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Idiopathic intracranial hypertension (IIH) is characterized by symptoms and signs of unexplained elevated intracranial pressure (ICP) in an alert and awake patient. The condition has potentially devastating effects on vision, headache burden, increased cardiovascular disease risk, sleep disturbance, and depression.  In this episode, Teshamae Monteith, MD, FAAN speaks with Aileen A. Antonio, MD, FAAN, author of the article “Clinical Features and Diagnosis of Idiopathic Intracranial Hypertension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Antonio is an associate program director of the Hauenstein Neurosciences Residency Program at Trinity Health Grand Rapids and an assistant clinical professor at the Michigan State University College of Osteopathic Medicine in Lansang, Michigan. Additional Resources Read the article: Clinical Features and Diagnosis of Idiopathic Intracranial Hypertension Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @aiee_antonio Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: Hi, this is Dr Teshamae Monteith. Today I'm interviewing Dr Aileen Antonio about her article on clinical features and diagnosis of idiopathic intracranial hypertension, which appears in the June 2025 Continuum issue on disorders of CSF dynamics.  Hi, how are you? Dr Antonio: Hi, good afternoon. Dr Monteith: Thank you for being on the podcast. Dr Antonio: Thank you for inviting me, and it's such an honor to write for the Continuum. Dr Monteith: So why don't you start off with introducing yourself? Dr Antonio: So as mentioned, I'm Aileen Antonio. I am a neuro-ophthalmologist, dually trained in both ophthalmology and neurology. I'm practicing in Grand Rapids, Michigan Trinity Health, and I'm also the associate program director for our neurology residency program. Dr Monteith: So, it sounds like the residents get a lot of neuro-ophthalmology by chance in your curriculum. Dr Antonio: For sure. They do get fed that a lot. Dr Monteith: So why don't you tell me what the objective of your article was? Dr Antonio: Yes. So idiopathic intracranial hypertension, or IIH, is a condition where there's increased intracranial pressure, but without an obvious cause. And with this article, we want our readers---and our listeners right now---to recognize that the typical symptoms and learning about the IIH diagnostic criteria are key to avoiding errors, overdiagnosis, or sometimes even misdiagnosis or underdiagnosis. Thus, we help make the most of our healthcare resources. Early diagnosis and management are crucial to prevent disability from intractable headaches or even vision loss, and it's also important to know when to refer the patients to the appropriate specialists early on. Dr Monteith: So, it sounds like your central points are really getting that diagnosis early and managing the patients and knowing how to triage patients to reduce morbidity and complications. Is that correct? Dr Antonio: That is correct and very succinct, yes. Dr Monteith: And so, are there any more recent advances in the diagnosis of IIH? Dr Antonio: Yes. And one of the tools that we've been using is what we call the optical coherence tomography. A lot of people, neurologists, physicians, PCP, ER doctors; how many among those physicians are well-versed in doing an eye exam, looking at the optic disc? And this is a great tool because it is noninvasive, it is high resolution imaging technique that allows us to look at the optic nerve without even dilating the eye. And we can measure that retinal nerve fiber layer, or RNFL; and that helps us quantify the swelling that is visible or inherent in that optic nerve. And we can even follow that and monitor that over time. So, this gives us another way of looking at their vision and getting that insight as to how healthy is their vision still, along with the other formal visual tests that we do, including perimetry or visual field testing. And then all of these help in catching potentially early changes, early worsening, that may happen; and then we can intervene more easily. Dr Monteith: Great. So, it sounds like there's a lot of benefits to this newer technology for our patients. Dr Antonio: That is correct. Dr Monteith: So, I read in the article about the increased incidence of IIH, and I have to say that I completely agree with you because I'm seeing so much of it in my clinic, even as a headache specialist. And I had a talk with a colleague who said that the incidence of SIH and IIH are similar. And I was like, there's no way. Because I see, I can see several people with IIH just in one day. That's not uncommon. So, tell me what your thoughts are on the incidence, the rising incidence of IIH; and we understand that it's the condition associated with obesity, but it sounds like you have some other underlying drivers of this problem. Dr Antonio: Yes, that is correct. So, as you mentioned, IIH tends to affect women of childbearing age with obesity. And it's interesting because as you've seen that trend, we see more of these IIH cases recently, which seem to correlate with that rising rate of obesity. And the other thing, too, is that this trend can readily add to the burden of managing IIH, because not only are we dealing with the headaches or the potential loss of vision, but also it adds to the burden of healthcare costs because of the other potential comorbidities that may come with it, like cardiovascular risk factors, PCOS, and sleep apnea. Dr Monteith: So why don't we just talk about the diagnosis of IIH? Dr Antonio: IIH, idiopathic intracranial hypertension, is also called pseudotumor cerebri.  It's essentially a condition where a person experiences increased intracranial pressure, but without any obvious cause. And the tricky part is that the patients, they're usually fully awake and alert. So, there's no obvious tumor, brain tumor or injury that causes the increased ICP. It's really, really important to rule out other conditions that might cause these similar symptoms; again, like brain tumors or even the cerebral venous sinus thrombosis. Many patients will have headaches or visual disturbances like transient visual obscurations---we call them TVOs---or double vision or diplopia. The diplopia is usually related to a sixth nerve palsy or an abducens palsy. Some may also experience some back pain or what we call pulsatile tinnitus, which is that pulse synchronous ringing in their ears. The biggest sign that we see in the clinic would be that papilledema; and papilledema is a term that we only use, specifically use, for those optic nerve edema changes that is only associated with increased intracranial pressure. So, performing of endoscopy and good eye exam is crucial in these patients. We usually use the modified Dandy criteria to diagnose IIH. And again, I cannot emphasize too much that it's really important to rule out other secondary causes to that increased intracranial pressure. So, after that thorough neurologic and eye evaluation with neuroimaging, we do a lumbar puncture to measure the opening pressure and to analyze the cerebrospinal fluid. Dr Monteith: One thing I learned from your article, really just kind of seeing all of the symptoms that you mentioned, the radicular pain, but also- and I think I've seen some papers on this, the cognitive dysfunction associated with IIH. So, it's a broader symptom complex I think than people realize. Dr Antonio: That is correct. Dr Monteith: So, you mentioned TVOs. Tell me, you know, if I was a patient, how would you try and elicit that from me? Dr Antonio: So, I would usually just ask the patient, while you're sitting down just watching TV---some of my patients are even driving as this happens---they would suddenly have these episodes of blacking out of vision, graying out of vision, vision loss, or blurred vision that would just happen, from seconds to less than a minute, usually. And they can happen in one eye or the other eye or both eyes, and even multiple times a day. I had a patient, it was happening 50 times a day for her. It's important to note that there is no pain associated with it most of the time. The other thing too is that it's different from the aura that patients with migraines would have, because those auras are usually scintillating and would have what we call the positive phenomena: the flashing lights, the iridescence, and even the fortification that they see in their vision. So definitely TVOs are not the migraine auras. Sometimes the TVOs can also be triggered by sudden changes in head positions or even a change in posture, like standing up quickly. The difference, though, between that and, like, the graying out of vision or the tunneling vision associated with orthostatic hypotension, is that the orthostatic hypotension would also have that feeling of lightheadedness and dizziness that would come with it. Dr Monteith: Great. So, if someone feels lightheaded, less likely to be a TVO if they're bending down and they have that grain of vision. Dr Antonio: That is correct. Dr Monteith: Definitely see patients like that in clinic. And if they have fluoride IIH, I'm like, I'll call it a TVO; if they don't, I'm like, it's probably more likely to be dizziness-related. And then we also have patient migraines that have blurriness that's nonspecific, not necessarily associated with aura. But I think in those patients, it's usually not seconds long, it's usually probably longer episodes of blurriness. Would you agree there, or…? Dr Antonio: I would agree there, and usually the visual aura would precede the headache that is very characteristic of their migraine, very stereotypical for their migraines. And then it would dissipate slowly over time as well. With TVOs, they're brisk and would not last, usually, more than a minute. Dr Monteith: So, why don't we talk about routine imaging? Obviously, ordering an MRI, and I read also getting an MRV is important. Dr Antonio: It is very important because, one: I would say IIH is also a diagnosis of exclusion. We need to make sure that the increased ICP is not because of a brain tumor or not because of cerebral venous sinus thrombosis. So, it's important to get the MRI of the brain as well as the MRV of the head. Dr Monteith: Do you do that for all patients' MRV, and how often do you add on an orbital study? Dr Antonio: I usually do not add on an orbital study because it's not really going to change my management at that point. I really get that MRI of the brain. Now the MRV, for most of my patients, I would order it already just because the population that I see, I don't want to lose them. And sometimes it's that follow-up, and that is the difficult part; and it's an easy add on to the study that I'm going to order. Again, it depends with the patient population that you have as well, and of course the other symptoms that may come with it. Dr Monteith: So, why don't we talk a little bit about CSF reading and how these set values, because we get people that have readings of 250 millimeters of water quite frequently and very nonspecific, questionable IIH. And so, talk to me about the set value. Dr Antonio: Right. So, the modified Dandy criteria has shown that, again, we consider intracranial pressure to be elevated for adults if it's above 250 millimeters water; and then for kids if it's above 280 millimeters of water. Knowing that these are taken in the left lateral decubitus position, and assuming also that the patients were awake and not sedated during the measurement of the CSF pressure. The important thing to know about that is, sometimes when we get LPs under fluoroscopy or under sedation, then these can cause false elevation because of the hypercapnia that elevated carbon dioxide, and then the hypoventilation that happens when a patient is under sedation. Dr Monteith: You know, sometimes you see people with opening pressures a little bit higher than 25 and they're asymptomatic. Well, the problem with these opening pressure values is that they can vary somewhat even across the day. People around 25, you can be normal, have no symptoms, and have opening pressure around 25- or 250; and so, I'm just asking about your approach to the CSF values. Dr Antonio: So again, at the end of the day, what's important is putting everything together. It's the gestalt of how we look at the patient. I actually had an attending tell me that there is no patient that read the medical textbook. So, the, the important thing, again, is putting everything together. And what I've also seen is that some patients would tell me, oh, I had an opening pressure of 50. Does that mean I'm in a dire situation? And they're so worried and they just attach to numbers. And for me, what's important would be, what are your symptoms? Is your headache, right, really bad, intractable? Number two: are you losing vision, or are you at that cusp where your optic nerve swelling or papilledema is so severe that it may soon lead to vision loss? So, putting all of these together and then getting the neuroimaging, getting the LP. I tell my residents it's like icing on the cake. We know already what we're dealing with, but then when we get that confirmation of that number… and sometimes it's borderline, but this is the art of neurology. This is the art of medicine and putting everything together and making sure that we care and manage it accordingly. Dr Monteith: Let's talk a little bit about IIH without papilledema. Dr Antonio: So, let's backtrack. So, when a patient will fit most of the modified Dandy criteria for IIH, but they don't have the papilledema or they don't have abducens palsy, the diagnosis then becomes tricky. And in these kinds of cases, Dr Friedman and her colleagues, when they did research on this, suggested that we might consider the diagnosis of IIH. And she calls this idiopathic intracranial hypertension without papilledema, IIHWOP. They say that if they meet the other criteria for modified Dandy but show at least three typical findings on MRI---so that flattening of the posterior globe, the tortuosity of the optic nerves, the empty sella or the partially empty sella, and even the narrowing of the transverse venous sinuses---so if you have three of these, then potentially you can call these cases as idiopathic intracranial hypertension without papilledema. Dr Monteith: Plus, the opening pressure elevation. I think that's key, right? Getting that as well. Dr Antonio: Yes. Sometimes IIHWOP may still be a gray area. It's a debate even among neuro-ophthalmologists, and I bet even among the headache specialists. Dr Monteith: Well, I know that I've had some of these conversations, and it's clear that people think this is very much overdiagnosed. So, that's why I wanted to plug in the LP with that as well. Dr Antonio: Right. And again, we have not seen yet whether is, this a spectrum, right? Of that same disease just manifesting differently, or are they just sharing a same pathway and then diverging? But what I want to emphasize also is that the treatment trials that we've had for IIH do not include IIHWOP patients. Dr Monteith: That is an important one. So why don't you wrap this up and tell our listeners what you want them to know? Now's the time. Dr Antonio: So, the- again, with IIH, with idiopathic intracranial hypertension, what is important is that we diagnose these patients early. And I think that some of the issues that come into play in dealing with these patients with IIH is that, one: we may have anchoring bias. Just because we see a female with obesity, of reproductive age, with intractable headaches, it does not always mean that what we're dealing with is IIH. The other thing, too, is that your tools are already available to you in your clinic in diagnosing IIH, short of the opening pressure when you get the lumbar puncture. And I need to emphasize the importance of doing your own fundoscopy and looking for that papilledema in these patients who present to you with intractable headaches or abducens palsy. What I want people to remember is that idiopathic intracranial hypertension is not optic nerve sheath distension. So, these are the stuff that you see on neuroimaging incidentally, not because you sent them, because they have papilledema, or because they have new headaches and other symptoms like that. And the important thing is doing your exam and looking at your patients. Dr Monteith: Today, I've been interviewing Dr Aileen Antonio about her article on clinical features and diagnosis of idiopathic intracranial hypertension, which appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Thank you again. Dr Antonio: Thank you. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

En este episodio, Edgardo Sobenes conversa con el Dr. Héctor Olásolo sobre el Instituto Ibero-Americano de La Haya para la Paz, los Derechos Humanos y la Justicia Internacional (IIH).A lo largo de la conversación, el Dr. Olásolo comparte cómo surgió la idea de crear el Instituto, quiénes estuvieron involucrados en su fundación y cuál fue el contexto que dio origen a esta iniciativa. Además, analiza los objetivos fundamentales del IIH y su estrecha vinculación con la labor de los tribunales internacionales con sede en La Haya.El episodio también ofrece un recorrido por las principales actividades del Instituto, con especial atención a la Semana Ibero-Americana de la Justicia Internacional; el impacto formativo del Concurso de Simulación Judicial en español ante la Corte Penal Internacional; la labor de la Clínica Jurídica Internacional; y el papel de redes académicas como “Perspectivas Iberoamericanas sobre la Justicia” y la red sobre “Corrupción y Crimen Organizado Transnacional”.Finalmente, el Dr. Olásolo reflexiona sobre las publicaciones académicas promovidas por el Instituto, sus principales líneas de investigación, los logros alcanzados en estos 15 años y los retos y proyecciones hacia el futuro.Sobre el Prof. Dr. Héctor OlásoloEl Prof. Héctor Olasolo (España) es Licenciado y Doctor en Derecho por la Universidad de Salamanca (España), Licenciado en Teología por la Universidad Santo Tomás (Colombia) y tiene una Maestría en Derecho por la Universidad de Columbia (EE. UU). Preside desde 2011 el Instituto Iberoamericano de la Haya para la Paz, los Derechos Humanos y la Justicia Internacional (IIH) (Países Bajos). Se desempeña desde 2013 como Profesor Titular de Carrera en la Facultad de Jurisprudencia de la Universidad del Rosario (Colombia), donde dirige el Programa de Maestría en Derecho Internacional, la Clínica Jurídica Internacional, el Anuario Iberoamericano de Derecho Internacional Penal (ANIDIP), el International Law Clinic Reports (ILCR) y es el Investigador Principal de las Redes Perspectivas Ibero-Americanas sobre la Justicia y Respuestas a la Corrupción asociada al Crimen Organizado transnacional. Es además Miembro del Colegio de Abogados de Madrid (España), Investigador Senior del Ministerio de Ciencia y Tecnología de Colombia (Minciencias), Miembro del Comité Científico de la Editorial Tirant lo Blanch (España), Miembro de los Comités Científicos y Editoriales de numerosas publicaciones en español e inglés, y Director del ANIDIP y, junto con la Prof. Carol Proner, de la Colección Perspectivas Iberoamericanas sobre la Justicia.Finalmente, el Prof. Olasolo ha sido también miembro de la Delegación Española en la Comisión Preparatoria de la Corte Penal Internacional (1999-2002), asesor jurídico de la Fiscalía del Tribunal Penal Internacional para la ex Yugoslavia (2002-2004) y letrado de Sala de Corte Penal Internacional (2004-2010). Objetivos del IIH: https://www.iberoamericaninstituteofthehague.org/mision/objetivos Estructura IIH: https://www.iberoamericaninstituteofthehague.org/organization/estructura Aliados del IIH: https://www.iberoamericaninstituteofthehague.org/organizaSupport the showAdquiere aquí el nuevo libro " Hablemos de Derecho Internacional Volumen II" https://www.hablemosdi.com/libros

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Wieder einmal muss Joshi in der Kita auf Mama warten. Da fliegt er doch lieber mit Kitadrache Priseglut in den Zoo. Iih, die Lamas spucken! Und was spuckt Priseglut? Aus der OHRENBÄR-Hörgeschichte: Abflug Kita Drachengold (Folge 1 von 7) von Susanne Kronblum. Es liest: Markus Meyer. ▶ Mehr Hörgeschichten empfohlen ab 4: https://www.ohrenbaer.de/podcast/empfohlen-ab-4.html ▶ Mehr Infos unter https://www.ohrenbaer.de & ohrenbaer@rbb-online.de

