Podcasts about neurologic

Elena presents with significant muscle atrophy in the lower extremities, fasciculations of the gastrocnemius, and a 1+ Achilles tendon reflex. During gait, the patient demonstrates a "slapping" foot strike. These signs are MOST indicative of: A) A lesion in the corticospinal tractB) An injury to the cerebellumC) Compression of the posterior columns D) A lesion in the anterior horn cellsJoin the FREE Facebook Group: www.nptegroup.com

Neurologic care during pregnancy and menopause requires careful attention to the dynamic interplay between hormonal transitions, evolving evidence on diagnostic and treatment safety, and the lifelong risks associated with neurologic complications of pregnancy. In this episode, Katie Grouse, MD, FAAN, speaks with Sara C. LaHue, MD, author of the article "Neurologic Complications of Pregnancy and Menopause" in the Continuum® February 2026 Neurology of Systemic Disease issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California, San Francisco in San Francisco, California. Dr. LaHue is an assistant professor of neurology for the Weill Institute for Neurosciences in the Department of Neurology at the University of California, San Francisco School of Medicine in San Francisco, California Additional Resources Read the article: Neurologic Complications of Pregnancy and Menopause 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 Full episode transcript available here Dr Grouse: Despite the high prevalence of neurologic conditions in women, critical gaps remain in training, research, and clinical guidelines on sex and gender specific considerations across the lifespan. Today, I have the opportunity to speak with an expert on neurologic complications of pregnancy and menopause and coauthor of the and women's neurology curriculum core competencies, Dr Sara LaHue about the latest issue of Continuum on neurology of systemic disease. Dr Jones: This is Dr 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 Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Sara LaHue about her article, Neurologic Complications of Pregnancy and Menopause, which appears in the February 2026 Continuum issue on Neurology of Systemic Disease. Welcome to the podcast and please tell us more about yourself. Dr LaHue: Well, thanks so much for having me. I'm really excited to talk about this topic. So, I'm Sara LaHue. I'm a neurologist at UCSF, assistant professor of neurology, and a neurohospitalist. So much of my role is taking care of people who are coming into the hospital with urgent and emergent neurologic conditions. And so that's very much a framing that I come to this chapter with. Dr Grouse: I just want to start by congratulating you on your article, which is such a phenomenal compendium of important neurologic issues related to pregnancy and menopause, which I think I really needed and a lot of us really need and was missing, I think, in all of the literature out there. This article will be such an important clinical resource. I know for me, and I'm sure for many of our listeners, this may be a difficult question to answer because of how comprehensive the article is. But what do you hope will be the main takeaway for those who read your article? Dr LaHue: So, I really hope that listeners walk away with understanding that pregnancy and menopause are not contraindications to providing excellent neurologic care. I think too often we default to withholding treatment, pseudo-assumed risk, rather than actual evidence of harm. And so, I think that the key message here is that protecting maternal health is protecting fetal health, and that under-treating neurologic conditions during pregnancy can harm both mother and baby. Dr Grouse: You did say specifically in your article that I thought it was so important that presumption of harm from medications during pregnancy, due to lack of evidence rather than evidence of harm, was something that we really had to be aware of, of that bias. And how do you recommend neurologists listening to this podcast approach situations where diagnostic or management strategies become less certain due to safety considerations in pregnancy? Dr LaHue: Yeah, that's such an important question. I really frame it as a risk-benefit calculation with a patient, and I'm very transparent about what we know and what we don't know. And I emphasize that untreated disease may also impact fetal health. I use resources like LactMed and pregnancy registries that can help provide some of the more latest data. And then when evidence is limited, I document our discussion thoroughly, and I'll often involve maternal-fetal medicine colleagues for their multidisciplinary input. So, the goal is really to have an informed, shared decision-making process rather than a reflexive avoidance of all treatments. Dr Grouse: I think that's really important to reiterate, and I think something that we're all I think working on as we try to manage these difficult situations and conditions. Now, I want to switch gears a little bit and ask. Your article was so comprehensive and so helpful, but what isn't in the article that you wanted to put in? Dr LaHue: There was a fair amount that I ended up having to take out. So, this is a question that's near and dear to my heart. So, I would have liked to include more on the neurodevelopmental outcomes for children who are exposed to various neurologic medications in utero. And I also wanted to discuss more about transgender and non-binary individuals who are experiencing pregnancy and menopause, as they're often underrepresented in research. They've faced unique challenges accessing care. Dr Grouse: Now, I was really struck by one statistic in your article, specifically that intimate partner violence is a leading cause of head injury during pregnancy, and that actually homicide is a leading cause of death during pregnancy in the postpartum period in the US, which was absolutely a surprising statistic to me. What does this mean for our listeners caring for pregnant patients with concussions and head injuries? What should we be doing differently? Dr LaHue: This is also something that really struck me when I first encountered it. I think that the statistics should really fundamentally change how we approach head injuries in pregnant patients. I think we need to screen everyone routinely and privately for violence in the home and in the relationships, and to document injuries very carefully. But we also need to be prepared if someone does screen positive. And so, it's important to be familiar with what's available in terms of resources within your community, where you work, and also to remember that that strangulation in particular is something that can cause dissection and stroke. And so, to maintain a high index of suspicion for any kind of vascular injury in these cases. So not just thinking about head injury itself, but also thinking about complications of strangulation as well. Dr Grouse: Really a great reminder of the role that we can play in our own careers and our own clinical settings when we see cases like this. So, I really appreciate that this point was made, and I hope this will change people's practice. Now switching gears to stroke in pregnancy. Could you walk us through your evaluation and management of a patient who comes in with acute stroke in the peripartum period? Dr LaHue: This is such an important topic, and I think the first thing I'd like to emphasize is that time is brain. Whether or not you're pregnant. It's important to get whatever imaging modality is going to be fastest. Get the CT or get the MRI as soon as you can. Don't delay for fetal concerns. The radiation risk is minimal compared to missing a treatable, disabling stroke. In terms of