman CB. Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: Implications for the current covid-19 pandemic. Clin Neuropsychol. 2020:1-27 Gilmour SJ, Saito E, Yoneoka D. Importance of survival strategies after a zombie pandemic. Bmj. 2016;532:i259 Hughes DP, Andersen SB, Hywel-Jones NL, Himaman W, Billen J, Boomsma JJ. Behavioral mechanisms and morphological symptoms of zombie ants dying from fungal infection. BMC Ecol. 2011;11:13 

#83 Halloween Special: Zombies in neurology

As the second most common vascular malformation in the central nervous system, cerebral cavernomas are often incidental radiographic findings. Also incidental is Jim’s interest in mediocre sci-fi television shows, such as Netflix’s recent series, Away—which incidentally includes one character with a symptomatic cerebral cavernoma. This week on the podcast, Dr. Siegler discusses with Dr. Dena Little (Cooper University Hospital) the epidemiology, clinical course, and management (including counseling) of patients with this vascular malformation. Plus, a critical appraisal of Away’s medical consultant. 0_o Produced by James E. Siegler and Dena Little. Music courtesy of Ars Sonor, Andrew Sacco, Chris Zabriskie, and Purple Planet Music. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. 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 Pozzati E, Acciarri N, Tognetti F, Marliani F and Giangaspero F. Growth, subsequent bleeding, and de novo appearance of cerebral cavernous angiomas. Neurosurgery. 1996;38:662-9; discussion 669-70. Batra S, Lin D, Recinos PF, Zhang J and Rigamonti D. Cavernous malformations: natural history, diagnosis and treatment. Nature reviews Neurology. 2009;5:659-70. Gross BA, Lin N, Du R and Day AL. The natural history of intracranial cavernous malformations. Neurosurgical focus. 2011;30:E24. Horne MA, Flemming KD, Su IC, Stapf C, Jeon JP, Li D, Maxwell SS, White P, Christianson TJ, Agid R, Cho WS, Oh CW, Wu Z, Zhang JT, Kim JE, Ter Brugge K, Willinsky R, Brown RD, Jr., Murray GD, Al-Shahi Salman R and Cerebral Cavernous Malformations Individual Patient Data Meta-analysis C. Clinical course of untreated cerebral cavernous malformations: a meta-analysis of individual patient data. The Lancet Neurology. 2016;15:166-173. Zafar A, Quadri SA, Farooqui M, Ikram A, Robinson M, Hart BL, Mabray MC, Vigil C, Tang AT, Kahn ML, Yonas H, Lawton MT, Kim H and Morrison L. Familial Cerebral Cavernous Malformations. Stroke; a journal of cerebral circulation. 2019;50:1294-1301. Zuurbier SM, Hickman CR, Tolias CS, Rinkel LA, Leyrer R, Flemming KD, Bervini D, Lanzino G, Wityk RJ, Schneble HM, Sure U, Al-Shahi Salman R and Scottish Audit of Intracranial Vascular Malformations Steering C. Long-term antithrombotic therapy and risk of intracranial haemorrhage from cerebral cavernous malformations: a population-based cohort study, systematic review, and meta-analysis. The Lancet Neurology. 2019;18:935-941. 

#172 Cavernoma

BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology and medicine. Follow us on Twitter @brainwavesaudio, or just tune in every Thursday for the latest shows! **NOT FOR CLINICAL DECISION MAKING**

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BrainWaves: A Neurology Podcast

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