Double vision is a symptom often experienced by patients with neurologic disease. An organized systematic approach to evaluating patients with diplopia needs a foundational understanding of the neuroanatomy and examination of eye movements and ocular alignment. In this episode, Teshamae Monteith, MD, FAAN, speaks with Devin Mackay, MD, FAAN, author of the article “Approach to Diplopia” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Mackay is an associate professor of neurology, ophthalmology, and clinical neurosurgery at Indiana University School of Medicine in Indianapolis, Indiana. Additional Resources Read the article: Approach to Diplopia Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: This is Dr Teshamae Monteith. Today I'm interviewing Dr Devin Mackay about his article on approach to diplopia, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Welcome to the podcast. How are you? Dr Mackay: Thank you. It's great to be here. Dr Monteith: Congratulations on your article. Dr Mackay: Thank you. I appreciate that. Dr Monteith: Why don't you start off with introducing yourself to our audience? Dr Mackay: So, yeah, my name is Devin Mackay. I'm a neuro-ophthalmologist at Indiana University. I did my residency at what was used to be known as the Partners Healthcare Program in Boston, and I did a fellowship in neuro-ophthalmology in Atlanta. And I've been in practice now for about ten years. Dr Monteith: Oh, wow. Okay. Tell us a little bit about your goals when you were writing the chapter. Dr Mackay: So, my goal with the approach to double vision was really to demystify double vision. I think double vision is something that as trainees, and even as faculty members and practicing neurologists, we really get intimidated by, I think. And it really helps to have a way to approach it that demystifies it and allows us to localize, just like we do with so many other problems in neurology. Dr Monteith: I love that, demystification. So why don't you tell us what got you interested in neuro-ophthalmology? Dr Mackay: Yeah, so neuro-ophthalmology I stumbled on during a rotation during residency. We rotated in different subspecialties of neurology and I did neuro-ophthalmology, and I was just amazed by the exam and how intricate it was, the value of neuroanatomy and localization, the ability to take a complicated problem and kind of approach it as a diagnostic specialist and really unravel the layers of it to make it better. To, you know, figure out what the problem is and make it better. Dr Monteith: Okay, so you had a calling, clearly. Dr Mackay: I sure did. Dr Monteith: You talked about latest developments in neuro-ophthalmology as it relates to diplopia. Why don't you share that with our listeners? Dr Mackay: Yeah. So, you know, double vision is something that's really been around since the beginning of time, essentially. So that part hasn't really changed a lot, but there are some changes that have happened in how we approach double vision. Probably one of the bigger ones has been, we used to teach that with a, you know, patient over the age of fifty with vascular risk factors who had a cranial nerve palsy of cranial nerves 3, 4, or 6, we used to automatically assume that was a microvascular palsy and we just wouldn't do any more testing and we'd just, you know, wait to see how they did. And it turns out we're missing some patients who have significant pathologies, sometimes, with that approach. And so, we've really shifted our teaching with that to emphasize that it's a lot easier to get an MRI, for example, than it ever has been. And it can be important to make sure we're not missing important pathology in patients, even if they have vascular risk factors over the age of fifty and they just have a cranial nerve 3, 4, or 6 palsy. So that's been one change. Dr Monteith: Interesting. And why don't you tell us a little bit about the essential points that you want to get across in the article? Dr Mackay: Yeah. So, I think one is to have a systematic approach to double vision. And a lot of that really revolves around localization. And it even begins with the history that we take from the patients. There's lots of interesting things we can ask about double vision from the patient. For example, the most important thing you can ever ask someone with double vision is, does it go away when you cover either eye? And that really helps us figure out the first question for us as neurologists, which is, is it neurologic or non-neurologic? If it's still there when covering one eye, then it is not neurologic and that's usually a problem for an ophthalmologist to sort out. So that's really number one. And then if it is binocular double vision, then we get into details about, is it horizontal or vertical misalignment? Is it- what makes it better and worse? Is there an associated ptosis or other symptoms? And based on all of that, we can really localize the abnormality with the double vision and get into details about further testing if needed, and so forth. I also love that that approach really reduces our need to rely on things like neuroimaging sometimes when we may not need it, or on other tests. So, I think it really helps us be more efficient and really take better care of patients. Dr Monteith: So definitely that cover/uncover test, top thing there. Your approach- and you mentioned, are you really getting that history, and are there any other kind of key factors when you're approaching diplopia before getting into some of the details? Dr Mackay: Yeah, that's a good question. I think also having some basics of how to examine the patient, because double vision is such a challenging thing. A lot of us aren't as familiar with the exam toolkit, so to speak, of what you would do with a patient with double vision. And so, I go over in the article a bit about a Maddox rod, which is a handy little tool that I always keep in my pocket of my lab coat. It allows you to assign a red line to one eye and a light to the other eye, and you can see if the eyes line up or not. And you don't need any other special equipment, you just need the light in that Maddox rod. That really helps us understand a lot about the pattern of misalignment, which is really important for evaluating double vision. So, for example, if someone has a right 6th nerve palsy, I'll expect a horizontal misalignment of the eyes that worsens when the patient looks to the right and improves when they look to the left. And especially if it's a partial palsy, it's not always easy to see that just by looking at their eye movements. And having a way to really measure the eye alignment and figure out, is it worse or better in certain directions, is really essential to localization, I think, in a lot of cases. Dr Monteith: You caught me. I skipped over that Maddox rod part, even though you spent a lot of time talking about Maddox rods. Kind of skipped over it. So, you're saying that I need one. Dr Mackay: Everyone needs one. I've converted some of our residents here to carry one with them. And yeah, I realize it's a daunting tool at first, but when you have a patient with double vision and their eye movements look normal, I feel like a lot of neurologists are- kind of, their hands seem like they're tied and they're like, oh, I don't know, I don't know what to do at this point. And if you can get some more details with a simple object like that, it can really change things. Dr Monteith: So, we've got to talk to the AAN store and make sure that they have enough of these, because now there's going to be lots of… Dr Mackay: We're going to sell out on Amazon today now because of this podcast. Dr Monteith: Cyber Monday. So, let's talk about the H pattern. And I didn't know it had the- well, yeah, I guess the official name is “H pattern.” In medical school, I mean, that's what I learned. But as a resident and, you know, certainly as an attendee, I see people doing all sorts of things. You're pro-H pattern, but are there other patterns that you also respect? Dr Mackay: It depends on what you're looking for, I think. The reason I like the H pattern is because you get to look at upgaze and downgaze in two different directions. So, you get to look at upgaze and downgaze when looking to the left, and up- and downgaze when looking to the right. And the reason that matters is because vertical movements of the eyes are actually controlled by different eye muscles depending on whether the eye is adducted toward the nose or abducted away from the nose. And so that's why I love the H pattern, is because it allows you to see that. If you just have them look up and down with just a cross pattern, for example, then you really lose that specificity of looking at both the adduction and abduction aspects. So, it's not wrong to do it another way with, like, the cross, for example, but I just think there are some cases where we'll be missing some information, and sometimes that can actually make a difference. Dr Monteith: Well, there you have it. Let's talk a little bit about eliciting diplopia during the neurologic exam. What other things should we be looking out for? Dr Mackay: So, in terms of eliciting diplopia, it really starts with the exam and again, figuring out, are we covering one eye? And figuring out, is this patient still having double vision? It's tricky because sometimes the patients won't even know the answer to that question or they've never done it, they've never covered one eye. And so, if that's the case, I really make them do it in the office with me and it's like, okay, well, are we having double vision right now? Well, great, okay, we are, then we're going to figure this out right now. And we cover one eye and say, is it still double? And that way we can really figure out, are we monocular or binocular? That's always step one. And then if we've established that it's binocular diplopia, then that's when we get into the other details that I mentioned before. And then as far as other things to look for, we're always in tune to other things that are going on in terms of symptoms, like ptosis, or if there's bulbar weakness, or some sensory change or motor problem that seems to be associated with it. Obviously, those will give us clues in the localization as well. Dr Monteith: And what about ocular malalignment? Dr Mackay: Yeah. So ocular malalignment, really, the cardinal symptom of that is going to be double vision. And so, if a patient has a misalignment of the eyes and they don't have double vision, then usually that means either we're wrong and they don't have double vision, or they do have double vision and they, you know, haven't said it correctly. Or it could be that the vision is poor in one eye. Sometimes that can happen. Or, some patients were actually born with an eye misalignment and their brain has learned in a way to kind of tune out or not allow the proper development of vision in one eye. And so that's also known as amblyopia, also known as the lazy eye, some people call it. But that finding can also make someone not experience double vision. But otherwise, if someone's had normal vision kind of throughout their life, they'll usually be pretty aware of when they first notice double vision. It'll be an obvious event for them in in most cases. Dr Monteith: And then the Cogan lid twitch? Dr Mackay: Oh yes, the Cogan lid twitch. So, the Cogan lid twitch is a feature of myasthenia gravis. The way you elicit it is, you have the patient look down. I'm not sure there's a standardization for how long; you want to have it long enough that you're resting the levator muscle, which is the muscle that pulls the upper lid open. And so, you rest that by having them look down for… I usually do about ten or fifteen seconds. And then I have them look up to looking straight forward. And you want to pay careful attention to their lid position as their eye settles in that straight-forward position. What will happen with a Cogan's lid twitch is, the lid will overshoot, and then it'll come back down and settle into its, kind of, proper position. And what we think is happening there is, it's almost like a little mini “rest test” in a way, where you're resting that muscle just long enough to allow some of the neurotransmission to recover. You get a normal contraction of the muscle, but it fades very quickly and comes back down. And that's experienced as a twitch. Dr Monteith: So, the patient can feel it. And it's something you can see? Dr Mackay: Yeah, the patient may not feel it as much. It's usually it's going to be something that the clinician can see if they're looking for it. And I would say that's one of the physical exam findings that can be a hallmark of myasthenia gravis, but certainly not the only one. Some others that we often look for are fatigable ptosis with sustained upgaze. You have the patient look up for a prolonged time and you'll see the lid droop down. So that can be one. Ice pack test is very popular nowadays, and it has pretty good sensitivity and specificity for myasthenia. So, you keep an ice pack over the closed eyes for two minutes and you compare the lid position before and after the ice pack test. And in the vast majority of myasthenia patients, if they have ptosis, the ptosis will have resolved, or at least significantly improved, in those patients. And yet one more sign is, if you find the patient's eye with ptosis and you lift open the eye manually, you'll often see that the other eyelid and the other eye will lower down. So, I'm not sure there's a name for that, but that can be a helpful sign as well. Dr Monteith: Since you're going through some of these, kind of, key features of different neurologic disease, why don't you tell us about a few others? Dr Mackay: Yeah, so another I mentioned in the in the article is measurement of levator function, which is really a test of eyelid strength. And so, that can be helpful if we have- someone has ptosis, or we're not sure if they have ptosis and we're trying to evaluate that to see if it's linked to the double vision, because that really changes the differential if ptosis is part of the clinical situation. So, the way that's measured is you have a patient look down as far as they can. And you get out a little ruler---I usually use a millimeter ruler---and I set the zero of the ruler at the upper lid margin when they're looking down. So, I hold the ruler there, and then I ask the patient to look up as far as they can without moving their head. Where the lid position stops of the upper lid is the new point on the ruler. And so, you measure that and see how much that is. And so, a normal patient may have a value somewhere between, I don't know, twelve or thirteen millimeters up to seventeen or eighteen millimeters, probably, in most cases. Especially if there is an asymmetric lid position, if you find that the levator function is symmetric, then it tells you that the muscle is working fine and that the ptosis is not from the muscle. So then the ptosis may be from dehiscence of the lid margin from the muscle. And so, that's a really common cause of ptosis, and that's often age-related or trauma-related. And we can dismiss that as being part of the symptom constellation of double vision. So, it can be really helpful to clarify, is this a muscle problem, which you'd expect with myasthenia or a third nerve palsy, or is this a mechanical problem with the lid, which is non-neurologic and really should be dismissed? So that can be a really helpful exam tool. Dr Monteith: So, you're just now getting into a little localization. So why don't we kind of start from the most proximal pistol with localization. Give us a little bit of tips. I know they just got to read your article, but give us a few tips. Dr Mackay: So, in terms of most proximal causes, there are supranuclear causes of ocular misalignment. For example, a skew deviation would qualify as that. Anything that's happening from some deficient input before you get to the cranial nerve nuclei, that we would consider supranuclear. So, we also see that with things like progressive supranuclear policy and certain other conditions. And then there can be lesions of the cranial nerve nuclei themselves. So, cranial nerves 3, 4, and 6 all have nuclei, and if they're lesioned they will cause double vision in specific patterns. And then there's also another subgroup, which is known as intranuclear problems with eye alignment. And so, the most common of that is going to be intranuclear ophthalmoplegia. And so that's very common in patients with demyelinating disorders, or it can also happen with strokes and tumors and other causes. And then there's infranuclear problems, which are from the cranial nerve nuclei out, and so those would be the cranial nerves themselves. So that's where your microvascular palsies, any tumor pressing on the nerve in those locations can cause palsies like that, any inflammatory disorder along that course. Then as we get more distal, we get into the orbit, we have the neuromuscular junction---so, the connection between the nerve and the muscle. And of course, that's our myasthenia gravis. And there are rare causes, things like botulinum and tick borne illnesses and certain other things that are more rare. And then, of course, we get to the muscle itself, and there can be different muscular dystrophies, different things like myositis or inflammatory disorders of the orbit or even physical trauma. So, if a patient, you know, had a trauma in trapping an extraocular muscle, that can be a localization. So really, anywhere along that pathway you can have double vision. So, I love to approach it from that perspective to help narrow down the diagnostic possibilities. Dr Monteith: Okay, just like everything? Dr Mackay: Just like all of the rest of the neurology. See, it's not that scary. Dr Monteith: You know, and so, yeah. And then you do a lot more than, you know, a few cranial nerves, right? Dr Mackay: Right. That's right. There's a lot more to double vision than that. I think as neurologists, we get lost if it's not a cranial nerve palsy, we're like, oh, I don't know what this is. And if it's not myasthenia, not a cranial nerve palsy. But it's worth also considering that there are ophthalmologic causes of someone having double vision that we often don't consider. So maybe someone who was born with strabismus, or maybe they have a little bit of a tendency toward an eye misalignment that their brain compensates, for and then it decompensates someday and that now they have a little bit of double vision intermittently, so that those can be causes to consider as well. Dr Monteith: Yeah, well, we'll just have to, you know, request those records from forty years ago. No problem. Dr Mackay: That's right. Dr Monteith: Why don't you also give us a little bit of tip when we're on the wards and we want to teach either a medical student or a resident, or if it's a resident listening, may want to teach a junior resident and seem like a star when approaching a patient with diplopia. Give us some teaching pearls. Dr Mackay: Yeah. So, I would love people teaching more about this at the bedside. I'd say probably the first thing to do would be to equip yourself by recognizing what some of the pertinent questions are to ask someone with double vision. Those things would include, is the double vision worse when looking in a certain direction? Does the double vision go away or not when you cover one eye? What happens when you tilt your head one direction or the other? Is it intermittent or constant? What makes it better? What makes it worse? Those kinds of things can really help us narrow down the possibilities. And then the other thing would be to equip yourself with some tools for examining. And it doesn't have to be physical tools. These can actually be things like, you mentioned the cross-cover test or cover/uncover test. That's described in the article. And I think knowing how to do that properly, knowing how to examine the eye movements properly and how to check for subtle things like a subtle intranuclear ophthalmoplegia, which is also mentioned in the article, being familiar with those things can be a really useful exercise in allowing you to teach others later on. Dr Monteith: Cool. Why don't you tell us about some of the things you're most excited about in the field? Dr Mackay: One of the things about our subspecialty for so long is we really haven't had big data with, you know, big trials and all these things that all the stroke people have. And that's starting to change slowly. There's been, for example, the idiopathic intracranial hypertension treatment trial that was published back in, I think it was 2014. You know, of course we had the optic neuritis treatment trial, back a few decades ago now. Some of the exciting ones coming up, there's going to be a randomized controlled trial looking at different treatments for idiopathic intracranial hypertension that are surgically based. So, for example, comparing venous sinus stenting with optic nerve sheath fenestration. And so, figuring out, is there a best practice for surgical intervention for patients with IIH? So, we're starting to have more trials like that now than I think we've had in the past. And so, it's exciting to get to have an evidence base for some of the things that we recommend and do. Dr Monteith: And what about some of the treatment for diplopia? Like prisms, and where are we with some of that? Dr Mackay: Yeah, great. So, it's a pretty simple concept, but still kind of difficult in practice. I kind of say there are four different ways to treat double vision: you can ignore it, you can patch or cover one eye, you can treat with prisms, and you can treat with eye muscle surgery. And so, those are the main ways other than, of course, treating the underlying disorder if there's a disorder causing double vision. So those are the main ways to treat. In terms of knowing if someone's going to be a candidate for prism therapy, we also have to remember that prisms are really going to be most helpful for when someone's looking straight forward. So, we need to make sure that their double vision is happening when they look straight forward. So, for example, if they're only having double vision looking to the left or to the right, that patient may not benefit from prisms as much as someone who is having double vision when they look straight forward. So that's one thing I look for. And then strabismus surgery is something to be considered if someone is not tolerating prisms and they're not helping and their eye alignment is stable. So, if you think about it, if someone's eye alignment is changing a lot, you're probably not going to want to do surgery for that patient because it's going to keep changing after surgery. And so, if someone's eye alignment is stable for six months or more and they're not getting the benefit they'd like from prisms, then maybe referral to a strabismus surgeon might be something to consider. Dr Monteith: Great. And then, I guess another question is just popping up in my head selfishly. What are your thoughts about patients that get referrals for exercises? Say they have, like, a convergence efficiency or something causing diplopia, maybe after a concussion. Maybe there's not a lot of evidence, but what is your take on exercising? Dr Mackay: Yeah, excellent question. So, there actually is evidence for exercises for convergence insufficiency. So, we know that those do work. Now where exercises are probably not as helpful, or at least not- there isn't an evidence base for them, is really with just about every other kind of eye misalignment in adults. We hear a lot about eye movement therapies for concussion and barely any other acquired misalignment of the eyes as well. And really, the evidence really hasn't shown us that that's helpful; again, with the exception being convergence insufficiency. So, we know that an office-based vision therapy type program for convergence insufficiency does work, but of course it's kind of inconvenient. It can cost money that may or may not be covered by insurance. And so, there are difficulties even with doing that. And so, I often recommend that patients with convergence insufficiency at least try something called pencil push-ups, where they take a pencil at arm's length and they bring it in and exercise that convergence ability. You know, that's a cheap, easy way to try to treat that initially. So yeah, there can be some limited utility for eye muscle exercises in certain conditions. Dr Monteith: My one example. I was- it was fuzzy, but in a different way. So, what do you do for fun? I mean, it sounds like you like to see a lot of eyeballs? Dr Mackay: I do. I like to see a lot of eyeballs. Dr Monteith: When you're not doing these things, what do you do for fun? Dr Mackay: So, people ask me what my hobbies are, and I laugh because my hobby is actually raising children. Dr Monteith: Oh, okay! Dr Mackay: So, my wife and I have eight kids- Dr Monteith: Oh, wow! Dr Mackay: Ages three to thirteen. So, kind of doesn't allow me to have other things right now. I'm sure I'll have more hobbies later on, but no, I really love my kids. And I- they give me plenty to do. There's no shortage of- in fact, they were really, they were really excited about this podcast today. They're so excited that Dad gets to be on a podcast, and so I'm going to have to show this to them later. They're going to be thrilled about it. Dr Monteith: Excellent. Well, thank you so much for being on the podcast. Dr Mackay: Thank you. It's been my pleasure. Dr Monteith: Again, today I've been interviewing Dr Devin Mackay about his article on approach to diplopia, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Papilledema describes optic disc swelling (usually bilateral) arising from raised intracranial pressure. Due to its serious nature, there is a fear of underdiagnosis; hence, one major stumbling points is correct identification, which typically requires a thorough ocular examination including visual field testing. In this episode, Kait Nevel, MD speaks with Susan P. Mollan, MBChB, PhD, FRCOphth, author of the article “Papilledema” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Mollan is a professor and neuro-ophthalmology consultant at University Hospitals Birmingham in Birmingham, United Kingdom. Additional Resources Read the article: Papilledema Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guest: @DrMollan Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kait Nevel. Today I'm interviewing Dr Susan Mollan about her article Papilledema Diagnosis and Management, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Susie, welcome to the podcast, and please introduce yourself to our audience. Dr Mollan: Thank you so much, Kait. It's a pleasure to be here today. I'm Susie Mollan, I'm a consultant neuro-ophthalmologist, and I work at University Hospitals Birmingham- and that's in England. Dr Nevel: Wonderful. So glad to be talking to you today about your article. To start us off, can you please share with us what you think is the most important takeaway from your article for the practicing neurologist? Dr Mollan: I think really the most important thing is about examining the fundus and actually trying to visualize the optic nerves. Because as neurologists, you're really acutely trained in examining the cranial nerves, and often people shy away from looking at the eyes. And it can give people such confidence when they're able to really work out straightaway whether there's going to be a problem or there's not going to be a problem with papilledema. And I guess maybe a little bit later on we can talk about the article and tips and tricks for looking at the fundus. But I think that would be my most important thing to take away. Dr Nevel: I'm so glad that you started with that because, you know, that's something that I find with trainees in general, that they often find one of the more daunting or challenging aspects of learning, really, how to do an excellent neurological exam is examining the fundus and feeling confident in diagnosing papilledema. What kind of advice do you give to trainees learning this skill? Dr Mollan: So, it really is practice and always carrying your ophthalmoscope with you. There's lots of different devices that people can choose to buy. But really, if you have a direct ophthalmoscope, get it out in the ward, get it out in clinic. Look at those patients that you'd know have alternative diagnosis, but it gives you that practice. I also invite everybody to come to the eye clinic because we have dilated patients there all the time. We have diabetic retinopathy clinics, and it makes it really easy to start to acquire those skills because I think it's very tricky, because you're getting a highly magnified view of the optic nerve and you've got to sort out in your head what you're actually looking at. I think it's practice. and then use every opportunity to really look at the fundus, and then ask your ophthalmology colleagues whether you can go to clinic. Dr Nevel: Wonderful advice. What do you think is most challenging about the evaluation of papilledema and why? Dr Mollan: I think there are many different aspects that are challenging, and these patients come from lots of different areas. They can come from the family doctor, they can come from an optician or another specialist. A lot of them can have headache. And, as you know, headache is almost ubiquitous in the population. So, trying to pull out the sort of salient symptoms that can go across so many different conditions. There's nothing that's pathognomonic for papilledema other than looking at the optic nerves. So, I think it's difficult because the presentation can be difficult. The actual history can be challenging. There are those rare patients that don't have headache, don't have pulsatile tinnitus, but can still have papilledema. So, I think it- the most challenging thing is actually confirming papilledema. And if you're not able to confirm it, getting that person to somebody who's able to help and confirm or refute papilledema is the most important thing. Dr Nevel: Yeah, right. Because you talk in your article the importance of distinguishing between papilledema and some other diagnoses that can look like papilledema but aren't papilledema. Can you talk about that a little bit? Dr Mollan: Absolutely. I think in the article it's quite nice because we were able to spend a bit of time on a big table going through all the pseudopapilledema diagnoses. So that includes people with shortsightedness, longsightedness, people with optic nerve head drusen. And we've been very fortunate in ophthalmology that we now have 3D imaging of the optic nerve. So, it makes it quite clear to us, when it's pseudopapilledema, it's almost unfair when you're using the direct ophthalmoscope that you don't get a cross sectional image through that optic nerve. So, I'd really sort of recommend people to delve into the article and look at that table because it nicely picks out how you could pick up pseudopapilledema versus papilledema. Dr Nevel: Perfect. In your article, you also talk about what's important to think about in terms of causes of papilledema and what to evaluate for. Can you tell us, you know, when you see someone who you diagnose with papilledema, what do you kind of run through in terms of diagnostic tests and things that you want to make sure you're evaluating for or not missing? Dr Mollan: Yeah. So, I think the first thing is, is once it's confirmed, is making sure it's isolated or whether there's any additional cranial nerve palsies. So that might be particularly important in terms of double vision and a sixth nerve palsy, but also not forgetting things like corneal sensation in the rest of the cranial nerves. I then make sure that we have a blood pressure. And that sounds a bit ridiculous in this day and age because everybody should have a blood pressure coming to clinic or into the emergency room. But sometimes it's overlooked in the panic of thinking, gosh, I need to investigate this person. And if you find that somebody does have malignant hypertension, often what we do is we kind of stop the investigational pathway and go down the route of getting the medics involved to help with lowering the blood pressure to a safe level. I would then always think about my next thing in terms of taking some bloods. I like to rule out anemia because anemia can coexist in a lot of different conditions of raised endocranial pressure. And so, taking some simple blood such as a complete blood count, checking the kidney function, I think is important in that investigational pathway. But you're not really going to stop there. You're going to move on to neuroimaging. It doesn't really matter what you do, whether you do a CT or an MRI, it's just getting that imaging pretty much on the same day as you see the patient. And the key point to that imaging is to do venography. And you want to rule out a venous sinus thrombosis cause that's the one thing that is really going to cause the patient a lot of morbidity. Once your neuroimaging is secure and you're happy, there's no structural lesion or a thrombosis, it's then reviewing that imaging to make sure it's safe to proceed with lumbar puncture. And so, we would recommend the lumbar puncture in the left lateral decubitus position and allowing the patient to be as calm and relaxed as possible to be able to get that accurate opening pressure. Once we get that, we can send the CSF for contents, looking for- making sure they don't have any signs of meningitis or raised protein. And then, really, we're at that point of saying, you know, we should have a secure diagnosis, whether it would be a structural lesion, venous sinus thrombosis, or idiopathic intracranial hypertension. Dr Nevel: Wonderful. Thank you for that really nice overview and, kind of, diagnostic pathway and stepwise thought process in the evaluations that we do. There are several different treatments for papilledema that you go through in your article, ranging from surgical to medication options. When we're taking care of an individual patient, what factors do you use to help guide you in this decision-making process of what treatment is best for the patient and how urgent treatment is? Dr Mollan: I think that's a really important question because there's two things to consider here. One is, what is the underlying diagnosis? Which, hopefully, through the investigational save, you'll have been able to achieve a secure diagnosis. But going along that investigational pathway, which determines the urgency of treatment, is, what's happening with the vision? If we have somebody where we're noting that the vision is affected- and normally it's actually through a formal visual field. And that's really challenging for lots of people to get in the emergency situation because syndromes of raised endocranial pressure often don't cause problems with the visual acuity or the color vision until it's very late. And also, you won't necessarily get a relative afferent papillary defect because often it's bilateral. So I really worry if any of those signs are there in somebody that may have papilledema. And so, a lot rests on that visual field. Now, we're quite good at doing confrontational visual fields, but I would say that most neurologists should be carrying pins to be able to look at the visual fields rather than just pointing fingers and quadrants if you're not able to get a formal visual field early. It's from that I would then determine if the vision is affected, I need to step up what I'm going to do. So, I think the sort of next thing to think about is that sort of vision. So, if we have somebody who, you know, you define as have severe sight loss at the point that you're going through this investigational pathway, you need to get an ophthalmologist or a neuro-ophthalmologist on board to help discuss either the surgery teams as to whether you need to be heading towards an intervention. And there are a number of different types of intervention. And the reason why we discuss it in the article---and we'll also be discussing it in a future issue of Continuum---is there's not high-class evidence to suggest one surgery over another surgery. We may touch on this later. So, we've got our patients with severe visual loss who we need to do something immediately. We may have people where the papilledema is moderate, but the vision isn't particularly affected. They may just have an enlarged blind spot. For those patients, I think we definitely need to be thinking about medical therapy and talking to them about what the underlying cause is. And the commonest medicine to use for raised endocranial pressure in this setting is acetazolamide, a carbonic anhydrous inhibitor. And I think that should be started at the point that you believe somebody has moderate papilledema, with a lot of discussion around the side effects of the medicine that we go into the article and also the fact that a lot of our patients find acetazolamide in an escalating dose challenging. There are some patients with very mild papilledema and no visual change where I might say, hey, I don't think we need to start treatment immediately, but you need to see somebody who understands your disease to talk to you about what's going on. And generally, I would try and get somebody out of the emergency investigational pathway and into a formal clinic as soon as possible. Dr Nevel: Thank you so much for that. One thing that I was wondering that we see clinically is you get a consult for a patient, maybe, who had an isolated episode of vertigo, back to their normal self, completely resolved… but incidentally, somebody ordered an MRI. And that MRI, in the report, it says partially empty sella, slight flattening of the posterior globe, concerns for increased intracranial pressure. What should we be doing with these patients who, you know, normal neurological exam, maybe we can't detect any definite papilledema on our endoscopic exam. What do you think the appropriate pathway is for those patients? Dr Mollan: I think it's really important. The more neuroimaging that we're doing, we're sort of seeing more people with signs that are we don't believe are normal. So, you've mentioned a few, the sort of partially empty sella, empty sella, tortuosity of the optic nerves, flattening of the globes, changes in transverse sinus. And we have quite a nice, again, table in the article that talks about these signs. But they have really low sensitivity for a diagnosis of raised endocranial pressure and isolation. And so, I think it's about understanding the context of which the neuroimaging has been taken, taking a history and going back and visiting that to make sure that they don't have escalating headache. And also, as you said, rechecking the eye nerves to make sure there's no papilledema. I think if you have a good examination with the direct ophthalmoscope and you determine that there's no papilledema, I would be confident to say there's no papilledema. So, I don't think they need to necessarily cry doubt. The ophthalmology offices, we certainly are having quite a few additional referrals, particularly for this, which we kind of called IIH-RAD, where patients are coming to us for this exclusion. And I think, in the intervening time, patients can get very anxious about having a sort of MRI artifact picked up that may necessarily mean a different diagnosis. So, I guess it's a little bit about reassurance, making sure we've taken the appropriate history and performed the examination. And then knowing that actually it's really a number of different signs that you need to be able to confidently diagnose raised ICP, and also the understanding that sometimes when people have these signs, if the ICP reduces, those signs remain. You know, we're learning an awful lot more about MRI imaging and what's normal, what's within normal limits. So, I think reassurance and sensible medical approach. Dr Nevel: Absolutely. In the section in your article on idiopathic intracranial hypertension, you spend a little bit of time talking about how important it is that we sensitively approach the topic of potential weight loss for those patients who are overweight. How do you approach that discussion in your clinic? Because I think it's an important part of the holistic patient care with that condition. Dr Mollan: I think this is one of the things that we've really listened to the patients about over the last number of years where we recognize that in an emergency situation, sometimes we can be quite quick to sort of say, hey, you have idiopathic endocranial hypertension and weight loss is, you know, the best treatment for the condition. And I think in those circumstances, it can be quite distressing to the patient because they feel that there's a lot of stigma attached around weight management. So, we worked with the patient group here at IIH UK to really come up with a way of a signposting to our patients that we have to be honest that there is a link, you know, a strong evidence that weight gain and body shape change can cause someone to fall into a diagnosis of IIH. And we know that weight loss is really effective with this condition. So, I think where I've learned from the patients is trying to use language that's less stigmatizing. I definitely signpost that I'm going to talk about something sensitive. So, I say I'm going to talk about something sensitive and I'm going to say, do you know that this condition is related to body shape change? And I know that if I listen to this podcast in a couple of years, I'm sure my words will have changed. And I think that's part of the process, is learning how to speak to people in an ever-changing language. And they think that sort of signpost that you're going to talk about something sensitive and you're going to talk about body shape change. And then follow up with, are you OK with me talking about this now? Is it something you want to talk about? And the vast majority of people say, yes, let's talk about it. There'll be a few people that don't want to talk about it. And I usually come in quite quickly, say, is it OK if I mention it at the next consultation? Because we have a duty of care to sort of inform our patients, but at the same time we need to take them on that journey to get them back to health, and they need to be really enlisted in that process. Dr Nevel: Yeah, I really appreciate that. These can be really difficult conversations and uncomfortable conversations to have that are really important. And you're right, we have a duty as medical providers to have these conversations or inform our patients, but the way that we approach it can really impact the way patients perceive not only their diagnosis, but the relationship that we have with our patients. And we always want that to be a positive relationship moving forward so that we can best serve our patients. Dr Mollan: I think the other thing as well is making sure that you've got good signposts to the professionals. And that's what I say, because people then say to me, well, you know, kind of what diet should I be on? What should I be doing? And I say, well, actually, I don't have professional experience with that. I'm, I'm very fortunate in my hospital, I'm able to send patients to the endocrine weight management service. I'm also able to send patients to the dietetic service. So, it's finding, really, what suits the patient. Also what's within licensing in your healthcare system to be able to provide. But not being too prescriptive, because when you spend time with weight management professionals, they'll tell you lots of different things about diets that people have championed and actually, in randomized controlled trials, they haven't been effective. I think it's that signpost really. Dr Nevel: Yeah, absolutely. So, could you talk a little bit about what's going on in research in papilledema or in this area, and what do you think is up-and-coming? Dr Mollan: I think there's so much going on. Mainly there's two parts of it. One is image analysis, and we've had some really fantastic work out of the Singapore group Bonsai looking at a machine learning decision support tool. When people take fundal pictures from a normal fundus camera, they're able to say with good certainty, is this papilledema, is this not papilledema? But more importantly, if you talk to the investigators, something that we can't tell when we look in is they're able to, with quite a high level of certainty, say, well, this is base occupying lesion, this is a venous sinus thrombosis, and this is IIH. And you know, I've looked at thousands and thousands of people's eyes and that I can't tell why that is. So, I think the area of research that is most exciting, that will help us all, is this idea about decision support tools. Where, in your emergency pathway, you're putting a fundal camera in that helps you be able to run the image, the retina, and also to try and work out possibly what's going on. I think that's where the future will go. I think we've got many sort of regulatory steps and validation and appropriate location of a learning to go on in that area. So, that's one side of the imaging. I think the other side that I'm really excited about, particularly with some of the work that we've been doing in Birmingham, is about treatment. The surgical treatments, as I talked about earlier… really, there's no high-class evidence. There's a number of different groups that have been trying to do randomized trials, looking at stenting versus shunting. They're so difficult to recruit to in terms of trials. And so, looking at other treatments that can reduce intracranial pressure. We published a small phase two study looking at exenatide, which is a glucagon-like peptide receptor agonist, and it showed in a small group of patients living with IIH that it could reduce the intracranial pressure two and a half hours, twenty-four hours, and also out to three months. And the reason why this is exciting is we would have a really good acute therapy---if it's proven in Phase III trials---for other diseases, so, traumatic brain injury where you have problems controlling ICP. And to be able to do that medically would be a huge breakthrough, I think, for patient care. Dr Nevel: Yeah, really exciting. Looking forward to seeing what comes in the future then. Wonderful. Well, thank you so much for chatting with me today about your article. I really enjoyed learning more from you during our conversation today and from your article, which I encourage all of our listeners to please read. Lots of good information in that article. So again, today I've been interviewing Dr Susie Mollan about her article Papilledema Diagnosis and Management, which appears in the most recent issue of Continuum on neuro-ophthalmology.Please be sure to check out Continuum episodes from this and other issues. And thank you to our listeners for joining us today. Thank you, Susie. Dr Mollan: Thank you so much. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Too busy to read the Lens? Listen to our weekly summary here! In this week's episode we discuss…IIH affects 3.44 per 10,000 US women and has a higher prevalence in the Midwest and SouthChildren with atopic dermatitis are at increased risk for developing uveitis A shorter length of the interdigitation zone band on OCT may predict diabetic retinopathy 