treatment, thrombolysis and mechanical thrombectomy should be considered just as in a non-pregnant person, when the benefits outweigh the risks. And so, I think the key is involving obstetrics early for shared decision making, and being very transparent with what treatment options are available for the individual, and to not let pregnancy alone stop you from offering standard stroke therapies. Dr Grouse: Definitely a helpful resource, and I think the resources that you put in specifically around the considerations and differentials in these various populations. Postpartum, while still pregnant during the period of period, I think is all just so helpful and a great review. So, I encourage our listeners to check that out. Now switching over to the topic of menopause. I have to say, I really appreciated your coverage of neurologic issues related to the perimenopause period. What do you think is the biggest debate or controversy in this area? Dr LaHue: I think this has to be our understanding of the use of menopausal hormone therapy. The pendulum, when using menopausal hormone therapy, has really swung dramatically. So, we went from routine use to predominantly avoidance. After the Women's Health Initiative was published in 2002, and now we're finding that we're starting to come more to a middle ground. I think there's still great debate when it comes around timing of initiation, formulation of the different therapies, a route of administration and also the dosing, as well as just including how to individualize therapy for individuals with neurologic conditions. Dr Grouse: Well, going into that a little further, I know I get a lot of questions about the use of hormone therapy as it relates to stroke risk and particularly in higher risk patients such as patients who've had prior strokes, dissections, a history of migraine with aura. And I find it hard to get the answers in the literature that's out there. How are you counseling these patients? Dr LaHue: So, I think this is where discussions around the route of administration and dosing become especially important. And this is where there's emerging literature that I think is helping to guide some of these discussions. So, for higher risk patients, I discuss how low dose transdermal formulations which can bypass hepatic metabolism and reduce clotting risk. These are medications that can appear safer in those higher risk individuals. I think the key is really individualizing the risk-benefit discussion with the patient. For a woman with severe vasomotor symptoms that are affecting sleep and cognition, who had a remote stroke. I think this is a person for whom low dose transdermal patch might be a reasonable option. All of these factors end up being considerations for that shared decision-making. Dr Grouse: Now your article covers another topic that I often get questions about, and that's specifically regarding safety of vaginal delivery for patients with neurologic conditions that are sensitive to increased intracranial pressure. Could you summarize your advice for these types of questions when they come up? Dr LaHue: So broadly speaking, most neurologic conditions don't require C-section delivery. And this is a procedure that, just globally speaking, as has been increasing dramatically. And so, I think that's the key message that really, most neurologic conditions don't require a C-section as a main indication. And really, the indication should be based on obstetric considerations. For most conditions, like controlled idiopathic intracranial hypertension, a vaginal delivery is fine. But for patients with mass effect or obstruction at the foramen magnum, a C-section with general anesthesia, it's probably going to be safer. The transient increase in intracerebral pressure that can come with pushing. It hasn't really been shown to harm patients who have stable, treated neurologic conditions. Dr Grouse: I really appreciated the advice that you given in the article, which was that if generally you feel like this would be a patient who would be safe to get a lumbar puncture, you have a little less concern about vaginal delivery versus those that you feel would not be safe to get a lumbar puncture, that you'd be more leaning towards a C-section. Dr LaHue: Yeah, that's exactly right. Dr Grouse: Now, why do you think we have so many gaps in our understanding of how pregnancy and menopause affect neurologic conditions? Dr LaHue: So, I think it really comes down to a perfect storm of factors. So, in 1977, the USFDA came down with the recommendation, stating that it was best to exclude all women of reproductive potential from both phase one and phase two studies. And this recommendation wasn't reversed until 1993. And there are also concerns around liability and also the fact that pregnancy is a temporary state is something that may falsely minimize the potential for delays. The potential for harms that come with delays in treatment. And I think that the fact of menopause is also historically been dismissed, despite this is something that is affecting half of the population. I think we need systemic change. We need to mandate inclusion in research. We need funding for dedicated studies. We also need to recognize women's health as a core competency and not just a special interest. Dr Grouse: That all sounds like a great roadmap for improving our knowledge. And I really hope we get there. But hearing you talk about it really does give me hope that we can improve how we are understanding and treating these conditions. Now, your article included a really helpful overview of headaches in pregnancy, and that's certainly something I think many of our listeners are very familiar with. We do have a lot of questions around that, and I think there's a lot of areas where we don't really always know what the best thing to do is. I think that your article really gave a lot of great information and a really great framework to think about. It would be wonderful to hear you walk through your approach to evaluation of a patient who was pregnant with a new onset headache. Dr LaHue: You'll see in this chapter that I introduce a mnemonic that's spelled out pericardium as a framework for thinking about headache and pregnancy. And here are the you specifically points to an unusual headache, referring to a new or atypical presentation of headache for the patient. I think this is an important place to start, because one of the initial considerations should be this is a new headache, or is this an old headache? If this is a patient who already has a preexisting diagnosis of migraine or some other primary headache disorder, then it's certainly possible that the headache that they're experiencing during pregnancy is also a continuation of their primary headache disorder. But certainly, our role is to make sure that we're not missing a scary complication, a secondary headache that could be dangerous to the patient. And so, then this is where I also think about, well, where are they in the course of their pregnancy. Is this person currently pregnant or are we in the postpartum period? When someone is after 20 weeks gestation, one of the first things to consider is going to be preeclampsia. And so, it's important in those individuals to check blood pressure, check urine to rule out preeclampsia, as this is always going to be top of mind after 20 weeks. I think it's also important to emphasize that preeclampsia is not just a condition that can occur when someone is pregnant. This is also something that can occur postpartum. One needs to be vigilant for looking out for this complication during both time periods. And then I think for new headaches, I really want to focus on what the timing is and any other red flags. For example, if it's a