 In this episode, I dive into Charlie's story, who develops Idiopathic Intracranial Hypertension (IIH) in their early thrities. Charlie's journey reveals the terrible reality of weight stigma in healthcare - from delayed diagnosis to being blamed for their condition, and ultimately being prescribed weight loss instead of effective treatment. I also get pretty fired up discussing how the medical establishment continues to prescribe weight loss for IIH based on a single terrible study with just 25 participants who were essentially starved on 425 calories a day!  If you'd like to learn more about IIH and weight-inclusive approaches to healthcare, head to noweigh.org for my free resources. My IIH Masterclass which is available now to all Masterclass members (£40/month). I also referenced my upcoming book and No Weigh program where I cover the evidence that everything you've been told about weight loss is a lie. And don't forget to grab a free ticket to my Fat Joy Celebration happening on Friday, March 21st at 5pm UK time (1pm Eastern, 10am Pacific) - we'll have a virtual potluck, dancing, and celebration of fat community! Got a question for the next podcast? Let me know! Connect With Me FREE GUIDES: evidence-based, not diet nonsense NEWSLETTER: Life-changing insights straight to your inbox UNSHRINKABLE: Find out why your body is not designed to shrink MASTERCLASSES: All the evidence doctors should give you NO WEIGH PROGRAM: Join the revolution against weight-loss lies THE WEIGHTING ROOM: A community where authenticity thrives and every voice matters CONSULTATION: For the ultimate transformation in your healthcare journe Find me on Instagram, YouTube, and LinkedIn.

Revero Clinic for treating chronic diseases: https://revero.com Join Revero Now to transform your health: https://revero.com/membership Tracy is a health journalist and advocate for the carnivore diet. Together, Tracy and Dr. Baker dive deep into the challenges and misconceptions surrounding modern dietary practices, particularly the detrimental effects of processed foods, seed oils, and sugars on our health. They discuss the transformative benefits of a meat-focused diet, sharing compelling personal stories and highlighting significant improvements in physical and mental health. Tracy recounts her family's journey, including her husband's remarkable weight loss of 215 pounds and reversal of multiple health issues, all achieved through dietary changes. The conversation touches on the broader implications of nutrition on societal issues, the corporatization of healthcare, and the growing movement toward more traditional, low-carb eating habits. Join us as we explore the powerful impacts of diet on overall well-being and the importance of making informed food choices for a healthier future. Twitter: https://x.com/tracybeanz Website: http://UncoverDC.com Timestamps: 00:00 Trailer and introduction. 04:17 Husband diagnosed with MS; declined medication. 07:27 On low sodium diet due to IIH diagnosis. 10:45 Super curious why diseases disappear post-intervention. 16:12 Modern society overconsumes sweets; historical rarity highlighted. 19:37 Significant physical change noted; many commenting. 22:55 Processed foods harm health more than realized. 26:02 Convenience over nutrition leads to cooking decline. 26:59 Existence sparks vital, informed conversation and change. 30:03 Shift from vegan trends to conservative diets. 34:34 High-level support against meat industry changes. 37:04 Carnivorous diet's long-term benefits are compelling. 42:27 AI will increasingly automate healthcare processes. 45:19 Doctors lack curiosity due to training constraints. 47:26 Diet change helped child with rare disorder. 49:50 Where to find Tracy. See open positions at Revero: https://jobs.lever.co/Revero/ Join Carnivore Diet for a free 30 day trial: https://carnivore.diet/join/ Carnivore Shirts: https://merch.carnivore.diet Subscribe to our Newsletter: https://carnivore.diet/subscribe/ . ‪#revero #shawnbaker #Carnivorediet #MeatHeals #HealthCreation   #humanfood #AnimalBased #ZeroCarb #DietCoach  #FatAdapted #Carnivore #sugarfree  ‪

Host Dr. Amanda Redfern welcomes Dr. Sravanthi Vegunta, a pediatric and neuro-ophthalmologist, to explain how to select the right radiologic imaging when you suspect a neuro-ophthalmic disorder. Dr. Vegunta breaks down idiopathic intracranial hypertension (IIH), papilledema, optic neuritis, optic atrophy, third and fourth cranial nerve palsies, Horner syndrome, and nystagmus.  For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

We are honored to be joined by Dr. Diana Driscoll. An authority on the autonomic nervous system, Dr. Diana Driscoll, Optometrist, FAAO, is a world-renowned expert on POTS (Postural Orthostatic Tachycardia Syndrome), and other “invisible” illnesses. As an author, speaker, inventor, and devoted researcher with five patents to date, she continues to push forward with dramatic shifts in the evaluation and treatment of these conditions. Dr. Driscoll's personal battle with POTS inspired a decade of self-funded groundbreaking research and innovative treatment. Now an authority on POTS, IIH, ME/CFS, the vagus nerve, dry eye disease, neurological gastroparesis, and brain health, she offers the compassion of a former patient, as well as strong science. Topics: 1. Introduction and Personal Journey - Discussion of Dr. Diana Driscoll's personal battle with POTS and how it led to her groundbreaking research. 2. Overview of POTS (Postural Orthostatic Tachycardia Syndrome) - Diagnostic criteria and common symptoms. - How POTS develops. - The body systems affected by POTS and how they are impacted. 3. Inflammatory POTS - Definition and introduction to "Inflammatory POTS" 4. Nervous System and the Vagus Nerve, Specifically - Further exploration of the role of the nervous system in POTS. - The impact of the vagus nerve on various body functions, including digestion and bowel movements. - Understanding chronic dry eyes. 5. Supplementation and Solutions - TJ Nutrition resources and supplements. - Parasym Plus™ to support the vagus nerve and acetylcholine functions. - Beta Balance™ NAC MAX™ Check out TJ Nutrition and Dr. Diana Driscoll's supplements here and use code PORTER10 to get 10% off. Thanks for tuning in! Get Chloe's Book Today! "⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠75 Gut-Healing Strategies & Biohacks⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠" Follow Chloe on Instagram ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@synthesisofwellness⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Follow Chloe on TikTok @chloe_c_porter Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠synthesisofwellness.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ to purchase products, subscribe to our mailing list, and more! --- Support this podcast: https://podcasters.spotify.com/pod/show/chloe-porter6/support

Dr. Amy Gelfand and Dr. Matthew Bender discuss the possible association between glymphatic outflow and extent of TSS in patients with IIH. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000209529

Dr. Amy Gelfand talks with Dr. Matthew Bender about the possible association between glymphatic outflow and extent of transverse sinus stenosis in patients with intracranial hypertension. Read the related article in Neurology. Disclosures can be found at Neurology.org.

In this powerful and heartfelt episode of Innovate & Elevate, Sharon Kedar is joined by two remarkable young women, Alice Paul Tapper and Audrey Maged, for an inspiring discussion on the importance of self-advocacy and resilience, particularly in the face of medical misdiagnosis.Alice, a high school senior and author of two picture books, including her upcoming release "Use Your Voice," shares her harrowing experience of surviving untreated appendicitis that led to a life-threatening sepsis diagnosis. She details her journey from feeling dismissed by healthcare professionals to becoming a fierce advocate for herself and others. Her story is a testament to the critical need for patients, especially young girls, to speak up and advocate for their own health, even when it means challenging authority.Audrey Maged, Sharon's daughter and a fourth grade student, was diagnosed with pseudotumor cerebri, more commonly known as idiopathic intracranial hypertension (IIH), a condition that involves increased pressure around the brain, leading to symptoms like severe headaches. Audrey joins the conversation to reflect on the common barriers children face when trying to express their needs in a healthcare setting. Both Alice and Audrey emphasize the importance of teaching young people to use their voices, not just in healthcare but in all areas of life.Sharon, Alice, and Audrey unpack the societal norms that often discourage girls from being assertive and how these norms can have serious consequences when it comes to healthcare. They also discuss the emotional and psychological impacts of feeling unheard and the role parents and communities play in empowering children to advocate for themselves.Episode Outline(01:47) Raise Your Hand: Be Bold, Be Brave (09:42) Alice's Misdiagnosis Journey (18:45) Use Your Voice: You Are Your Best AdvocateConnect with SharonConnect with Sharon on LinkedIn: Sharon KedarFollow Sharon on Instagram: @sharonkedarcfa Learn more about Innovate and Elevate innovateandelevatepodcast.comSubscribe to Innovate and Elevate on YouTubeJoin the newsletter to receive the latest episodes in your inbox: Innovate and Elevate NewsletterAdditional ResourcesUse Your Voice by Alice Paul Tapper Raise Your Hand by Alice Paul Tapper Raise Your Hand Girl Scout PatchChildren's Hospital of Philadelphia This podcast is produced by the women at The Wave Editing

Un podcast corale sull'IA, a cura della classe IIH dell'I.T.I.S. "A. Avogadro".

Podcast: This week on the show, we present a pre-recorded conversation with Rawn Clark, author of A Bardon Companion: A Practical Companion for the Student of Franz Bardon's System of Hermetic Initiation. The Franz Bardon series of books on Magical Arts, Initiation into Hermetics (IIH), The Practice of Magical Evocation (PME), and The Key to the True Qabalah (KTQ), are considered by many as the most lucid and actionable written material on Hermetic practice. Initiation into Hermetics consists of a short introduction on theory and ten detailed lessons on practice covering work on the Mental, Astral, and Physical bodies. These lessons progress from very basic mental concentration and thought control practices through to advanced exploration of elemental and planetary realms and the merging with Unity. In A Bardon Companion, Rawn Clark combines two versions of his commentaries for each of the ten steps in IIH, additional commentaries on PME and KTQ, as well as years of correspondence with students of the Bardon system. It is an essential guide for anyone interested in exploring the Bardon system of Hermetics. Rawn Clark is a writer and video producer who dedicates his work to magical practice in general and providing support material for practitioners of the Bardon system. He began pursuing Bardon's system of Hermetic Initiation in the early 1980s at the age of 25. Years later he became involved in online blogging and discussion groups surrounding the Bardon work. He has emerged as one of the leading mentors for this system. His writings are clear, practical, and leavened with a gentle touch and humor. His work dispels many of the misconceptions associated with esoteric practice and makes the Bardon system available to anyone willing to put in the necessary consistent effort. More information about Rawn Clark's work can be found at: Rawn Clark's YouTube Channel: www.youtube.com, A Bardon Companion on Amazon: www.amazon.com, Franz Bardon on Wikipedia: en.wikipedia.org.

The February 2024 recall includes three episodes taken from the 2023 November Headache Series and will be part 1 of a two-part Recall series. In the first part of this two-part recall, Dr. Tesha Monteith begins with a discussion on the highlights of the 2023 International Headache Conference with Drs. Hayrunnisa Bolay, KC Brennan, and Gianluca Coppola. The episode continues with Dr. Stephanie Nahas discussing commonly missed and lesser-known primary headache disorders. Finally, the episode concludes with an interview with Drs. Deb Friedman and Kathleen Digre, who talk about the diagnosis and management of IIH and other CSF pressure disorders. Related Podcast Links: https://directory.libsyn.com/episode/index/id/28479644  https://directory.libsyn.com/episode/index/id/28567413 https://directory.libsyn.com/episode/index/id/28675078  Disclosures can be found at Neurology.org  

Acetazolamide is a common and important medication used in ophthalmology. It is used as a treatment for both high intraocular pressure and high intracranial pressure. Yet despite its many uses, many ophthalmologists feel nervous when prescribing it due its potential side effects and the concern of sulfa allergy. And while caution is always a good thing, have we perhaps overstated the risks with acetazolamide to such a point that we don't use it enough? What exactly is sulfa allergy, and does it even apply to acetazolamide? And how dangerous is acetazolamide, and how should we be counseling patients when prescribing it? Dr. Deborah Friedman joins the podcast. Learn more about Dr. Friedman at www.neuroeyes.com

This week's episode is with Levi Peterson, a fighter of Idiopathic Intracranial Hypertension, Neuro-Behçet's syndrome, and Parksinon's disease. Levi has also experienced 10 major brain surgeries, resulting in her becoming an expert on shunting technology from past complications. In the past, she was an EMT, and currently, she is a patient navigator, which we expand on in the episode.In addition, Levi shares ways she maintained hope and remained strong through her 10 brain surgeries and how she is using her experiences to help other patients currently. We also talk about the numerous complications Levi endured after her invasive surgeries and how artificial intelligence could play a role in the future of shunts. We later discuss the stigma behind IIH and how new research and technology are playing a role in reducing this stigma and increasing awareness of rare neurological disorders. Levi's bravery and strength are incredible, and her humor makes this episode an entertaining listen! Make sure to subscribe to the Neurological Disorder Podcast on Spotify, Apple Podcasts, or wherever you listen to your podcasts! Follow me on Instagram- @neurologicaldisorderpodcast Email me - neurologicaldisorderpodcast@gmail.comLinks Levi Mentioned/helpful resources:https://rarediseases.org/https://my.clevelandclinic.org/health/diseases/21968-idiopathic-intracranial-hypertensionhttps://www.mayoclinic.org/diseases-conditions/behcets-disease/symptoms-causes/syc-20351326

Dr. Tesha Monteith talks with Drs. Deb Friedman and Kathleen Digre about the diagnosis and management of idiopathic intracranial hypertension and cerebrospinal fluid pressure disorders. Disclosures can be found at Neurology.org

GB2RS News Sunday the 15th of October 2023 The news headlines: • RSGB Construction Competition • New chair of the RSGB's Exams and Syllabus Group • RSGB 2023 Convention The RSGB recognises the importance of construction as a key element of amateur radio, whether that is using traditional construction skills or is a software or systems engineering project. The Society has launched its 2024 Construction Competition and the deadline for entries is the 1st of March 2024. To enable members across the country, and even the world, to enter, entries will be judged over the internet rather than in person. This year a new category called ‘Antennas' has been introduced so there are five categories you can enter: Beginners; Construction Excellence; Innovation; Software and Systems; and Antennas. Special recognition will be given to entries submitted by radio amateurs under the age of 24, and to those who have just gained their Foundation licence. A cash prize will be awarded for the winner of each section, with a bonus for the overall winner, who will also be declared the winner of the Pat Hawker G3VA Award. You can find out more, including how to enter, on the RSGB website at rsgb.org/construction-competition The RSGB is delighted to welcome Andrew Lenton, G8UUG as the new Chair of the Exams and Syllabus Review Group. The Society would also like to thank Donard de Cogan, M0KRK for his hard work and dedication, including chairing the Group for the past three years. You can contact Andrew via esrg.chair@rsgb.org.uk The RSGB 2023 Convention takes place over both days this weekend. There is a fantastic range of presentations on a variety of amateur radio topics. If you haven't already booked, you can buy day tickets on the door or join the Livestream at any time over the weekend. The Livestream contains 12 of the Convention presentations as well as exclusive interviews and additional content. We are asking radio amateurs to register for the Convention Livestream this year. Whether you are there in person, or joining radio amateurs from across the world online, make sure you are part of this major annual event. For more information about the full programme of presentations go to rsgb.org/convention and to register for the Livestream head over to rsgb.org/livestream As we get closer to the ITU World Radio Conference, WRC-23, which starts next month, the future of amateur radio, particularly the 23cm band, is of key importance. The ITU News Magazine has a feature article by IARU President Tim Ellam, VE6SH regarding amateur activity in the 23cm band. This is the topic of a challenging agenda item at the Conference which calls for measures that protect primary radio-navigation services such as Glonass and Galileo from amateur terrestrial and satellite usage. You can read the article by visiting tinyurl.com/TimVE6SH In related news, the IARU also reports that the last formal preparatory meeting ahead of the WRC on this topic was difficult and could not achieve a consensus on measures such as power and bandwidth limits, or frequency restrictions. The IARU supports further efforts and will continue to try to find a solution regarding suitable recommendations, whilst opposing the unwarranted statutory imposition of such. You can read the IARU's post on this subject via tinyurl.com/ITUR23cm  Also, you can hear the latest updates at the RSGB Convention on Sunday, in a talk by IARU expert and RSGB Microwave Manager Barry Lewis, G4SJH.  Jamboree On The Air, or JOTA, is an annual event in which Scouts and Guides all over the world communicate with each other via amateur radio. JOTA 2023 will run from Friday the 20th to Sunday the 22nd of October. You can find out more at jotajoti.info And now for details of rallies and events Dartmoor Autumn Radio Rally is taking place today, Sunday the 15th of October. The venue is Yelverton War Memorial Hall, Meavy Lane, Yelverton, Devon, PL20 6AL. The event features bring and buy, trader stands, refreshments and free parking. The doors open at 10am and admission is £2.50. For more information, contact Roger on 07854 088 882 or email 2e0rph@gmail.com Hornsea Amateur Radio Club Rally is also taking place today, Sunday the 15th of October. The venue is Driffield Showground, YO25 9DW. For more information, visit hornseaarc.com Part 2 of the British Amateur Television Club Convention for Amateur TV 2023 will take place on Saturday the 21st of October from 10am until 3pm. The event will feature online talks about ATV-related topics. For more information visit batc.org.uk/events The Galashiels Radio Rally will take place on Sunday the 22nd of October. The venue will be the Volunteer Hall, St Johns Street, Galashiels, TD1 3JX. The doors open at 11am. Entrance is £2.50, although under-16s will be admitted free of charge.  Now the Special Event News Today, the 15th, is the last chance to work EI4FOTA from the Blasket Islands, EU-007. A team of ‘Friends on the Air' will be busy activating special locations in and around Ireland until the 31st of August 2024. See QRZ.com for more information. Members of Radio Club F5KDC will be active as TM400BPA until Monday the 16th of October. Listen for activity on the 80, 40 and 20m bands using SSB and CW. The special callsign marks the 400th anniversary of the birth of Blaise Pascal, the French polymath. Listen out for AT30IIH which is active until the 31st of December to celebrate the 30th anniversary of the Indian Institute of Hams, or IIH. The IIH's focus is training and bringing young people into the amateur radio community. QSL via the bureau, direct or via eQSL. Now the DX news Today, the 15th, is the last chance to work a team of German amateurs that is active as TX6D from Tahiti, OC-046, in French Polynesia. The team is operating using CW, SSB and digital modes on the 160 to 10m bands. QSL to DL7DF directly or via the bureau, Logbook of the World or OQRS. Uli, DL2AH is active as V73AH until the 16th of October from Majuro, OC-029, in the Marshall Islands. He will operate SSB and FT8 on the 80 to 6m bands. QSL via Logbook of the World, eQSL or direct to DL2AH. Now the contest news The Oceania DX CW Contest started at 0600UTC on Saturday the 14th of October and ends at 0600UTC today, Sunday the 15th of October. On Monday the 16th of October, the RSGB FT4 Contest runs from 1900 to 2030UTC. Using FT4 on the 80, 40 and 20m bands, the exchange is your report. On Tuesday the 17th of October, the 1.3GHz UK Activity Contest runs from 1900 to 2130UTC. Using all modes on 1.3GHz frequencies, the exchange is signal report, serial number and locator. On Thursday the 19th of October, the 70MHz UK Activity Contest runs from 1900 to 2130UTC. Using all modes on the 4m band, the exchange is signal report, serial number and locator. On Sunday the 22nd of October, the 50MHz Affiliated Societies Contest runs from 0900 to 1300UTC. Using all modes on the 6m band, the exchange is signal report, serial number and locator. The Worked All Germany Contest starts at 1500UTC on Saturday the 21st of October and ends at 1500UTC on Sunday the 22nd of October. Using CW and SSB on the 80 to 10m bands, where contests are permitted, the exchange is signal report and serial number. German stations also send their DOK reference. Now the radio propagation report, compiled by G0KYA, G3YLA, and G4BAO on Thursday the 12th of October 2023 We had a period of low geomagnetic disturbance last week, which allowed the upper HF bands to shine. There were lots of reports of DX being worked on the 10m band as the Kp Index sat mainly in the ones and twos, with a maximum of Kp 3.33 for one three-hour period on the 9th. The Solar Flux Index, or SFI, also remained in the 150s and 160s, hitting a maximum of 166 on the 9th. All in all, these were very good conditions for high-band DXing, especially at this optimum time in the calendar. As promised last week, let's take a look at HF paths from the UK to the W8S Swains Island DXpedition in the South Pacific. The good news is that operations are in full swing and are being spotted daily on the DX Cluster. At a distance of approximately 9,500 miles from the UK on the short-path, and 15,300 miles on the long-path, it's quite a distance for signals to traverse. The short-path beam heading you need to select is a polar path at 350 degrees, and for long-path 169 degrees. The best openings to Swains from the UK start on the 20m band from about 0630UTC. As the morning progresses, move up in frequency until you get to the 10m band around 1000 to 1100UTC. This path should remain open until 1500 or 1600UTC, at which point you can drop down to the 12, 15 or 17m bands. Long-path openings may be a lot weaker, with a short opening on the 15m band from 0600 to 0800UTC. Then move to the 12 or 10m bands from 0700 to 0900UTC. There may also be a long-path evening opening from 1800 to 2000UTC on the 17 and 10m bands. The above predictions are for SSB and CW. You may find FT8 openings extend these times a little. For more details, and to compute your own predictions, see VOACAP.com or Proppy at soundbytes.asia/proppy This weekend, ending today the 15th, may see some geomagnetic disturbances due in part to a coronal hole. But, as long as we don't get any coronal mass ejections, this should settle after the weekend.  The Solar Flux Index is predicted to remain in the 150s with a maximum Kp index of two. If this turns out to be true, we should have a good week of DX hunting to come. And now the VHF and up propagation news The coming period of weather offers many changes, and it looks as though we have said goodbye to the warm air, with low pressure controlling events.   Just a gentle reminder to keep an eye on your antennas as this time of year can produce surprisingly rapid developments of deep low-pressure systems with associated strong winds.  Early next week, a temporary high returns to give you a chance to give those antenna supports and guys a once-over while winds are light, and leave the potential Tropo until the evenings and overnight. Incidentally, this new high is essentially a cold air high, so may not be as productive as the recent Tropo of the week just ending. The new high will probably hang around until midweek when it should migrate north to allow an easterly wind across the south. This will probably bring some showery rain along the east coast. It's possible that we may have some rain scatter from these showers. Meteor scatter is always good in October, with high random meteor rates and a number of small showers. Most notable of these is the Orionids Meteor Shower which peaks on the 22nd of October and is active until the 7th of November with an average zenithal hourly rate of around 20. Of course, aurora is also worth keeping in mind if you get any spare time! For EME operators, Moon declination is negative and falling all week, reaching minimum on Friday the 20th with corresponding shortening Moon windows. As we are now past apogee, path losses will continue to fall.  144MHz sky noise starts very high with the annular eclipse on Saturday the 14th. The following week sees it moderate, increasing to a high of over 2000 Kelvin on Thursday. And that's all from the propagation team this week.