thunderclap headache and onset, then I might be worried about something like RCBS or cerebral venous sinus thrombosis. If the headache itself is orthostatic and patient may have had an epidural, then I might think about a post-dural puncture headache, which is a, unfortunately very common complication and reason for headache in the postpartum period. I think the key is that most dangerous headaches often will occur late in the third trimester or early postpartum. And I think it's also important to remember that if you need imaging to make the diagnosis, and you should get it. The risks of missing something serious far outweigh concerns that one might have around imaging. And when possible, it's certainly preferred to get an MRI if that's available. Dr Grouse: I really did appreciate articles, overview of the various imaging modalities out there and the overview of risk versus benefits and times where they may or may not be needed. So, yet another very useful piece of information that I think that our listeners will appreciate in your article. Now, I'm curious how did you get interested in this area of neurology? Dr LaHue: So, it really was my interest in both reproductive health and neurology that led me to go to medical school in the first place. I knew early on at the beginning of medical school that I was interested in neurology, but I also was very drawn to obstetrics, and I recognized in medical school and then further on as, as a resident, just how vast the knowledge gaps were. When I was counseling my own patients and I found this to be just a very frequent source of frustration as both a clinician and a researcher, I very much feel an obligation to try to help fill these gaps. And I've also just been very encouraged by an outstanding community of other neurologists that I've been able to meet in this space. It's been a just a wonderful collaborative network that we've been able to grow, both within United States and even more globally, when it comes to other neurologists who are interested in this topic. And I'm just very excited to see the direction that this field is going in. Dr Grouse: Well, we can't wait to learn more as this field develops and more is understood about the right way to approach these types of diagnostics and treatments. So, thank you for all your work in this space. And it's been absolutely fascinating reading your article and talking with you today. Dr LaHue: Well, thank you so much for having me, and I'm just so thrilled that these important topics are going to be part of this issue of Continuum. Dr Grouse: Again, today, I've been interviewing Dr Sara LaHue about her article and Neurologic Complications of Pregnancy and Menopause, which appears in the February 2026 Continuum issue on Neurology of systemic disease. 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 AA and members. You can get to me for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Neurologic emergencies don't wait for the hospital—and neither should neurology education. This episode breaks down a longitudinal EMS curriculum using cases, simulation, and gamification to improve prehospital neurologic assessment. We'll discuss feasibility, knowledge outcomes, and system-level metrics like door-to-needle time and thrombectomy transfers. Does active learning and simulation meaningfully change prehospital neurologic care—or just test scores? And what does “success” really look like for EMS education? Article: Curriculum Innovation: Training the Front Line A Neurologic Emergencies Curriculum Pilot for First Responders https://www.neurology.org/doi/10.1212/NE9.0000000000200286

Neurologic complications of hematologic disorders are frequently encountered in clinical practice and can involve both the central and peripheral nervous systems. Early recognition and appropriate management in collaboration with a hematologist are essential to reduce morbidity and mortality. In this episode, Kait Nevel, MD, speaks with Lauren Patrick, MD, and Mark Terrelonge, MD, MPH, authors of the article "Neurologic Complications of Hematologic Disorders" in the Continuum® February 2026 Neurology of Systemic Disease issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Patrick is an assistant professor of neurology at the University of California, San Francisco, in San Francisco, California. Dr. Terrelonge is an associate professor of neurology at the University of California, San Francisco, in San Francisco, California. Additional Resources Read the article: Neurologic Complications of Hematologic Disorders 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 Full episode transcript available here Dr Nevel: Thick blood, thin blood. These are terms often used by patients and caregivers to describe some of the hematologic disorders that can lead to neurological diseases such as stroke. So, when should we consider a hematologic disorder as a potential cause for neurological conditions, such as stroke or neuropathy. Today I have the opportunity to interview Drs Lauren Patrick and Mark Terrelonge to learn more about neurologic complications of hematologic disorders in their recent article in Continuum. 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 Kate Nevel. Today I'm interviewing Drs Lauren Patrick and Mark Terrelonge about their article on neurologic complications of hematologic disorders. This article appears in the February 2026 Continuum issue on neurology of systemic disease. Welcome to the podcast, and please introduce yourself to the audience. Dr Patrick: Thank you for having us. We're both thrilled to be here. I'm Lauren Patrick, a vascular neurologist and assistant professor at the University of California, San Francisco, and program director for the Vascular Neurology Fellowship here. Dr Terrelonge: And I'm Mark Terrelonge, I'm an associate professor of neurology and neuromuscular medicine here at UCSF and one of the associate program directors for the adult neurology residency. Nice to meet you. Dr Nevel: Nice to meet you both. Really looking forward to getting into your article and learning more. So, to kind of kick us off, I always like to ask what do you think is the most important takeaway from your article for the practicing neurologist? And maybe since there are two of you and I suspect you covered slightly different aspects of this article, maybe you could give us two most important takeaways. Dr Patrick: Sure. I think the biggest takeaway is to keep hematologic disorders on the differential when evaluating patients with neurologic symptoms. Conditions like sickle cell disease, myeloproliferative neoplasms, or plasma cell dyscrasias and paraproteinemia can cause strokes or peripheral neuropathies, and many have specific and targetable treatments. The early recognition and collaboration with our hematology colleagues can truly change patient outcomes, whether that's by initiating cytoreductive therapy, managing thrombocytopenia, or optimizing antithrombotic therapy. Dr Nevel: Great. So, this is a really big and diverse topic. As always, I'm going to urge our listeners to read the article because there is a lot of really good stuff in your article that we just don't have time to get into during this interview today. But you cover a lot of different hematological disorders and how they can cause neurological complications. One of the major neurological complications of hematological disorders is cerebral vascular events. So, I'm hoping, Warren, that you can walk us through a little bit. When should we consider workup of potential hematologic disorder as a cause when we see a patient with ischemic stroke, because certainly not all patients with ischemic stroke should be getting a broad hematological disorder work up. So how can we kind