This week, Mary and Alex watched the 1944 film “Gaslight” to learn about the origin of the commonly-used term of psychology of the same name. They discuss ways in which they have been gaslit by medical professionals, as well as how to recognize medical gaslight and ways to advocate for your health when a doctor tries to downplay your symptoms. #Podcast #Spotify #Anchor #research #advocacy #cancer #gaslighting #IIH #CSF #ocularmigraine #lumbarpuncture #shoulderdystocia Stay Connected  Email Us: downthereaware@gmail.com Instagram:@downthereaware  Facebook: Down There Aware  Twitter: @downthereaware Pinterest: Down There Aware TikTok: Down There Aware Episode Links What is gaslighting? Examples and how to respond Shoulder Dystocia: Signs, Causes, Prevention & Complications Episode Highlights Intro [0:13] Welcome Back! [1:23] Pickleball  [1:57] Gaslighting [3:05] American 1944 movie [3:40] Mary's personal gaslighting story [5:28] Shoulder dystocia [6:47] High risk pregnancy [8:35] Elective C-section [9:40] Advocate for yourself [11:34] Alex's personal gaslighting story [12:05] Idiopathic Intracranial Hypertension (IIH) [12:20] Ocular Migraine [13:15] Lumbar puncture [13:40] Thank you, Merry-Jennifer! [15:20] Cerebral Spinal Fluid  [15:48] Vulvar Cancer Network [19:04] ER doc's perspective needed [20:03] Opioid crisis [22:50] High pain threshold [23:03] Mary's colonoscopy follow-up [23:43] Only apology[25:25] Ingrid Bergman & Angela Lansbury [28:33] Medical gaslighting [30:22] Thanks for listening! [31:20] Summary Keywords Podcast, Spotify, Anchor, research, advocacy, cancer, gaslighting, IIH, CSF, ocular migraine, lumbar puncture, shoulder dystocia --- Send in a voice message: https://podcasters.spotify.com/pod/show/downthereaware/message

Drs. Julie Falardeau and Mike Lee discuss guidelines and pearls for the management of idiopathic intracranial hypertension (IIH) during pregnancy and childbirth. They share how pregnancy shifts the evaluation and management of the initial diagnosis of IIH and how it can affect patients who already have a history of the disease. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

This week Mary and Alex discuss the reasons for and the process through which we might go about seeking a 2nd opinion. 1. To gather information, 2. Not comfortable with diagnosis, 3. Unsuccessful treatment #Podcast #Spotify #Anchor #research #advocacy #pectusexcavatum #IdiopathicIntracranialHypertension #discectomy #2nd opinion Stay Connected  Email Us: downthereaware@gmail.com Instagram:@downthereaware  Facebook: Down There Aware  Twitter: @downthereaware Pinterest: Down There Aware TikTok: Down There Aware Episode Links The Gift of Fear: And Other Survival Signals That Protect Us from Violence Pectus excavatum: Not just a cosmetic concern Idiopathic Intracranial Hypertension: Symptoms, Causes & Treatment Episode Highlights Intro [0:13] Welcome Back! [1:24] Happy Birthday, Mary & George! [1:48] Second opinions [2:20] Negative stigma? [2:58] Gathering more information [3:31] Will's 2nd opinion for pectus excavatum [4:31] Alex's 2nd opinion for IIH [7:13] The Gift of Fear [12:04] Treatment is unsuccessful [16:35] Didn't seek 2nd opinion [17:10] Back injury [18:28] No need to rush into decisions [23:31] Sadie may enters [26:07] Thanks for listening! [26:15] Summary Keywords  Podcast, Spotify, Anchor, research, advocacy, pectus excavatum, Idiopathic Intracranial Hypertension, discectomy, 2nd opinion --- Send in a voice message: https://podcasters.spotify.com/pod/show/downthereaware/message

Kari talks about her experience being diagnosed with a brain aneurysm and Idiopathic Intracranial Hypertension, navigating the healthcare system, and how it's impacted her life.

In this episode, Dr. Roy Baskind and Dr. Ahmit Shah answer such questions as: when is an opening pressure on LP required? When should we pull the trigger on ordering a CT venogram in the patient with unexplained headache? Which older patients who present with headache require an ESR/CRP? How do the presentations of cerebral venous thrombosis (CVT) and idiopathic intracranial hypertension (IIH) compare and contrast? When is it safe to start steroids in the ED for patients suspected of giant cell arteritis (GCA); will starting steroids affect the accuracy of a temporal artery biopsy? How soon should patients suspected of GCA get a temporal artery biopsy? When should we consider posterior reversible encephalopathy syndrome (PRES) and pituitary apoplexy in the peripartum patient? How should we think about the differential diagnosis of vascular headaches? and many more...  The post Ep181 Cerebral Venous Thrombosis, Idiopathic Intracranial Hypertension, Giant Cell Arteritis and Peripartum Headaches appeared first on Emergency Medicine Cases.

Michelle is unsure when her journey with idiopathic intracranial hypertension (IIH) began. She started experiencing chronic migraines and pulsatile tinnitus in her 20s, which may have been the first sign. However, a freak accident in which a man fell from a theater balcony onto Michelle in 2017 intensified her symptoms, […]

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.01.31.526446v1?rss=1 Authors: Wardman, J. H., Jensen, M. N., Andreassen, S. N., Styrishave, B., Wilhjelm, J. E., Sinclair, A. J., MacAulay, N. J. Abstract: Background: Idiopathic intracranial hypertension (IIH) is a condition characterized by increased intracranial pressure (ICP), impaired vision, and headache. Most cases of IIH occur in obese women of childbearing age, though age, BMI, and female sex do not encompass all aspects of IIH pathophysiology. Systemic metabolic dysregulation has been identified in IIH with a profile of androgen excess. However, the mechanistic coupling between obesity/hormonal perturbations and cerebrospinal fluid dynamics remains unresolved. Methods: Female Wistar rats were either fed a high fat diet (HFD) or exposed to adjuvant testosterone treatment to recapitulate IIH causal drivers. Cerebrospinal fluid (CSF) and blood testosterone levels were determined with mass spectrometry, ICP and CSF dynamics with in vivo experimentation, and the choroid plexus function revealed with transcriptomics and ex vivo isotope-based flux assays. Results: HFD-fed rats presented with increased ICP, which was not accompanied by altered CSF dynamics or modified choroid plexus function. Chronic adjuvant testosterone treatment of lean rats caused elevated CSF secretion rate, in association with increased activity of the choroid plexus Na+,K+,2Cl- cotransporter, NKCC1. Conclusions: HFD-induced ICP elevation in experimental rats did not originate from an increased rate of CSF secretion. Such modulation of CSF dynamics only came about with adjuvant testosterone treatment, mimicking the androgen excess observed in female IIH patients. Obesity-induced androgen dysregulation may thus play a crucial role in the disease mechanism of IIH. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Iih is a social activist who has walked over 14,000km in South Asia. He has walked across Mechi-Mahakali multiple times. In this podcast, Iih and Sushant discuss about his journey, traveling on foot, Nepali politics, campaigns, protests, and much more. Follow Iih on Instagram: https://www.instagram.com/iihgram/?hl=en

Series 5 new episode is out now! Our host, leading Headache Specialist Dr Katy Munro discusses Idiopathic intracranial hypertension (IIH) with Professor Alex Sinclair and Dr Susan Mollan. Idiopathic intracranial hypertension (IIH), also known as benign intracranial hypertension or Pseudotumor cerebri, is a rare condition with an unknown cause or causes. The condition is associated with raised fluid pressure around the brain. Expert guests: Professor Sinclair is a Professor of Neurology at the University of Birmingham, and Head of the Metabolic Neurology Research Group. She is an international figure in translational research in Idiopathic Intracranial Hypertension (IIH), headache and traumatic brain injury. Dr Susan Mollan, is an Honorary Professor at the University of Birmingham and a Consultant Neuro-ophthalmologist at University Hospitals Birmingham. She is an International Senior Examiner for the Royal College of Ophthalmologists. If you have any questions/comments or any topics you would like us to cover in our future episodes email: info@nationalmigrainecentre.org.uk.   WE ARE A CHARITY Please help us keep going in the following ways: Please donate to help us continue to release new episodes: https://www.justgiving.com/campaign/headsup    Links mentioned in the episode 1. https://www.iih.org.uk/ 2. https://www.nhs.uk/conditions/intracranial-hypertension/  

Invex Therapeutics (ASX: IXC) executive director and chief science officer Alex Sinclair joins Small Caps to discuss the company's Evolve phase III trial which is now underway and evaluating its lead drug Presendin in patients with idiopathic intracranial hypertension (IHH). IIH is a rapidly growing disease, with incidences rising 350% over the last 10 year. Around 240 newly diagnosed IIH patients will be recruited to the trial which will be open at 40 sites around the world. Articles:https://smallcaps.com.au/invex-therapeutics-recruiting-iih-patients-nz-clinical-trial-regulatory-approvals/https://smallcaps.com.au/invex-therapeutics-recruits-first-idiopathic-intracranial-hypertension-patient-presendin-trial/ For more information on Invex Therapeutics:https://smallcaps.com.au/stocks/IXC/See omnystudio.com/listener for privacy information.

The November 2022 replay of past episodes showcases four incredible interviews with topics in headache. This episode features conversations with Dr. Todd Schwedt on medicine overuse headaches, followed by an interview with Dr. Eoin Flanagan on brain processing in patients with migraine. The November recall's final two interviews feature discussions about IIH; Dr. Susan Mollan discusses the effects of weight loss in IIH, and then Dr. Tesha Monteith and Prof. Rigmor Højland Jensen discuss psychiatric co-morbidities in IIH.

"Vielleicht gelingt es ja, der Qualle nicht jedes Mal mit einem Ooh! oder Iih! zu begegnen, sondern ruhig ze bleiben angesichts ihrer ..." schreift de Lëtzebuerger Schrëftsteller Samuel Hamen a sengem neie Buch "Quallen", dat am däitsche Verlag Matthes & Seitz erauskoum. Argumenter fir op den Iih! ze verzichten, gi genuch an dësem Wierk gebueden. Den ëmfangräiche Portrait vun de Jelliskäpp huet d'Valerija Berdi gelies.

Can weight loss cure eye disease?Effectiveness of Bariatric Surgery vs Community Weight Management Intervention for the Treatment of Idiopathic Intracranial Hypertension.Can weight loss cure eye disease? In the case of Idiopathic Intracranial Hypertension (IIH), yes! A/Prof Clare Fraser talks us through the much-awaited follow-up article examining the Effectiveness of Bariatric Surgery vs Community Weight Management Intervention for the Treatment of IIH. The main take-away is not pizza – listen in to find out what is it!View article hereClare Fraser completed neuro-ophthalmic training at Moorfields Eye Hospital and the National Hospital for Neurology, London. She completed a research fellowship at Emory Eye Centre, Atlanta and was a consultant neuro-ophthalmologist for Moorfields Eye Hospital and Kings College Hospital, London. She is a senior clinical lecturer at the University of Sydney and Macquarie University and consults at St Vincent's Hospital, Sydney Eye Hospital and Macquarie University Hospital. She holds several National and International committee positions as a Director on the RANZCO Board and a reviewer for Clinical & Experimental Ophthalmology and The American Journal of Ophthalmology. 

Hovedpine kan skyldes mange ting og dække over vidt forskellige tilstande. Idiopatisk intrakraniel hypertension (IIH) er på få årtier gået fra at være yderst sjælden til hyppigere at ses i venteværelset hos både øjenlæger og praktiserende læger. Gæst: Rigmor Jensen, professor ved Københavns Universitet og leder af Dansk Hovedpinecenter, Rigshospitalet Glostrup Tilrettelæggelse: Mie Brandstrup

Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I'm looking forward to sharing with you some of our community's questions that have come in over the past few weeks… Tennea: Hi Dr Cabral, I'm currently doing your IHP training. I wanted to know if you have any advice on the condition called Chronic Regional Pain Syndrome (CRPS) I had an accident 4 years ago leaving me “permanently disabled” in my left arm, hand, and shoulder after breaking my elbow (terrible triad). And I ended up with this nerve chronic pain CRPS. I also developed a anaphylactic reaction to seafood last year (I LOVE seafood), I believe it's related to the CRPS. I would be eternally great full for your advice or thoughts on this. Warm regards Teena Lara: Hi, dr. Cabral :) I'm hoping you could talk about the “extra” ingredients in supplements.. like different fillers, additives, preservatives..? Which ones should we be careful about, which different names do they use for the same crappy substance, for example, citric acid is in lots of them, also lactic acid, etc. What kind of a capsule (vegan) should it be and so on? Would love to buy extra clean supplements but sometimes it's really difficult to get them, especially with the crazy prices.. Thank you! Happy healing, everyone!   Rachel: Body odour. I sometimes find that I have very very strong body odour in my armpits. It's not the "normal" BO smell. It is pungent but more like a strong gasoline smell. When it happens it's almost as if I can't wash it off. Showering and washing my armpits helps lessen it, but the smell is still there. Any idea what the cause could be or how to rectify it? Thank you! Debra: I have mast cell disease,, hereditary alpha tryptaemia syndrome, and Intracranaian increased hypertension which causes debilitating migraines. I have done your detox and despite the debilitating migraines getting worse I stuck it out. I did the hair migraine erase test and I had to stop all supplements recommended for now. I was reacting to everything. Especially the shakes high in vitamin A. Do you have experience in IIH aka pseudo tumor? Would love to work together further. I'm a huge fan and desperate to heal.thanks, Debra Nick: Hi Dr. Cabral! I have two questions for you — one, i recently had a snowboarding accident where i hit my head and got a CT scan and MRI which showed a Cavernoma in the back upper outer edge of my head. Do you have any natural remedies advice for controlling / improving it? i've had no symptoms and it was found incidentally. (i'm 25 years old) my second question is — they told me i will need to monitor it probably 1-2 times a year with contrast and no contrast MRI. Should i be concerned with the gadolinium metal that's used to contrast the MRI? if so, would you have any alternative suggestions (i.e. recommending no contrast) or any detox solutions you'd recommend if you think it's necessary? thank you! Karen: Hi Dr. Cabral - I recently found your practice and I love what you do. My question is - my son joined the navy and had extensive blood work done. He discovered that he has a high percentage of sickle cell trait. He was 1% from the navy's limit. Are there health issues associated with a higher percentage of this trait? Thank you so much! Karen Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes & Resources:  http://StephenCabral.com/2256 - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - -  Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Stress, Sleep & Hormones Test (Run your adrenal & hormone levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels)

Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I'm looking forward to sharing with you some of our community's questions that have come in over the past few weeks… Let's get started!    Simon: Hi Dr Cabral, I am looking to improve my immune defenses against a 'certain virus' and am concerned that my white blood cell count is sub-optimal (4,000/ul) despite my otherwise good health. I suspect this may be a hangover from having VERY low WBC levels after contracting dengue fever 5 years ago. Is increasing my WBC something I should be exploring and what can I do to get my count up?   Lorena: Thank you so much for all you do for your community! Not sure if you remember but I asked here a few weeks ago regarding my elevated heart rate at night according to my Oura ring and that I started to experience a lot of neurological symptoms (similar to MCAS) such as anxiety, heart palpitations and pseudoseizures at the same time. You mentioned that I should check my cortisol levels at night (which I did and was slightly elevated in the PM and low in the AM). I'm a Vata level 1 and 2 IHP so I literally ran all of the labs that you can imagine as I was very confused as to what was going on. Hormones, heavy metals, stool, OAT, neurotransmitters + more. Everything was fine except some candida/mould overgrowth as well as elevated toxic metals. I started the CBO again (last one was over a year ago) + heavy metal detox + 21 day detox all at the same time lol. Anyways, I haven't felt any neurological symptoms after just a couple of days of starting these protocols. I can't figure out how this would have happened. Surely 2 days worth of protocols is not enough to stop these symptoms (very happy though). Any idea why?   Lorena: Hi Doc, me again! I forgot to mention that I also ran a precision allergy test by Precision Point Diagnostics because they test IgE, IgG, IgG4 and complement (C3d) from blood serum. It's much more expensive so not very affordable for a lot of people. Anyways, a lot of things came up and I also eliminated the ones in the red section of my IgE and IgG (vanilla, banana & more) at the same time that I started all the protocols. A lot of them showed in the IgE section and these were foods that I was consuming on a daily basis when I was having all of those symptoms. Do you think it might have been the removal of these foods that caused the relief of symptoms so quickly? If so, it's crazy how consuming foods you're sensitive to from an IgE and IgG perspective can do to you! I always thought this wasn't a big deal but it clearly is.    Nina: Hi doctor Cabral, I get very lightheaded every time I bend down to pick up something. Do you know why this is happening? I do have a low blood pressure, so maybe that could have something to do with it, but I really want to know if there's anything else that could be causing it. I also always feel cold, especially in my extremities. Just to give you some background, I'm a 44 year old female, no kids, vegan and pretty active. Thanks so much for your answer, I really appreciate your help! Nina   Farrel: Hello, Dr Cabral. I trust you and your family are in great health. Listening to older episodes and about two years ago on a House call segment you were asked about Tongkat Ali and it's use for athletes and men in their 30's. You went on to say there's a product your team will be launching around September 2020 called Libido Booster. I purchase from the site and I've never seen it. Has the launch been put on hold or it won't be released? Keep up great work.   Andjela: Hello Dr!! Thanks for your information! Love following you on Instagram. I had covid (delta) in October 2021, and now 3 months later experiencing hair loss. So are many of my relatives who all had it at the same time. Any suggestions on remedies?   Danielle: Hello Dr. Cabral,Thank you so much for sharing your knowledge in functional medicine. I've read your book twice and have no doubt I'll read it again. I listen to this podcast daily and am awaiting the arrival of the minerals and metals test. My question is related to IIH. (I understand the medical advice disclaimer) Are there any natural ways to reduce pressure in the head? I do not want a LP. How else can I reduce excess fluid? I do take L-Lysine and well as a long list of other supplements daily. I'm also taking Goduchi and Triphala as herbal support and am on 2 pharmaceuticals as well, which Id love to come off of, safely, of course. Thanks so much for your time. Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes & Resources:  http://StephenCabral.com/2214 - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - -  Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Stress, Sleep & Hormones Test (Run your adrenal & hormone levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels)

Venous sinus stenting (VSS) is a safe, effective, and increasingly popular treatment option for selected patients with idiopathic intracranial hypertension (IIH). Serious complications associated with VSS are rarely reported. In this podcast, JNIS Editor-in-Chief, Felipe C. Albuquerque, interviews Dr. Kyle Fargen, from the Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, about a case series in which serious complications after VSS were identified retrospectively from multicenter databases. The cases are reviewed and learning points regarding complication avoidance and management are presented in his paper (https://jnis.bmj.com/content/early/2021/04/27/neurintsurg-2021-017361).

Do you find yourself getting angry more frequently? Crying more or sometimes feel like you have a rogue persona inside of you that takes control and sends you into worry tail spins or eating binges? My guest on this episode is Rene Brent, RN and Certified Clinical Hypnotherapist/Instructor. Today Rene shares a quick, and I mean quick, exercise you can do to calm your mind and your nervous system plus she shares her favorite phrase for shifting that rogue persona from control to the backseat. Rene and I discuss how to give yourself permission to change your behavior that no longer serves you and a few questions you can ask yourself to gain awareness of patterns that build worry and increase your use of the but. Rene Brent has been a RN for 30 years and has worked in ICU, Trauma/ER and the Recovery Room. In her experience, she was inspired by the powerful mind/body connection and how self-awareness and reframing negative thoughts helps us heal emotionally and physically. It was a natural transition for Rene Brent to go from being a healer of the body to a healer of the mind. She is passionate about helping her clients use the power of the mind and move forward in their lives and reach personal and professional goals. Rene attended The Institute of Interpersonal Hypnotherapy (IIH in Tampa, Fl.) IIH is the only state licensed school of Hypnotherapy in Florida. Rene has trained over 1000 hours. Rene Brent's solo practice is located in Maitland, Florida. She is certified as a Clinical and Transpersonal Hypnotherapist. She is highly trained and uses a variety of modalities including Hypnotherapy, NLP, EMT and EFT. She finds these protocols help her clients change negative habits and behaviors. When her clients release false beliefs and let go of past hurts and events, then true healing can occur. Rene Brent is an International speaker and a #1International Best Selling Author of  “How Big Is Your BUT?”. On March 16th, 2021 Rene released her latest book “Breaking the Worry Agreement” and has already reached International Best Seller status on Amazon. Rene Brent is a registered member of The American Council of Hypnotherapist (ACHE) and the International Association of Interpersonal Hypnotherapist (IAIH) 

Invex Therapeutics (ASX: IXC) executive director Thomas Duthy joins Small Caps to discuss the company's new partnership with Korean biopharmaceutical company Peptron. The pair have signed an exclusive collaboration and manufacturing agreement that is expected to de-risk the development of Invex's lead drug Presendin for the treatment of idiopathic intracranial hypertension (IIH). The deal will grant Invex access to drug product, extensive data and Peptron's manufacturing and technical expertise, enabling it to bypass required activities saving both money and time in Presendin's development pathway.Article:https://smallcaps.com.au/invex-therapeutics-signs-major-collaboration-with-peptron/For more information:https://smallcaps.com.au/stocks/IXC/

Join Hazal and I today where we chat all about Hazal's rare chronic illness, IIH and how this led her to start her own business, Blind Beauty which provides luxury skincare for blind people, always making beauty accessible. If you loved this episode, be sure to leave a 5* review on iTunes and take a screenshot to share on social media, tagging me @chronicglow! I can't wait to speak to you again in the next episode! Amy xx FREEBIE: 30 morning rituals for your mind, body & soul ➡️ https://chronicglow.co.uk/morningflow/ ✨ WEBSITE: https://chronicglow.co.uk/ ✨ INSTAGRAM: https://www.instagram.com/chronicglow/ ✨ 1:1 COACHING: https://chronicglow.co.uk/flow/ ✨ MEMBERSHIP: https://chronicglow.co.uk/collective/ Follow Hazal at:

Today I will be discussing the mental section of Step Five. I think for the modern reader especially, this is perhaps the most enigmatic section in the whole of IIH. But with just a few essential bits of additional information it begins to reveal its meaning. --- Support this podcast: https://anchor.fm/MysticalThoughts/support

I have chosen this title, “Simple Beginnings”, to emphasize that Step One is just the beginning and that it is simple. All too often a new student of initiation will read the Step One exercises and think that they are very complex and that completing them requires already advanced abilities, or that performing the exercises will require so much time each day that they will have no time left over for anything else, such as making a living and entertaining their friends, etc., etc., etc.. None of these assumptions are accurate. According to his own words, Bardon arranged IIH as if it was “meant for the busiest man”, and even though Bardon's way of phrasing things may seem somewhat archaic and oftentimes confusing to a modern reader, the exercises he is describing in Step One are rudimentary and the essence of simplicity, designed with the absolute beginner in mind. Furthermore, according to Bardon's own instructions, they are each to be completed relatively quickly, within one to two weeks in most cases. --- Support this podcast: https://anchor.fm/MysticalThoughts/support

Actor and fellow podcaster, Maddi Albregts speaks about IIH, internal ableism, and living with an invisible disability. Please check out her wonderful podcast BrainFart and add it to your playlist! Links for MaddiEpisode where Maddi is interviewed by her friend who took her to the hospital her sophomore year. One of my favorite episodes: HereLink to BrainFart homepage: HereLink to BrainFart IG Page: Here Links for The Landscape PagesLink to The Landscape FB PageLink to The Landscape Instagram PageLink to sign up News LetterLink to The Landscape LinkedIn

In this week's episode, Alex and Mary discuss pain, something we can all relate to. They share their own personal worst pain and most strange pain, as well as discuss the origins of various pain scales. The opioid crisis is touched on, as are some alternative therapies for pain. This week is Part One on pain. Part Two will follow next week. Listen on our website, www.downthereaware.com/podcast, or wherever you get your podcasts. Episode Highlights Good Morning?? [0:38] Chit-chat [0:57] Two-part mini series [2:00] Everyone experiences pain [2:20] Virginia Woolf quote [2:40] Descriptions of pain [3:00] Communication with doctors [3:50] Individuals feel pain differently [4:20] Childbirth pain [5:00] Alex's worst pain [6:20] Brain surgery [7:00] I've got you under my skin! [7:55] Gas pain after abdominal surgery [9:10] Mary's worst pain [10:30] When pain is temporary [11:00] “Valvey” veins [13:30] Papa Joe [16:15] Acute pain [18:22] Referred pain [20:10] Chronic pain [23:23] Back pain [23:45] Degenerative disc disease [23:50] Sciatica [25:45] Chiropractor [26:55] Migraine treatment [26:34] Triptan, vasoconstrictor [27:17] Insurance [28:05] Opioids [28:38] Alex's strangest pain [29:17] Mary's strangest pain [32:03] Injured joint capsule [32:45] Vionic shoes [33:50] Thanks for listening! [36:04] Stay Connected Email Us: downthereaware@gmail.com Instagram:@downthereaware Facebook: Down There Aware Twitter: @downthereaware Pinterest: Down There Aware TikTok: Down There Aware Links Mentioned in the Episode Pain: What it is and how to treat it Ask Me About My Uterus: A Quest to Make Doctors Believe in Women's Pain Summary Keywords Podcast, Spotify, Anchor, research, advocacy, advanced imaging, diagnosis, knowledge, women, fear, technology, Virginia Woolf, pain, idiopathic intracranial hypertension, cerebral spinal fluid, peritoneal cavity, visceral pain, referred pain, somatic pain, fight or flight, rotator cuff, frozen shoulder, physical therapy, papilledema chronic pain, arthritis, migraines, degenerative disc disease, sciatica, chiropractor, vasoconstrictor, triptan, insurance, opioids, joint capsule, Vionic shoes #Podcast #Spotify #Anchor #research #advocacy #advancedimaging #diagnosis #women #womenshealth #gynecology #health #wombstories #mother #daughter #cancer #VirginiaWoolf #pain #brainsurgery #shunt #IIH #frozenshoulder #idiopathicintracranialhypertension #cerebralspinalfluid #CSF #peritonealcavity #visceralpain #referredpain #somaticpain #fightorflight #rotatorcuff #physicaltherapy #papilledema #chronicpain #arthritis #migraines #degenerativediscdisease #sciatica #chiropractor #vasoconstrictor #triptan #insurance #opioids #jointcapsule #vionic --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Interview mit Andreas Weinhart zum Thema Fußekel IIIIIiiiiiihhhhhh Füße – auch das hören wir oft, wenn wir barfuß unterwegs sind, oder auch in der Community wenn ihr damit konfrontiert werdet. Total spannend, wie unterschiedlich das sein kann. Mal ist der Fuß ein Objekt der Begierde und dann wird er wiederum als Fremdkörper angesehen. Andreas Weinhardt kennt das selbst auch, er ist berufsbedingt oft in Situationen, wo er fremder Menschen Füße sieht oder auch anfassen muss. Als Pfleger hat er da auch nicht immer die hübschesten Füße vor Augen. Das löste allerdings nicht seinen EKEL vor Füßen aus – wir vermuten zusammen, dass es in der Kindheit oder Jugend Situationen gegeben hat, die das versucht haben. Er ist allerdings kein Fußphobiker, also Menschen die dann sogar Panikattacken und Angstzustände bekommen, sondern bekämpft schon seit langem seinen Ekel. Er pflegt seine eigenen Füße und beschäftigt sich mit dem Barfußgehen, um einen anderen Blickwinkel zu bekommen. Wir entdecken immer wieder, dass der Umgang der Eltern eine große Rolle spielt. Aus „Spaß“ zu sagen „Iih, Stinkefüße“ oder auch das während der Pflege der Füße nicht gut über diese gesprochen wird. Aber löst das tatsächlich den Ekel aus oder sogar eine Phobie? Zusammen mit Andreas sprechen wir darüber…..Fühlt mal in euch rein ;-) [Facebook Gruppe](https://www.facebook.com/groups/370125074000880) [Barfuss im Pott](https://barfuss-im-pott.de/) [Körper Dynamik](http://koerper-dynamik.de/) [goFree Concepts](https://gofreeconcepts.de/discount/BARFUSSIMPOTT) Affiliate Link mit 5% Rabatt [Knitido](https://www.knitido.de/) 10% Rabatt mit “POTT10” [Vivobarefoot Affiliate](https://www.vivobarefoot.de/?campaign=VIV/AF/ALTO/Gt55zr98ba)

This week's interview is with an amazing, funny, and fascinating woman named Jen Roman! Jen is a rare disease patient whose life as an EMT was turned upside down, and since then, she has become well acquainted with spinal taps, brain surgeries, and unknown problems. Jen was diagnosed with Idiopathic Intracranial Hypertension, or IIH, which is a rare disease caused by an overproduction of cerebrospinal fluid. However, Jen's life is still full of unknowns because she has yet to pinpoint what caused her IIH. She and I talk about struggles of rare disease life, how a scientific occupation can change your perspective on diagnosis, and more! Be sure to subscribe to R is for Rare on Apple Podcasts, Spotify, or wherever you get your podcasts! Follow Jen Roman on Instagram - @kylo_jen_94 Jen's spotlight blog post on Our Odyssey - https://ourodyssey.org/our-odyssey-spotlight/jentruth Follow me on Instagram - @risforrarepodcast Questions? Email me at risforrarepodcast@gmail.com --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/annie-watson/message

In this third episode in the birth hypnosis series, Michelle and Rene Brent, Clinical and Transpersonal Hypnotherapist, dispel the myths and misconceptions surrounding hypnosis and hypnotherapy. They discuss the power of the subconscious mind works and how it works. Rene explains the imprinting that can happen within the subconscious mind, especially when we are children. Together Michelle and Rene share the transform that hypnotherapy can create. "Thoughts create chemistry, and chemistry, we feel that in our physical body. If it's fear then we have another thought because we feel it in our stomach or our gut. And that's called the felt sense… When you are in worry and fear because worry is all about fear. Nobody worries about things being amazing." —Rene Brent About Rene Brent:Rene has been an RN for 30 years and has worked in ICU, Trauma/ER, and the Recovery Room. In her experience, she was inspired by the powerful mind/body connection and how self-awareness and reframing negative thoughts help us heal emotionally and physically. It was a natural transition for Rene Brent to go from being a healer of the body to a healer of the mind. She is passionate about helping her clients use the power of the mind and move forward in their lives and reach personal and professional goals. Rene attended The Institute of Interpersonal Hypnotherapy (IIH in Tampa, Fl.) IIH is the only state-licensed school of Hypnotherapy in Florida. Rene has trained over 1000 hours.Rene Brent's solo practice is located in Maitland, Florida. She is certified as a Clinical and Transpersonal Hypnotherapist. She is highly trained and uses a variety of modalities including Hypnotherapy, NLP, EMT and EFT. She finds these protocols help her clients change negative habits and behaviors. When her clients release false beliefs and let go of past hurts and events, then true healing can occur. Rene Brent is an international speaker and a #1 International Best Selling Author of “How Big Is Your BUT?”. On March 16th, 2021 Rene released her latest book “Breaking the Worry Agreement” and has already reached International Best Seller status on Amazon.Rene Brent is a registered member of The American Council of Hypnotherapist (ACHE) and the International Association of Interpersonal Hypnotherapist (IAIH) Rene's Books: "How Big Is Your BUT?”“Breaking the Worry Agreement” Connect with Rene:Websites: https://www.practicehappynow.com/, https://renebrenthypnosis.com/Facebook: @ReneBrentHypnosis, @PracticeHappyNowInstagram: @ReneHypnosisLinkedIn: Rene Brent, RN-CCHTYou Tube: ReneBrentHypnosis Connect with Michelle Smith:Classes with Michelle: birtheaseservices.com/birth-ease-childbirth-educationFacebook:   Birth Ease,   The Birth Ease Podcast,  Birth Ease Baby Loss SupportInstagram:    @birtheasemichellesmith, @birtheaselossssupportYouTube:    Birth EaseLinkedIn:  Birth Ease Michelle SmithWebsite: BirthEaseServices.com

Idiopathic intracranial hypertension (IIH, occasionally called pseudotumour cerebri or benign intracranial hypertension) is a condition characterised by features of raised intracranial pressure without any other cause identified. The main complication is progressive vision loss.  In this episode we discuss presentation, diagnosis and treatment. Follow us on Instagram @yourekiddingrightdoctors Facebook: https://www.facebook.com/yourekiddingrightpod-107273607638323/ Our email is yourekiddingrightpod@gmail.com Make sure you hit SUBSCRIBE/FOLLOW so you don’t miss out on any pearls of wisdom and RATE if you can to help other people find us! (This isn’t individual medical advice, please use your own clinical judgement and local guidelines when caring for your patients)

Alex goes into how living with IIH is and also touches on a topic a lot a people are curious about. His journey with food. He has been not eating meat since 2019 and a lot of people are curious how has it effected him and does he miss it..... Listen to the podcast and let him know your thoughts on the podcast!!!! --- Support this podcast: https://podcasters.spotify.com/pod/show/jorge-reyes617/support

In this episode we sit down with pediatric neurologist Dr. Ekta Bery to discuss the headache that is IIH (also known as pseudotumor cerebri) management. Pun intended. Don't forget to check out mdnotified.com for our QuickNotes and episode sources!