of identify early on that there might be something else at play? Dr Patrick: Absolutely, great question. So, in many cases, the underlying hematologic disorder is already known, such as sickle cell disease or polycythemia vera. But sometimes stroke is the initial presentation or manifestation of the disease. So red flags can include young age, recurrent cryptogenic strokes or thrombosis, and unusual locations like the cerebral venous system. Laboratory clues such as unexplained erythrocytosis, thrombocytosis, thrombocytopenia, or hemolytic anemia should raise suspicion for an occult hematologic disorder. In the setting of acute illness, immune-mediated or heparin-induced thrombocytopenia or thrombotic microangiopathies should be suspected in patients that have hemorrhagic and or thrombotic complications, particularly when relevant lab disturbances are present. Acquired thrombophilia such as anti-phospholipid antibody syndrome should be considered in young patients with autoimmune disease, prior venous or arterial thrombotic complications, or pregnancy morbidity. Now, these are rare causes overall, but they're important to catch because the management can differ dramatically from our typical stroke care. Dr Nevel: Great. And what are some of the most common inherited or acquired thrombophilias and when should we be sending these labs? Dr Patrick: The hematologic causes really account for small minority of arterial strokes approximately one to two percent, but among those, sickle cell disease, anti-phospholipid antibody syndrome and the myeloproliferative neoplasms are the most common. Timing of testing is key. So, the genetic thrombophilia panels can be drawn at presentation, but lab values such as protein C, protein S, and antithrombin levels may be falsely low during acute thrombosis, so they're often repeated weeks later. Similarly, for anti-phospholipid antibody testing that should be done at presentation and when positive, confirmed at twelve weeks, since transient positivity can occur with affections or acute events. So, in patients that are already anticoagulated for anti-phospholipid antibody syndrome, testing becomes particularly tricky, especially with lupus anticoagulant assays. Some results need to be interpreted carefully or repeated when feasible. The main message is to collaborate early with our hematology colleagues to guide the timing and interpretation of these studies. Dr Nevel: Yeah, wonderful. Thank you. I'll ask some similar questions about neuropathy. So when should we consider an underlying hematologic disorder as being the cause for someone's neuropathy? Dr Terrelonge: So, luckily for a neurologist, then serum protein electrophoresis or an SPEP is already a part of the first pass evaluation for even the most common neuropathies we see, technically already considered every time we do an evaluation. However, we do know that most neuropathies progress very slowly and don't really lead to significant limitations in patient activities of daily living. And for those, the initial workup step, you may not need to do any additional search for any hematologic diseases after that first step. Within patients who start to have more unusual features with their neuropathy, including a rapid progression, early proximal weakness, significant and extremely painful neuropathies, significant ataxia, or new tremor or anything that's kind of outside of the garden variety neuropathy, then you should start to think about a hematologic cause. Additionally, if a patient already has a known hematologic malignancy or process before their neuropathy, there should be some form of assessment to see through exam or electrodiagnostically if the two are correlated. I do have to add one caveat, though, and that's just because someone has a hematologic malignancy or a paraprotein seen in their blood, their neuropathy and the neurologic syndrome don't necessarily have to be causally related. So, we have to do some additional testing to determine if the patient's presentation of the paraprotein are actually linked. Dr Nevel: Can you walk us through a little bit how we determine if they're associated or just coincidental? Dr Terrelonge: Yeah. So, for some of the proteins, there's a specific phenotype that will come with the specific protein. For example, an anti MAG proteinopathies or MAG standing for a myelin associated glycoprotein, it usually leads to a distal sensor and motor polyneuropathy where the most distal portions of nerves are affected. So, in that case, people might notice that they have numbness and weakness in their toes and their fingers, and it doesn't follow that typical length dependent pattern. So, in that case, if you have the anti mag neuropathy and the electrodiagnostic signature of an anti mag neuropathy along with the symptoms, you're more likely to think that the two are related then if not. Dr Nevel: Great. Thank you. And I was hoping you could speak a little bit more about amyloidosis just because I think that that's one that can be really tricky to diagnose. And I see patients, you know, have sometimes more drawn out evaluations or see multiple providers before a diagnosis is reached. So, can you speak a little bit more to how we diagnose amyloidosis in relationship to neuropathy or other neurological conditions and when we should push for more invasive testing like a nerve biopsy? Dr Terrelonge: So, amyloidosis certainly is a tricky diagnosis. I've been tricked by it and I think most of my neuromuscular colleagues have probably been tricked by it at least once. It's a hard diagnosis to make is it usually requires a pretty high index of suspicion, and also requires a tissue diagnosis to cinch. There're some patients who will come in with a prior history of amyloidosis and they're a little bit easier to figure out if the neuropathy is related. Maybe it's started in their heart or their kidney first and then you can just see if the type of amyloid they have usually deposits in nerve, and that may be enough. But if there's any diagnostic uncertainty, you could go forward with tissue biopsy. But it's patients in which the neuropathy is the first symptom that amyloidosis can be especially tricky to diagnose. It's a primarily light chain disease. So, if you do only an SPEP as a part of your initial neuropathy evaluation, you could miss it. But usually, the patients will have either a severely painful neuropathy, early autonomic dysfunction, or really prominent bilateral carpal tunnel syndrome. So, if they have any of those, usually we'll add in an amyloid workup as a part of that of the rest of the workup, which would include both light chain evaluations to see if there's any increase in Lambda or Kappa light chains and then also biopsy. Biopsy can be of the skin or fat pad first, which have reasonable sensitivity for picking up disease, but they're not necessarily a hundred percent. So if the suspicion remains high in those cases, a nerve biopsy should be considered. And the reason why this is important is that the chemotherapeutic agents that we have now can actually help arrest a lot of these diseases and stop further organ involvement. So, if you think about it, it is important to keep pushing and looking until you find it. Dr Nevel: Thank you so much for that. And a follow up question to that, once patients are started on appropriate therapy, the diagnosis is made, chemotherapy is started, what's the typical clinical course that you see in terms of their neuropathy? Do you ever see improvement or is it arrest of worsening? Dr Terrelonge: Usually for amyloid, there is an arrest of disease, but in some patients, they could have some improvement, not necessarily a dramatic improvement, but some patients could see some reversal