In this episode of the Epigenetics Podcast, we caught up with Dr. Danny Reinberg from the New York University School of Medicine to talk about his work on transcription and polycomb in inheritance and disease. Dr. Danny Reinberg is a pioneer in the characterization of transcription factors for human RNA polymerase II. In his groundbreaking work in the 1990s, he purified the essential transcription factors and reconstituted the polymerase in vitro on both naked DNA and chromatin.  Dr. Reinberg next started focusing on the polycomb repressive complex 2 (PRC2), which is the only known methyltransferase for lysine 27 on histone H3. He biochemically characterized the PRC2 subunits EZH1 and EZH2. More recently, Dr. Reinberg has been investigating the role of PRC2 in neurons.  This interview discusses the story behind how Dr. Danny Reinberg started his research career by identifying the essential RNA polymerase transcription factors, how he discovered and characterized the polycomb repressive complex 2 (PRC2), and what his research holds for the future.   References H. Lu, L. Zawel, … D. Reinberg (1992) Human general transcription factor IIH phosphorylates the C-terminal domain of RNA polymerase II (Nature) DOI: 10.1038/358641a0 A. Merino, K. R. Madden, … D. Reinberg (1993) DNA topoisomerase I is involved in both repression and activation of transcription (Nature) DOI: 10.1038/365227a0 G. Orphanides, W. H. Wu, … D. Reinberg (1999) The chromatin-specific transcription elongation factor FACT comprises human SPT16 and SSRP1 proteins (Nature) DOI: 10.1038/22350 Andrei Kuzmichev, Kenichi Nishioka, … Danny Reinberg (2002) Histone methyltransferase activity associated with a human multiprotein complex containing the Enhancer of Zeste protein (Genes & Development) DOI: 10.1101/gad.1035902 Andrei Kuzmichev, Raphael Margueron, … Danny Reinberg (2005) Composition and histone substrates of polycomb repressive group complexes change during cellular differentiation (Proceedings of the National Academy of Sciences of the United States of America) DOI: 10.1073/pnas.0409875102 Ozgur Oksuz, Varun Narendra, … Danny Reinberg (2018) Capturing the Onset of PRC2-Mediated Repressive Domain Formation (Molecular Cell) DOI: 10.1016/j.molcel.2018.05.023 Contact Active Motif on Twitter Epigenetics Podcast on Twitter Active Motif on LinkedIn Active Motif on Facebook Email: podcast@activemotif.com

Webster defines ‘idiopathic’ as “arising spontaneously or from an obscure or unknown cause”. By definition, this means idiopathic intracranial hypertension (IIH) has no proximate cause. But that’s not exactly true. This week on the podcast, we explore the recent evidence behind the theory that transverse sinus stenosis may contribute to this condition. Disclaimer: No chicken or eggs were harmed in the making of this episode. Produced by James E. Siegler. Music courtesy of Squire Tuck, Swelling, Three Chain Links, and Unheard Music Concepts. 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 Martins AN. Resistance to drainage of cerebrospinal fluid: clinical measurement and significance. Journal of neurology, neurosurgery, and psychiatry. 1973;36:313-8. Gjerris F, Soelberg Sorensen P, Vorstrup S and Paulson OB. Intracranial pressure, conductance to cerebrospinal fluid outflow, and cerebral blood flow in patients with benign intracranial hypertension (pseudotumor cerebri). Annals of neurology. 1985;17:158-62. Orefice G, Celentano L, Scaglione M, Davoli M and Striano S. Radioisotopic cisternography in benign intracranial hypertension of young obese women. A seven-case study and pathogenetic suggestions. Acta Neurol (Napoli). 1992;14:39-50. Karahalios DG, Rekate HL, Khayata MH and Apostolides PJ. Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies. Neurology. 1996;46:198-202. King JO, Mitchell PJ, Thomson KR and Tress BM. Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology. 2002;58:26-30. Farb RI, Vanek I, Scott JN, Mikulis DJ, Willinsky RA, Tomlinson G and terBrugge KG. Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology. 2003;60:1418-24. Rohr A, Dorner L, Stingele R, Buhl R, Alfke K and Jansen O. Reversibility of venous sinus obstruction in idiopathic intracranial hypertension. AJNR American journal of neuroradiology. 2007;28:656-9. Sinclair AJ, Kuruvath S, Sen D, Nightingale PG, Burdon MA and Flint G. Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review. Cephalalgia. 2011;31:1627-33. Riggeal BD, Bruce BB, Saindane AM, Ridha MA, Kelly LP, Newman NJ and Biousse V. Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. Neurology. 2013;80:289-95. Satti SR, Leishangthem L and Chaudry MI. Meta-Analysis of CSF Diversion Procedures and Dural Venous Sinus Stenting in the Setting of Medically Refractory Idiopathic Intracranial Hypertension. AJNR American journal of neuroradiology. 2015;36:1899-904. Dinkin MJ and Patsalides A. Venous Sinus Stenting in Idiopathic Intracranial Hypertension: Results of a Prospective Trial. J Neuroophthalmol. 2017;37:113-121. Mohammaden MH, Husain MR, Brunozzi D, Hussein AE, Atwal G, Charbel FT and Alaraj A. Role of Resistivity Index Analysis in the Prediction of Hemodynamically Significant Venous Sinus Stenosis in Patient With Idiopathic Intracranial Hypertension. Neurosurgery. 2020;86:631-636.

Expert neuroophthalmologist Dr Anthony Fok takes us through the common but commonly vexing condition of intracranial atherosclerosis. We talk about how to assess IIH patients, how to manage them medically, when surgery is required, what to do when they don't tolerate the usual medications and more!

In this episode we will be talking about IIH, treatments and medications In next Friday's episode I will be talking about Pituitary Cyst's and my partner will be speaking about her experience living with me and my conditions. Black Lives Matter Links: Petitions, Donations - blacklivesmatters.carrd.co How you can help How to financially help BLM with no money/leaving your house - https://www.youtube.com/watch?v=bCgLa25fDHM&t=6s Dr Robin DiAngelo - "White Fragility" - https://www.youtube.com/watch?v=45ey4jgoxeU&t=826s Dr Robin DiAngelo - "How Structural Racism Works" - https://www.youtube.com/watch?v=bC3TWx9IOUE&t=1313s LGBTQ+ Links Petitions - https://actionnetwork.org/petitions/sign-the-petition-to-congress-lgbtq-people-are-under-attack-by-trump-restore-all-basic-human-rights-that-have-been-stripped?source=2020RestoreLGBTQRights_FOE&referrer=group-friends-of-the-earth-action Information About the Bill - https://www.vox.com/identities/2020/4/24/21234532/trump-administration-health-care-discriminate-lgbtq Information About the LGBTQ+ Community - https://www.stonewall.org.uk/lgbt-inclusive-education-everything-you-need-know IIH Links: IHH Information/Help - www.iih.org.uk Information Cards - www.iihukshop.moonfruit.com Speech Cards - stickmancommunications.co.uk Contact Us: We would love to hear from you! Twitter - @gingerbogue. Instagram - @bogu3. Email - mydrowningbrain@gmail.com

In this episode we will be talking about IIH, what it is and how it effects me daily. I will be uploading another episode on Tuesday where I will go through treatments and in Friday's episode I will be talking about Pituitary Cyst's. Black Lives Matter Links: Petitions, Donations - blacklivesmatters.carrd.co How you can help How to financially help BLM with no money/leaving your house - https://www.youtube.com/watch?v=bCgLa25fDHM&t=6s Dr Robin DiAngelo - "White Fragility" - https://www.youtube.com/watch?v=45ey4jgoxeU&t=826s Dr Robin DiAngelo - "How Structural Racism Works" - https://www.youtube.com/watch?v=bC3TWx9IOUE&t=1313s IIH Links: IHH Information/Help - www.iih.org.uk Information Cards - www.iihukshop.moonfruit.com Speech Cards - stickmancommunications.co.uk Contact Us: We would love to hear from you! Twitter - @gingerbogue. Instagram - @bogu3. Email - mydrowningbrain@gmail.com

ABOUT MY GUEST For my next guest in the LVG PODCAST, I have Haz Here is a quick intro about Haz. “A little over a year ago Haz was diagnosed with a rare neurological disease called idiopathic intracranial hypertension (IIH) and lost her sight as a result of it. Now legally blind, she uses her social media platform to raise awareness of her rare condition and help others who are in a similar position. Haz is a strong-minded and positive girl with a determined.” SPONSORS LVG MARKETING: If you have a disability and you would like to learn how to start an online business. LVG MARKETING can help. LVG MARKETING. is a small boutique digital agency that caters to people with disabilities and shows them how to start an online business from home. No Experience needed and if you click on the below and fill out the form, you can get access to a FREE 30 MINUTE BUSINESS INTRO SESSION with Demarco. Click Here to BOOK YOUR SESSION. (Spaces are limited) Schedule your session here:>>>>>>>>. https://bit.ly/3bU1TYu SCRIBD: I have been a fan of Scribd for about 2 years now. I love the fact that for only $9 a month, I have access to digital books, audiobooks, and magazines. The best part about magazines is that I can “increase” the font size! Click on the link and get 2 months of free on me Get your 2 months of FREE reading here: >>>>>>>>>>>. https://bit.ly/2xZ01ix BLUEHOST: Have you ever wanted to write your own blog so that you can tell your own story? Well, that is what happened when I started LOW VISION GUY. BLUEHOST is a one-stop-shop for finding the name of your website, building your website and publishing your blog/website to the world. CLICK HERE TO GET STARTED. Start your blog today: >>>>>>>>>>>>>>. http://bit.ly/33s1VUw JOIN THE LVG PODCAST FACEBOOK COMMUNITY AND TALK TO HAZ Join the Facebook group today: >>>>>>>>>>> https://bit.ly/3bq17CK FOR SHOW NOTES AND MORE ABOUT THIS PODCAST, GO TO: THELOWVISIONGUY.COM THELOWVISIONGUY.COM THELOWVISIONGUY.COM --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/lvgpodcast/message Support this podcast: https://anchor.fm/lvgpodcast/support

JNIS Editor-In-Chief Felipe C. Albuquerque discusses idiopathic intracranial hypertension (IIH) and a new patient classification paradigm with Kyle Fargen (Neurological Surgery, Wake Forest University, Winston-Salem, USA) and Michael Levitt (Neurological Surgery, University of Washington, Seattle, USA). Both authors recently wrote about the intersection between IIH and venous sinus stenosis, an increasingly hot topic within the neurointerventional community. In the podcast, the participants discuss this novel classification, venous sinus stenting, and issues pertaining to this diverse patient population. Read the paper and the commentary on the JNIS website: Idiopathic intracranial hypertension is not idiopathic: proposal for a new nomenclature and patient classification https://jnis.bmj.com/content/12/2/110 Commentary: Another version of the truth https://jnis.bmj.com/content/12/4/335

In this episode Chris and I wrap up our IIH discussion, and we included some fun conversations.

We continue our conversation on IIH! Hope you enjoy!

In this episode we begin talking about Franz Bardon and Initiation into Hermetics, the classic Hermetic training manual. We have both worked IIH so you get to hear our thoughts from a practical view.

In this episode QB details her medical update with IIH. Talks on medications and its side effects. She also reviews THC/CBD oil, Kingpen.