of symptoms. That may not necessarily be because nerves injured nerves are regrowing, but because of reorganization of nerves to muscle, they could have some strength increases or at least less pain. Dr Nevel: Yeah, thank you. So, when should we involve a hematologist in aiding in the evaluation of patients we suspect may have an underlying hematological disorder? You guys really outlined very nicely in your article some of the laboratory workup or other workup like you just talked about with amyloidosis. But at what point in that workup should we reach out to our hematology colleagues? Dr Patrick: I would say almost always. So, these disorders are inherently multi-system and benefit from early co-management. In acute sickle cell stroke, for example, hematology helps direct emergent exchange transfusion. For myeloproliferative disorders they guide cyto reduction and long term antithrombotic strategy. And for antibody mediated or plasma cell disorders, hematology determines disease specific therapies. So, neurology may help with identifying the presentation, but the definitive management is almost always shared with our hematology colleagues. Dr Nevel: And as you both have mentioned that a lot of times in these cases, their hematologic disorder may be already known before they present with their neurological symptoms. So, I imagine obviously in those cases that a hematologist hopefully is already heavily involved in their care. What do you think is the most difficult aspect of identifying and diagnosing patients with neurologic illness as having an underlying hematological disorder? Dr Patrick: The hardest part is maintaining a high index of suspicion, especially since hematologic causes account for a very small minority of arterial strokes. Most strokes are from traditional vascular risk factors like you mentioned, or cardio embolism, so it's easy to stop diagnostic evaluation after standard studies have been performed. An example of a challenging case is a patient that's young, they've had recurrent cryptogenic stroke, and they could have antiphospholipid antibody syndrome, but it can be easy to miss if their antibody titers are borderline or if they're already anticoagulated, which would complicate retesting. So, it's about balancing the urge to over-test with recognizing the few cases where identifying A hematologic cause truly changes that management. Dr Terrelonge: And then on the neuropathy side, probably the hardest part is deciding what's causal and what's coincidence. Monoclonal gammopathy of unknown significance, or MGUS, is really common in older adults, so not every M-spike on an SPEP explains a neuropathy. And even sometimes there's times when the neurologic picture will develop a little bit faster than the hematologic one. So, it's hard to put the two together. Dr Nevel: Yeah. What's the most rewarding aspect of taking care of patients with complications from their hematologic disorders? Dr Patrick: It's deeply rewarding when a targeted diagnosis leads to a tangible improvement in that patient's care. For example, identifying A cryptogenic stroke is being due to myeloproliferative neoplasm or an inherited thrombophilia allows us to move from empiric treatment to possible disease specific strategy. It's really gratifying to give patients that clarity, to give them a diagnosis and in some cases prevent future events. Dr Terrelonge: Agreed. And even on the neuropathy side, almost all of the neuropathies that are hematologically related are treatable. So, it's so satisfying whenever you have a patient with say an anti-MAG neuropathy or Waldenström can start the patient on therapy, and you can see someone who's been having a progressive decline to stability and in those cases sometimes even significant recovery. Dr Nevel: Yeah, absolutely. Very rewarding when you can identify the problem and make it better. That's what it's all about. So, what are the future areas of research in this area? What do we still need to learn? Dr Patrick: There's still a lot to learn. I think we need better data on the safety of acute reperfusion therapy and antithrombotic agents, particularly in patients that are at dual risk for bleeding and thrombosis. Other examples, secondary prevention strategies and anti-phospholipid antibody syndrome. What's the best target INR? Do you add aspirin to warfarin or not? All of that is often left up to expert opinion. What's the best management for adults with sickle cell stroke? There are many open questions there. A lot of the protocols that we have in place for sickle cell patients that are adults as derived from pediatric literature and there's vast potential in terms of disease modifying therapies, especially in the fields of sickle cell disease and amyloidosis. And we'll need to reassess how those treatments may change neurologic outcomes. Dr Terrelonge: I think on the neuropathy side that having some form of new biomarkers to help us clearly know of the neuropathy and that hematologic illness are associated would be very helpful. On the treatment side, a lot of this is really being driven by the hematology space, but new therapies that treat hematologic plasma cell disorders, including some of the new BTK inhibitor, may be incorporated relatively soon into the algorithm for how we treat many of our patients. I'm excited to see what's to come from this. Dr Nevel: Wonderful. Thank you so much for sharing your knowledge with us today. I know I've certainly learned a lot by reading your article and through our discussion today. Highly encourage our listeners to read your wonderful article, which is a very thorough review of hematologic disorders and neurological complications. Again, today I've been interviewing Dr Lauren Patrick and Dr Mark Terrelonge on their article Neurologic Complications of Hematologic Disorders, which appears in the February 2026 Continuum issue on Neurology of Systemic Disease. Please be sure to check out Continuum Audio episodes from this and other issues. And as always, thank you so much to our listeners for joining today, and thank you so much to Lauren and Mark. Dr Terrelonge: Yeah, thank you so much for having us. Dr Patrick: Thank you so much for having us and for highlighting this topic. We hope the issue encourages clinicians to think broadly about hematologic causes of neurologic disease and to continue collaborating closely with our hematology colleagues. It's a complex but very fascinating intersection for both of our fields. 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 this 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.

Many serious medical illnesses are associated with some degree of serum electrolyte abnormality, renal impairment, or both. The neurologist must determine if the patient's neurologic symptoms are related to the renal and electrolyte disturbances or whether a concurrent primary neurologic process is at play. In this episode, Casey Albin, MD, speaks with Eelco F. M. Wijdicks, MD, PhD, FAAN, FACP, FNCS, author of the article "Neurologic Manifestations of Renal and Electrolyte Disorders" in the Continuum® February 2026 Neurology of Systemic Disease issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Wijdicks is a professor of neurology and attending neurointensivist for the Neurosciences Intensive Care Unit at Mayo Clinic in Rochester, Minnesota. Additional Resources Read the article: Neurologic Manifestations of Renal and Electrolyte Disorders 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: @caseyalbin Guest: @EWijdicks Full episode transcript available here

Neurologic Physical Therapist Mike Studer, author of The Brain That Chooses Itself, reveals how our daily choices shape our health, longevity and independence as we age.

In this episode, Erin Gallardo, PT, DPT, NCS interviews physical therapist Mariah King, PT, DPT from RISE Healthcare Group and Hiroki (Hiro) Kimura from Cyberdyne about the HAL (Hybrid Assistive Limb) robotic exoskeleton and its role in neurologic rehabilitation. They discuss how the HAL system reads patients' intent to move via surface EMG signals and converts those signals into assisted movement to drive neuroplasticity and functional recovery for people with spinal cord injury, stroke, TBI, Parkinson's disease, and progressive neuromuscular disorders such as MS, SMA, and muscular dystrophy. Mariah explains RISE's one-on-one outpatient model, how patients are evaluated for HAL use, typical dosing (2–3x/week over about 2 months), and the outcome measures they track, including 10-Meter Walk, 2-Minute Walk, 30-Second Sit-to-Stand, and TUG. She shares powerful case examples, including a person with MS who relies on a wheelchair for mobility progressing to prolonged standing and assisted gait, and another individual with MS whose falls dropped from several per month to just one across four months. Hiro digs into what makes HAL unique compared to other exoskeletons: its emphasis on intention-based control, the ability for therapists to visualize and shape EMG patterns (for example, reducing co-contraction), and asymmetric or joint-specific assistance tailored to each limb. They also touch on the different HAL configurations (lower limb, single-joint, lumbar), its current status as a clinic-based rehab device (not take-home), billing considerations, the new pediatric version and forthcoming wrist device, as well as opportunities for students, clinicians, and clinic owners to get involved with RISE's HAL programs. Website: www.risehealthcaregroup.com Instagram: risehealthcaregroup Facebook: risehealthcaregroup YouTube: https://www.youtube.com/@risehealthcaregroup7766 Cyberdyne USA Inc. https://www.cyberdyne.jp/english/ mariah@socalelitephysicaltherapy.com

Clinicians and patients are in a state of prognostic uncertainty when they are unsure about the future course of an illness. By embracing uncertainty while cultivating prognostic awareness, neurologists can serve the critical role of supporting patients and families through the living and dying process. In this episode, Casey Albin, MD, speaks with Robert G. Holloway, MD, MPH, FAAN, author of the article "Managing Prognostic Uncertainty in Neurologic Disease" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Holloway is the Edward and Alma Vollertsen Rykenboer Chair and a professor of neurology in the department of neurology at the University of Rochester School of Medicine and Dentistry in Rochester, New York. Additional Resources Read the article: Managing Prognostic Uncertainty in Neurologic Disease 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: @caseyalbin 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 Albin: Hello, this is Dr Casey Albin. Today I'm interviewing Dr Bob Holloway about his article on managing prognostic uncertainty in neurologic disease, which appears in the December 2025 Continuum issue on neuropalliative care. Welcome to the podcast, and please introduce yourself to our audience. Dr Holloway: Hi, Casey, and thank you. Again, my name is Bob Holloway. I'm a clinician and neurologist up in Rochester, New York, and I've been doing both neurology and palliative care for many years. Dr Albin: Well, that's fantastic. And I really wanted to emphasize how much I really enjoyed reading this article. I know that we're going to get into some of the pearls that you offer, but I really want to tell the listeners, like, this is a great one to read because not only does it have sort of a philosophical take, but you also really provide some pragmatic tips of how we can help our patients manage this prognostic uncertainty. But maybe just tell us a little bit, what is prognostic uncertainty? Dr Holloway: Yes, thank you. Well, I think everyone has a sense of what prognostic uncertainty is. And it's just the uncertain futures that we as clinicians and our patients face. And I would just say that a way to summarize it is just, how do we manage the "not yet" of neurologic illness? Dr Albin: I love that. In neurologic illness, there is so much "not yet" and there are so many unknowns. And what I thought was really helpful about your article is you kind of give us three buckets in which we can think about the different types of uncertainty our patients are facing. What are those? Dr Holloway: This is, I think, an area that really is of interest to me, thinking about how to organize the prognostic "not yet" or that landscape. And one way I've tried to simplify it is to think about it as data-centered. And that's the world that we mostly live in as neurologists. That's the probability distributions. We also have kind of system-level uncertainties, and that's the uncertainties that our health system affords for our patients. And then we have, also, the patient-centered uncertainties and the uncertainties that those two prior categories cause for our patients. And that's a big uncertainty that we often don't address. Dr Albin: In reading the article, I was really struck by, we spend a lot of time thinking about data uncertainty. Can we get population-based research? Can we sort of look at prognostication scoring? I live in the ICU, and so we think a lot about these, like, scoring metrics and putting patients into buckets and helping us derive their care based on where their severity index is. And I'm sure that is true in many of the divisions of neurology. But what I did not really appreciate---and I thought you did a really fantastic job of kind of drawing our attention to---is there's a lot of system-centered uncertainty. Can you give us a little bit of examples, like, what is system-based uncertainty? Dr Holloway: I think system-level uncertainties just encompass the practical information gaps that may arise during our healthcare encounter. And a lot of, I think, the uncertainty that our patients face and families, they actually describe it as they feel captive by the uncertainty. And it's just the unknowns, not just what affords from the actual information about the disease and its prognosis in the future, but actually the level of the system, like, who's going to take care of them? How do you manage arranging for nurses to come into the home or all those practical-level uncertainties that the system provides that sometimes we don't do a good job of road-mapping for patients. Dr Albin: Absolutely. Because I feel like we have a little bit of a gap in that often as physicians. Like, the family asks, what will hospice at home look like? Well, you know, that's a question for case management. I think they'll come in and they'll tell you. But it strikes me that that's a real gap of my being able to walk patients through. Will they get home health care? Will they have transportation set up? Will there be a nurse who comes in to check? How often are they available? What's the cost going to be? All of these practical aspects of dealing with an illness that are beyond sort of our scope of knowledge, but probably have a huge practical impact to the patient. Dr Holloway: Without question, every encounter patients wonder about, that kind of future wish landscape that we- all our future-oriented desires and hopes. And so much of that is the practical aspects of our health system, which is often fragmented, kind of unknown, uncertain. And that's a huge source of uncertainty for our patients and families. And then that leads to many other uncertainties that we need to address. Dr Albin: Absolutely. I think another one that we, again, maybe don't spend quite as much time thinking about is this patient-level uncertainty. What's going on there? Dr Holloway: Yeah. So, I think patient-level uncertainty is that uncertainty that they experience when confronted with the two other types of uncertainty: the actual data-centered uncertainty and the system-level uncertainty. And that's that, kind of, very huge kind of uncertainty about what it means for them and their family and their future futures. And that's a source of huge stress and anxiety, and often frankly bordering on dread and fear for our patients and families. That actually gets into very levels of uncertainty that I would call maybe over even in the existential realm. Patient-level uncertainty in the actual existential questions or the