Shownotes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re tackling an incredibly important topic - evaluation and management of life threatening headaches in the Emergency Department. Nachi: Fear not, this will not simply be “who needs a head CT episode”; we’ll cover much more than that. Listen closely as this is an important topic, with huge consequences for mismanagement. Jeff: Absolutely. As some quick background - headaches account for 3% of all ED visits in the US, with 90% being benign primary headaches and less than 10% being secondary to other causes like vascular, infectious, or traumatic etiologies. It’s within these later 10% that we are looking for the red flag signs to identify the potentially life-threatening headaches. Nachi: And to do so, Dr. David Zodda and Dr. Amit Gupta, PD and APD at Hackensack University Medical and Trauma Center, and their colleague Dr. Gabrielle Procopio, a PharmD, have done a fantastic job parsing through the literature, which included over 500 abstracts, 89 full text articles, guidelines from ACEP and the American Academy of Neurology, as well as canadian and european neurology guidelines, to summarize the best evidence based recommendations for you all. Jeff: We would be remiss to not also mention Dr. Mert Erogul of Maimonides Medical Center and Dr. Steven Godwin, Chair of Emergency Medicine at the University of Florida College of Medicine. Nachi: Alright, so let’s get started with some definitions and pathophysiology. The international classification of headache disorders 3, or ICHD-3, classifies headaches into primary, secondary, and cranial neuropathies. Jeff: Primary headache disorders include migraine, tension, and cluster headaches. Secondary headaches include those secondary to vascular disorders, traumatic disorders, and disorders in hemostasis. These are the potentially life threatening headaches that can have a mortality has high as 50%. Nachi: And the final category includes cranial neuropathies, such as trigeminal neuralgia. Jeff: And I think we can safely say that that wraps up our discussion in this episode on cranial neuropathies, moving on…. Nachi: Headaches result from traction to or irritation of the meninges and blood vessels, which are the only innervated central nervous system structures. Activation of specific nerve ganglion complexes by neuropeptides like -- substance P and calcitonin gene-related peptide -- are thought to contribute to head pain. Jeff: It is important to note that all headache pain shares common pain pathways, thus response to pain medications does not exclude potential life threatening secondary causes of headache. This led to the ACEP guideline which states just that.. Nachi: I feel like that deserves ding sound as it's a critically important point. To repeat, just because a pain medication relieves a headache, that does not exclude dangerous secondary causes! Jeff: And what are the life threatening headaches? Life-threatening headaches include subarachnoid hemorrhage, cervical Artery Dissection, which includes both vertebral Artery Dissection and carotid artery dissection, cerebral Venous Thrombosis, idiopathic intracranial hypertension, giant cell arteritis, and posterior reversible encephalopathy syndrome, or PRES. Nachi: Slow down for a second and let’s not skip over your favorite section.. Let’s talk pre hospital care for headache patients. Jeff: Good call! Pre-hospital care is fairly straightforward and includes a primary survey, conducting a focused neurologic exam, and assessing for red flag signs, which include focal neurologic deficits, sudden onset headache, new headache in those over 50, neck pain or stiffness, changes in visual Acuity, fever or immunocompromised State, history of malignancy, pregnancy or postpartum status, syncope, and seizure. That’s quite a list. For a visual reference, see Table 3 in the print issue. Nachi: And patients with neurologic deficits or severe sudden-onset headaches, should be transported immediately to the nearest available stroke center. Tylenol should be offered for pain management. Avoid opioids and nsaids. Jeff: Upon arrival to the emergency department, history and physical should include your standard vitals, testing neurologic function, cranial nerve testing, head and neck exam, as well as a fundoscopic exam. As was the case for your pre-hospital colleagues, you should also assess for red flag signs for life-threatening headaches. Check out tables 2, 3, and 4 for more details here. Nachi: With respect to Vital Signs, in the setting of an acute headache, severe hypertension should prompt a search for signs of end-organ damage such as hypertensive encephalopathy, intracranial Hemorrhage, PRES, and preeclampsia in pregnant women. Additionally, fever, and especially fever and neck stiffness, should raise concern for CNS infection. Jeff: For your neurologic examination, make sure to include assessments of motor strength, coordination, reflexes, sensory function, and gait. Don't forget that lesions involving the anterior circulation, such as dysarthria, cognitive impairment, and Horner syndrome may be indicative of a carotid artery dissection, whereas dizziness, vision changes, and limb weakness may be due to a vertebral Artery Dissection. Nachi: And for cranial nerve testing - pay particular attention to cranial nerves 2, 3 and 6. For cranial nerve 2 - look out for an afferent pupillary defect, or a marcus-gunn pupil, which is seen in optic neuritis, giant cell artertitis, and central retinal artery occlusion. For CN3, oculomotor nerve palsies raise concern for a posterior communicating aneurysm and SAH. And lastly, CN6 palsies, which often presents with diplopia on lateral gaze , are often seen with intracranial idiopathic hypertension and cerebral venous thrombosis, in addition to impaired visual acuity, visual field defects, and tunnel vision. Jeff: For the head and neck exam, remember that a partial horner syndrome, with miosis and ptosis without anhidrosis, may be indicative of a cervical artery dissection. Unfortunately, if the patient presents acutely, their only complaint may be pain, as the neurologic sequelae may take days to develop. Nachi: Additionally, with respect to the head and neck exam, evaluate the patient for tenderness and beading along the temporal artery. Jeff: One review noted that temporal artery beading actually had the highest likelihood ratio for GCA, 4.6, whereas temporal artery tenderness only had a LR of 2.6 Nachi: And the last physical exam maneuver you should ideally perform is a fundoscopic exam for papilledema, which is often seen in IIH, malignant hypertension, and CVT. Jeff: Perfect so that rounds out the physical, next we have diagnostic studies. Most importantly, routine lab testing is typically of low utility in aiding in the diagnosis of headache. Nachi: Even ESR and CRP in the setting of possible giant cell arteritis have poor sensitivity and specificity to diagnose it. So even if the ESR and CRP are negative, if the suspicion for GCA is high enough, it should be treated and you should get a biopsy. Jeff: Do consider adding on a venous or arterial carboxyhemoglobin in the right clinical scenario, as CO poisoning represents an important cause of headache you wouldn’t want to miss. This is especially important at this time of year when heating systems are working overtime here in the states. Nachi: And hopefully you have a co-oximeter, so you can even check this non-invasively. Jeff: Interestingly, there may be a unique role for a d-dimer here as well. Several small studies have used the d-dimer to risk stratify patients with possible CVT. In one study a d-dimer level < 500 mcg/L had a 97% sensitivity and a negative predictive value of 99% - not bad! Nachi: Pretty impressive performance characteristics. I think that about wraps up lab work. Let’s talk radiology. Jeff: Though low yield, CT utilization is estimated at 2.5-10% of non-traumatic headaches. A non-con CT should be reserved for those with suspicion for an intracranial hemorrhage, while a contrast CT would be required in those in whom there is concern for an infectious process or space occupying lesion. Nachi: CT angio or MRI should be used in cases of possible cervical artery dissection. MRI also is the neuroimaging of choice for PRES, which is more sensitive for cerebral edema than CT. Jeff: Similarly, MRV is recommended in those with a concerning story for CVT. Nachi: To help guide your emergent neuroimaging utilization, ACEP suggests imaging in those with headache and an abnormal finding on neuro exam, those with new and sudden-onset severe headache, HIV positive patients with new headache, and those over 50 with a new headache. Jeff: With that in mind, let’s dive a bit deeper into the use of CT for SAH, a topic which doesn’t get a ding sound, but is certainly critically important. Recent literature have found that a CT within 6 hours of symptom onset has a sensitivity and specificity and negative predictive value of 100%. In addition, one 2016 study demonstrated a LR of 0.01 in those with a negative HCT within 6 hours. These are really important results because that means SAH is essentially ruled out with a negative study. Nachi: Unfortunately, the 2008 ACEP guideline and 2012 AHA guidelines still recommend a lumbar puncture in those being worked up for SAH. Luckily the ACEP guideline is currently being revised so your decision to forego the LP with a negative HCT in the first 6 hours will likely also be backed by ACEP in the near future. Jeff: That’s a nice transition into our next test - the LP. Since LP carries a risk of herniation, in those with signs of increased ICP, make sure to get appropriate neuroimaging before attempting the puncture. In those without signs of increased ICP, no imaging is necessary. Nachi: While the position in which the LP is performed doesn’t matter as much when ruling out infection or SAH, in those with suspected IIH, make sure to obtain an opening pressure with the patient lying in the lateral decubitus position. An opening pressure of greater than 25 is often seen in IIH. Jeff: And the LP in the setting of IIH is not only diagnostic but also potentially therapeutic, as the removal of 1 ml of CSF can lower the pressure by 1 cm of H20 and potentially relieve the patient’s symptoms. Nachi: Always rewarding to diagnose and treat simultaneously... Jeff: Absolutely. But back to the LP for SAH for a second or two. When evaluating for a subarachnoid hemorrhage, you’ll often note an opening pressure of greater than 20 with persistent RBC in all tubes. Nachi: While there are no RBC cutoffs, one study found no patients with a SAH with less than 100 RBC in the final tube. In contrast, greater than 10,000 RBC increased the odds by a factor of 6. In addition, one 2015 study found that patients without xanthrochromia and less than 2000 RBC were effectively ruled out of having a SAH with a combined sensitivity of 100% Jeff: Lots of 100% sensitivities and specificities being thrown around today, which is definitely not the norm. No complaints here, I’ll take it. Anyway, the last test to discuss is our good friend the ultrasound, specifically the ocular ultrasound. Nachi: Examining the optic nerve sheath 3 mm posterior to the globe, an optic nerve sheath diameter of 5 mm or greater is predictive of an ICP greater than 20. Jeff: Keep in mind that this may expedite the work up, though a normal diameter does not rule out increased ICP, so a head CT may still be indicated. Nachi: Alright, so we’ve talked a lot about testing, both lab and imaging, and we’ve mentioned a bunch of pathologies, but let’s spend a few minutes going over the specifics of each. Jeff: Let’s start with SAH. SAH account for 1% of all headache visits to the ED. Most nontraumatic SAH are caused by aneurysm rupture. A missed diagnosis of SAH can have a case-fatality rate as high as 50% Nachi: Although 75% of SAH patients report an abrupt onset, objective neck stiffness has the highest likelihood ratio of 6.6. Other important features include LOC, neurologic deficit, subjective neck stiffness, photophobia, and onset during exertion or intercourse. Jeff: Additionally, approximately 20% of patients with a SAH have warning signs of a sentinel bleed including headaches, cranial nerve palsies, neck pain, or nausea and vomiting. Nachi: In order to aid you in diagnosing a SAH, you should consider the ottawa SAH Rule which has a 100% sensitivity and a 15% specificity. To use this rule you must be between 15 and 40 with a GCS of 15 and present with a headache with maximal intensity within 1 hour of onset. If you meet those inclusion criteria, and you have no neurologic deficits, no neck pain or stiffness, no witnessed LOC, no onset during exertion, no limitation of neck flexion, and no thunderclap onset, you can essentially rule out a SAH. Jeff: While the ottawa SAH rule has been prospectively validated, know that this study has been challenged for its interobserver variability, but in any case it still provides helpful red flags to consider. If your patient is found to have a SAH, a CT angiogram and neurosurgical consultation should be considered immediately. Nachi: In addition to monitoring ABCs, early care involves the administration of analgesics and anti-emetics. Also consider elevating the head of the bed to 30 deg, which may also improve venous drainage and decrease ICP. Jeff: In terms of BP management, guidelines from the american stroke association recommend targeting a SBP of 160 with a titratable agent like nicardipine or clevidipine. Nachi: In addition, nimodipine, 60 mg q4h, should be given to those with aneurysmal SAH to improve outcomes. Jeff: and any role for anti-epileptics? Nachi: That’s controversial and the authors state it may be considered in the immediate post-hemorrhagic period and should be limited to a 3-7 day course with longer courses required in special populations. Jeff: The next pathology to discuss is cervical artery dissections, which account for 2% of all strokes and nearly 20% of strokes in those 50 and under. cervical artery dissections are most commonly due to trauma, but can occur spontaneously. Nachi: Risk factors include Ehlers-Danlos syndrome, osteogenesis imperfecta, and Marfan syndrome. Jeff: Regardless of the etiology, the management of cervical artery dissections is primarily medical with IV heparin followed by warfarin or a direct oral anticoagulant in those with extracranial dissections, and antiplatelet therapy like aspirin or clopidogrel in those with intracranial dissections. Nachi: Thanks to the CADISP study, we know there is no difference in mortality or neurologic outcome when choosing between antiplatelet therapy and anticoagulation. Jeff: Next we have cerebral venous thrombosis. This typically presents with a gradual onset headache. Though it can happen to anybody, cerebral venous thrombosis typically results from thrombotic disease. Nachi: Important risk factors include oral contraceptive use, pregnancy and postpartum states, Factor V Leiden deficiency, and lupus. Jeff: Treatment for CVT is controversial due to a high risk of hemorrhage and hemorrhagic transformation. According to the best available evidence, anticoagulation is the standard therapy with full dose anticoagulation of low-molecular weight heparin or heparin as a bridge to warfarin. Nachi: Yeah, it’s really a tough spot to be in as one third end up having some form of hemorrhage too…. Jeff: Perhaps yet another good place for shared decision making? Nachi: Honestly, it’s a good thought, but anticoagulation is the guideline recommendation, so I think that is likely the best route in this case. Jeff: Great point. Next we have idiopathic intracranial hypertension. This is typically associated with obese women of childbearing age. It may also be due to hypervitaminosis A from excessive dietary intake and even drugs like the retinoids used in treating dermatologic conditions and cancers. Nachi: idiopathic intracranial hypertension can be diagnosed by the modified dandy criteria which are found in table 8 on page 11. Let’s just run through the criteria. Jeff: The modified Dandy criteria for idiopathic intracranial hypertension include: signs and symptoms of increased ICP, no other neurologic abnormalities or altered level of consciousness, ICP > 20 on LP with normal CSF composition, neuroimaging without another etiology for intracranial hypertension, and lastly no other identified cause of intracranial hypertension. Nachi: And as we mentioned a few minutes ago, an LP can be both diagnostic and therapeutic, though the relief is likely temporary Jeff: For more permanent treatment, weight loss is the key. Acetazolamide, 250 mg to 500 BID is the first line pharmacotherapy. Combined with weight loss, acetazolamide and a low sodium diet has been shown to improve visual field function. Nachi: And if this fails, topiramate, furosemide, and in the worst case surgical options like CSF shunting, venous sinus stenting, and optic sheath fenestration are all options. Jeff: I imagine taking a diuretic for a headache could be a real hindrance on quality of life, though I suppose it’s better than risking vision loss or having a significant neurosurgery. Nachi: Agreed. Next we have giant cell arteritis. GCA is rare, with a prevalence of

In collaboration with many different specialists, professions and patient representatives, Mollan et al (2018) have developed the first ever guidelines for the investigation and management of idiopathic intracranial hypertension (IIH). Senior author, Dr Alexandra Sinclair (University of Birmingham) discusses these with the JNNP podcast editor, Elizabeth Highton. Read the full guidelines here: https://jnnp.bmj.com/content/89/10/1088 Access the Practical Neurology infographic summary here: https://pn.bmj.com/content/early/2018/08/28/practneurol-2018-002009

We are pleased to be discussing the results of the IIHTT, the use if acetazolamide and the role of weight loss in the management of IIH with world expert, Mr Tim Matthews. Mr Tim Matthews is the Clinical Lead for Ophthalmology and Neuro-ophthalmology at University Hospital Birmingham. He is passionate about teaching and has contributed greatly to neuro-ophthalmology in Australia over many years.

Kerstin Eichmann and Moritz Jungmann are a part of the Innogy Innovation Hub which is the corporate venture capital arm of Innogy.
The Innogy Innovation Hub and Innogy Ventures are funded by Innogy SE, a leading German energy company with revenue of around €43 billion (2017), more than 42,000 employees and activities in 16 countries across Europe. Innogy Innovation Hub, is looking to drive game-changing ideas that can revolutionise an existing business model or industry permanently. The key focus areas of IIH include: ‘Machine Economy', ‘Smart & Connected', ‘Disruptive Digital' and ‘Cyber Ventures'.  In our conversation, we talked about the difference between corporate venture capital and regular VC funds, the emerging machine economy and what it means for business, as well as how startups are integrated into the activities of the sponsor company behind the CVC. More of the topics we cover in the interview are: How does corporate venture capital differ from typical venture capital How does your activity with start-ups tie into the activity of Innogy as a whole Machine economy and how will it change business as we know it Why should start-up chose a CVC over a regular VC investment Areas of Focus: ‘Machine Economy', ‘Smart & Connected', ‘Disruptive Digital' and ‘Cyber Ventures' How to start a career in corporate venture capital and what skills to acquire As always, make sure you share the podcast with anyone you think might benefit from the information. And don't forget to leave us a 5-Star review on iTunes! Find out more at https://www.thewallstreetlab.com/ Luke, Leo & Andy

Tonight's program will be about a rare problem that causes spinal cerebral fluids to leak from the brain. Very rare!! A long road to healing. CSF leak, IIH and Pseudo Tumor are the correct terms. Donna Duff is my guest and she has been dealing with this more an a year. It truly takescourag journey with a CSF leak, IIH and Pseudo Tumor

Tonight's program will be about a rare problem that causes spinal cerebral fluids to leak from the brain. Very rare!! A long road to healing. CSF leak, IIH and Pseudo Tumor are the correct terms. Donna Duff is my guest and she has been dealing with this more an a year. It truly takescourag journey with a CSF leak, IIH and Pseudo Tumor

This week we talk about the subacute headache and the dangerous, can't miss diagnoses of cerebral venous thrombosis and IIH https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_127_0_Final_Cut.m4a Download Leave a Comment Tags: Cerebral Venous Sinus Thrombosis, Headache, Neurology Show Notes Take Home Points Keep IIH and CVST on the differential for patient's coming in with a subacute headache, particularly if they have visual or neuro symptoms. Consider an ocular ultrasound! It's quick, shockingly easy to do, and can help point you toward a diagnosis you may have otherwise overlooked.  I have made it my practice now to include a quick look in the physical exam of my patients with a concerning sounding headache or a headache with neurologic symptoms.  Consider IIH particularly in an overweight female of child bearing age with a subacute headache, but remember patients outside that demographic can have IIH as well. Consider CVST in a patient with a thrombophilic process like cancer, pregnancy or the use of OCPs or androgens or in a patient with a recent facial infection like sinusitis or cellulitis. Read More WikEM: Idiopathic Intracra...

This week we talk about the subacute headache and the dangerous, can't miss diagnoses of cerebral venous thrombosis and IIH https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_127_0_Final_Cut.m4a Download Leave a Comment Tags: Cerebral Venous Sinus Thrombosis, Headache, Neurology Show Notes Take Home Points Keep IIH and CVST on the differential for patient’s coming in with a subacute headache, particularly if they have visual or neuro symptoms. Consider an ocular ultrasound! It’s quick, shockingly easy to do, and can help point you toward a diagnosis you may have otherwise overlooked.  I have made it my practice now to include a quick look in the physical exam of my patients with a concerning sounding headache or a headache with neurologic symptoms.  Consider IIH particularly in an overweight female of child bearing age with a subacute headache, but remember patients outside that demographic can have IIH as well. Consider CVST in a patient with a thrombophilic process like cancer, pregnancy or the use of OCPs or androgens or in a patient with a recent facial infection like sinusitis or cellulitis. Read More WikEM: Idiopathic Intracranial Hypertensi...

Idiopathic intracranial hypertension, also known as the pseudotumor cerebri syndrome, is characterized by elevated intracranial pressure with clinical features of headaches, vision impairment, and occasionally cranial nerve palsies in the absence of a structural lesion on neuroimaging. But that doesn't mean the neuroimaging has to be normal. See what Dr. Anita Kohli has to say about the radiographic correlates of IIH, their relevance, and their prognostic utility in this week's episode. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. REFERENCES 1. Friedman DI, Liu GT and Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81:1159-65. 2. Bidot S and Bruce BB. Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension. Semin Neurol. 2015;35:527-38. 3. Agid R, Farb RI, Willinsky RA, Mikulis DJ and Tomlinson G. Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology. 2006;48:521-7. 4. Bidot S, Saindane AM, Peragallo JH, Bruce BB, Newman NJ and Biousse V. Brain Imaging in Idiopathic Intracranial Hypertension. J Neuroophthalmol. 2015;35:400-11. 5. Bidot S, Clough L, Saindane AM, Newman NJ, Biousse V and Bruce BB. The Optic Canal Size Is Associated With the Severity of Papilledema and Poor Visual Function in Idiopathic Intracranial Hypertension. J Neuroophthalmol. 2016;36:120-5. 6. Zagardo MT, Cail WS, Kelman SE and Rothman MI. Reversible empty sella in idiopathic intracranial hypertension: an indicator of successful therapy? AJNR American journal of neuroradiology. 1996;17:1953-6.

Gene transcription is a fundamental process of the living cell. Eukaryotic transcription of messenger RNA requires the regulated recruitment of the conserved transcribing enzyme RNA polymerase (Pol) II to the gene promoter. The most heavily regulated step is transcription initiation that involves the ordered assembly of Pol II, the general transcription factors (TF) -IIA, -IIB, -IID, -IIF, -IIE, -IIH and the co-activator Mediator complex. Mediator communicates between transcription regulators and Pol II, and is associated with human disease. Mediator from the yeast Saccharomyces cerevisiae (Sc) has a molecular mass of 1.4 megadaltons and contains 25-subunits that constitute a head, middle, tail and kinase module. The core of Mediator contains the head and middle modules that are essential for viability in Sc, and directly contact Pol II. Mediator co-operates with TFIIH, to assist assembly and stabilization of the transcription initiation complex and stimulate TFIIH kinase activity. Because of the large size and complexity of Mediator and the initiation machinery, the underlying mechanism remains poorly understood. In this work we studied the structure and function of Mediator head and middle modules, the structure of the reconstituted Pol II-core Mediator transcription initiation complex, and reveal mechanisms of transcription regulation. We report the crystal structure of the 6-subunit Schizosaccharomyces pombe Mediator head module at 3.4 Å resolution. The structure resembles the head of a crocodile and reveals eight elements that are part of three domains named neck, fixed jaw and movable jaw. The neck contains a spine, shoulder, arm and finger. The arm and essential shoulder elements contact the remainder of Mediator and Pol II. The head module jaws and central joint, important for transcription, also interact with Mediator and Pol II. The Sp head module structure is conserved and revises a 4.3 Å model of the Sc head module, explains known mutations, and provides an atomic model for one half of core Mediator. We further propose a model of the Mediator middle module based on protein crosslinking and mass spectrometry. To determine how Mediator regulates initiation, we prepared recombinant Sc core Mediator by co-expression of its 15 subunits in bacteria. Core Mediator is active in transcription assays and bound an in vitro reconstituted core initially transcribing complex (cITC) that contains Pol II, the general factors TFIIB, TBP, TFIIF, and promoter DNA. We determined the cryo-electron microscopy structure of the initially transcribing core initiation complex at 7.8 Å resolution. The structure reveals the arrangement of DNA, TBP, TFIIB, and TFIIF on the Pol II surface, the path of the complete DNA template strand and three TFIIF elements. The ‘charged helix’ and ‘arm’ of TFIIF subunit Tfg1, reach into the Pol II cleft and may stabilize open DNA. The linker region of TFIIF subunit Tfg2 extends between Pol II protrusion and TFIIB, and may stabilize TFIIB. The structure agrees with its human counterpart, and suggests a conserved architecture of the core initiation complex. Finally, we determined the cryo-electron microscopy architecture of the cITC-core Mediator complex at 9.7 Å resolution. Core Mediator binds Pol II at the Rpb4/Rbp7 stalk close to the carboxy-terminal domain (CTD). The Mediator head module contacts the Pol II dock and TFIIB ribbon and stabilizes the initiation complex. The Mediator middle module ‘plank’ domain touches the Pol II foot and may control polymerase conformation allosterically. The Med14 subunit bridges head and middle modules with a ‘beam’, and connects to the tail module that binds transcription activators located on upstream DNA. The ‘arm’ and ‘hook’ domains of core Mediator form part of a ‘cradle’ that may position CTD and the TFIIH kinase to stimulate Pol II phosphorylation. Taken together, our results provide a structural framework to unravel the role of Mediator in transcription initiation and determine mechanisms of gene regulation.

In this podcast, Dr Deborah Friedman expands upon themes raised in the recently published paper entitled “The Idiopathic Intracranial Hypertension Treatment Trial: Design Considerations and Methods”. The IIHTT is the first randomized, double-masked placebo-controlled trial to study the effectiveness of medical treatment for patients with IIH.

This podcast gives learners an approach to headaches in pediatric patients. The podcast gives an overview of headache classification and the pathophysiology of headache. Learners are given key pointers regarding the history, physical exam and investigations. The diagnosis and management of specific primary and secondary headaches is then discussed. This episode was written by Dr. John Neilson, a pediatric neurology resident at the University of Alberta. It was reviewed by Dr. Melanie Lewis, a general pediatrician at the University of Alberta. These podcasts are designed to give medical students an overview of key topics in pediatrics. The audio versions are accessible on iTunes. You can find more great pediatrics content at www.pedscases.com.   Related Content: Case: Acute Head Injury Cases Case: Abusive Head Trauma Cases Case: Unresponsive 2 Month Old Baby Podcast: Approach to Pediatric Head Injury Podcast: Meningitis