fear and the dread or the kind of just unnerving aspect of it is actually even more important to patients than the scientific or data-centered uncertainty that we focus most of our attention on. Dr Albin: Yeah, I think this is, to me, was getting towards that, like, what does the patient care about and how are they coping with what is in many times a really dramatic shift in their life expectancy or morbidity expectations and this sort of radical renegotiation about what it means to have a neurologic illness? And how does that shift their thinking about who they are and their priorities in the world? Is that right? Dr Holloway: One thousand percent, and in fact, I will say---and I think is one of the main take home messages is that, you know, managing prognostic certainty is not an end in itself. It really is to help patients and families adaptively cope to their new and often harsh new reality, that we could help them adapt to their new normal. I think that is one of our main tasks as neurologists in our care teams is to help patients find and ultimately maybe achieve existential or spiritual or well-being even in their new health states. You know, that you certainly often see in the intensive care unit, but we often always see in the outpatient realm as well, and all our other diseases. Dr Albin: I think that's really hard to do. I think those conversations are incredibly difficult and trying to navigate where patients want to be, what would bring meaning, what would bring value. I think many of us struggle to have these pretty real and intense conversations with families about what really is important. And one of the things I really liked about this article is you kind of walk us through some steps that we as clinicians can take to get a little bit more comfortable. Maybe just walk us through, what are some of the things that you have found most helpful in trying to get families and patients to open up about what brings them meaning? How are they navigating this new, really uncertain time in their life? Dr Holloway: Yeah, so I do kind of have a ten-point recommendations of how to help cultivate a more integrated awareness of an uncertain future. I mean, I think the most important thing is actually just recognizing that embracing uncertainty as an amazingly remarkable cognitive tool. I mean, let's face it, uncertainty, when it happens with neurologic illness and disease, is often fearful. It's scary. It kind of changes our world. But on the flip side of it, it's a remarkable cognitive tool that actually can help us find new ways and new paths and new creativity. And I think we can use that kind of opposites to help our patients find new meaning in very difficult situations. So, thinking about uncertainty, kind of being courageous, leaning into it and recognizing that it does create anxieties and fear, but it also can kind of help create new solutions and new ideas to help people navigate. Dr Albin: I was hoping that maybe you could give us an example of, like, how would you do that? If a patient comes in and they're dealing with, you know, a new diagnosis and they're navigating this new uncertainty, what are some of the things that you ask to help them reframe that, to kind of take some of the good about that uncertainty? How do you navigate that? Dr Holloway: One of the other recommendations is actually just resetting the timeline and expectations for these conversations. That it shouldn't be expected that patients should accept their harsh new reality immediately, that it takes time in a trusted environment. And that there's this, like, oscillating nature of hopes and fears and dread, and you've just got to work with them over time. And with time, and once you understand who the patient and family are and understand where they find meaning and where they find, actually, joy in their life, or what actually brings them meaning, you can start recasting their futures into credible narratives in their kind of future landscape in ways that I think can help them enter into their new realities within the, you know, framework of disease management that you can offer them within your healthcare team or your healthcare system or wherever you are in the world and the available resources that you have to offer patients and families. Dr Albin: So, this sounds like a lot to me like active listening and really trying to get to know what is important to the family, what is important to the patient. And I guess probably just creating that space even in that busy clinical environment. Do I have that right? Dr Holloway: You can absolutely do that, right. You know, and honestly, active listening, we are challenged in our busy healthcare system to do this, but I think with the right listening skills and the appropriate ways of paying attention, you can definitely illuminate these possible, kind of future-oriented worlds for patients and help them navigate those new terrains with them. Frankly, I think that's a real new space for us in neurology. We don't think about and train how to create credible narratives for patients and families. We do it on the fly, but I think there's so much more work to do. How do you actually keep, you know, that best-case, worst-case, most likely credible narratives for patients that can help them adapt to their new realities and support them on their new journeys? Dr Albin: I love that best-case, worst-case, most likely case. I find that framework really helpful. But you talk in your article, it's not just about using that best case or worst case or most likely, but it's actually building some forecasting into that and having some real data to kind of support what you're saying. And there's a lot of growth towards actually becoming good as a medical forecaster. Can you describe a little bit, what did you mean by that? Dr Holloway: You're absolutely right. I think, actually, one of the skillsets of becoming and managing prognostic uncertainty is actually becoming a skilled medical forecaster. And it's a really tall order. So, we've got to be both good medical forecasters as well as helping patients adaptively cope to their new reality. But the good medical forecasting is actually now going more quantitative in thinking about the data that's available to help think about the important outcomes for patients and families and then predicting what their probabilities are so you can shape those futures around. So, yes, we do have to have an open mindset. We do have to actually look at the data that's available and actually think about, what are those long-term probabilities and outcomes? And we can be honest about those and even communicate them with families. But it's a really good skill set to have. Dr Albin: Yeah. This to me was a little bit about, how do you bring in the data knowledge that we try to get over time as we develop our expertise? You're developing not just a reliance on population-based data, but in my experience, I have seen this. And that sort of ability to kind of look at the patient in front of you, think about the big picture, but also a little bit about their unique medical comorbidities or prior life experiences. So, some of that database knowledge, and then bringing in and getting to know what is important to the patient. And so, sort of marrying that data-centric/patient-centric mindset. Dr Holloway: I love it. I guess the other way of saying that, too, is we need to think with precision, but communicate in narratives. And it's okay to gently put more precise estimates on our probability predictions with patients and families, what we think is the most likely case, best and worst case. Because patients and families want us to be more precise. We often shy away from it, but- so, it's okay to think in precisions, but we've got to put those in narratives in the most likely, best-, and worst-case scenarios. And don't be afraid if you think in terms of ninety percents, ten percents, fifty percents; most patients and families don't mind that. And what they're telling us is they actually want to hear that, if you are comfortable talking in those terms. Dr Albin: Yeah, absolutely. And giving a sense of the humility to say, like, this is my best guess based on medical data and my experience, I would say, but again, none of us have a crystal ball. And I do think families, as long as you're sort of couching your expectations into the sort of imperfect, but I'm doing my best, really appreciate that. Dr Holloway: They totally do all the time. Just say, I simply don't know for certain, but these are my best estimates. That's a good way of just phrasing that. Dr Albin: Yeah. So powerful. I don't know for certain. And then I wanted to just kind of close out, because there's this one term that you use that I thought was so interesting. And I wanted you to kind of tell our listeners a little bit about what you mean here, which is that, when you're actively open-minded, you're using this, quote, "dragonfly eyes." What do you mean by that? Dr Holloway: So, the dragonfly eyes, as you know, they can look at three sixty around them and they just, they move in all directions. Being actively open minded, I guess the biggest example I would say is, I don't like the term prognostic discordance, which means that there's a difference of subjective estimates of prognosis between patients and families. Being openly minded is actually embracing the potential information that the family has about prognosis and incorporating that into your estimates. So, I wouldn't say it's discordances, per se; I think being really actively open-minded is taking that all in and utilizing that as, you know what, they know more than you do about the patient and their loved ones, and they may have insights that can inform your best estimates of prognosis. So, the true dragonfly prognosticator actually is one who embraces and doesn't consider it discord, but considers it kind of new, useful information that I just need to weigh in so I can help the family in my best professional way in terms of developing a prognosis, whatever the condition may be. Dr Albin: I can imagine this is just so challenging and something that takes a long time to sort of perfect all of this. I think you say right below that, you need a growth mindset to do this because it is hard, and it's going to take an active participation and an active desire to get better at these conversations with our families. Dr Holloway: One thousand percent. You are so right that it takes time, effort, and not feeling like you're being challenged, but that actually you are including them in your entire body of knowledge, that you're just- it's part of all you're collecting. And even, I was on service last week, and I talked to residents and students about that very issue. It's like take their prognosis. And someone who came in, we thought CJB, very sad, tragic case, but we were thinking about what the future may look like and how do we actually work with the family who had very what we thought was unrealistic expectations. I said, well, no, this is not discordance. This is just useful information that we can take understand where they're coming from and incorporate that into the ways we want to build relationships, build trust, and over time we'll get to a point where we hopefully can work with them and have them have that fully integrated awareness of their future. Dr Albin: Yeah, that's beautiful. It really is this ongoing negotiation that really requires so much listening, understanding, and then obviously information and expertise about the data that we're presenting and the likelihood outcome, recognizing that there's a lot of uncertainty in all of this. Which, you know, again, this is kind of a 360 talk. At every level there is uncertainty, and that's what makes it so hard. Dr Holloway: Yeah, you're absolutely right. And actually, even in the article I kind of used the term radical uncertainty as that, no matter how resolvable all this uncertainty is, there will always still remain that radical element of our existence which we have to actually incorporate and be prepared for. And actually, not only of ourselves, but actually for patients and families and helping manage that. Using narratives and credible narratives and kind of ranges of possibilities is the best way to do that in a personalized way. Dr Albin: Well, this has been a fantastic conversation, and I know that we are running a bit short on time. So, as we wrap up and you think about this topic, are there any key take-home messages that you hope our listeners will walk away with? Dr Holloway: I think one main emphasis is that despite all the successes we feel we have in neurology, is that we all have to recognize that prognostic uncertainty is just going to increase in the future. But this is going to be for several reasons. One is that, just, the illness uncertainty of all of our great therapies are just going to be creating more uncertainty for the future. And precision medicine is paradoxical, and that actually it creates more uncertainty. So, I think we need to be prepared that we have to manage prognostic uncertainty better, because it's definitely going to increase. And two, it's what I said earlier, is that actually managing prognostic uncertainty is not an end to itself. It's actually helping patients and families adapt to their new and sometimes harsh new reality and actually help them to ultimately get to a place where maybe either their condition is neither dreaded, but actually they can accept it as their new reality and actually achieve some sort of existential well-being and existential health. I think that we have a lot more to emphasize in this area. And for far too long, we've focused on the certainty aspect of our field and not enough on the uncertainty in the world of medicine to help our patients and families. Dr Albin: And gosh, isn't there just so much uncertainty? And I think this has been beautiful. So, thank you again for coming and sharing your expertise. Dr Holloway: Thank you very much. It's been a pleasure. Dr Albin: For all of our listeners out there, this is a truly fantastic article, and I would just like to direct you to going to read the cases because not only do the cases offer a little bit of practical advice, but there's one that's actually sort of a philosophical discussion about, what does it mean to be alive and confront death? There's some beautiful artwork that's featured as well. So this is just a really unique article, and I'm excited for our listeners to have a chance to check it out. So again, today I've been interviewing Dr Bob Holloway about his article on managing prognostic uncertainty in neurologic disease, which appears in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues. 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.

Meralgia Paresthetica Education and the Pain Boards This podcast episode from the NRAP Academy features Dr. David Rosenblum discussing Meralgia Paresthetica, a mononeuropathy affecting the lateral femoral cutaneous nerve. The condition involves entrapment or compression of this purely sensory nerve as it passes under the inguinal ligament near the anterior superior iliac spine, causing burning pain, tingling, and numbness in the anterior lateral thigh. Key clinical points covered include the nerve's L2-3 origin from the lumbar plexus, common causes such as obesity, tight clothing, pregnancy, and diabetes, and the absence of motor weakness or reflex changes. Diagnosis is primarily clinical, though ultrasound can visualize nerve entrapment effectively. Treatment approaches range from conservative management including weight loss, avoiding tight clothing, physical therapy, and neuropathic pain medications (gabapentinoids, duloxetine, tricyclics) to interventional procedures. Dr. Rosenblu strongly advocates for ultrasound-guided nerve blocks over fluoroscopic or blind approaches, citing better visualization and reduced risk of nerve trauma. Advanced treatments mentioned include peripheral neuromodulation and cryoablation for refractory cases. The episode emphasizes that this condition is commonly tested on pain management board examinations (ABA, ABPM, FIPP, osteopathic boards) and can be significantly more painful and disabling than typically appreciated. Upcoming Courses and Training Opportunities: Ultrasound training available at nrappain.org Regenerative medicine training courses Comprehensive Question Bank for Pain Management board preparation covering ABA, ABPM, FIPP, and osteopathic examinations CME credits available through the platform Clinical consultation services available at Dr. Rosenblu's Brooklyn office for patients seeking treatment   Meralgia Paresthetica Education and Clinical Guidance Overview: Focused on definition, anatomy, diagnosis, management, and board exam relevance for meralgia paresthetica. Anatomy and Pathophysiology: Nerve: lateral femoral cutaneous nerve (sensory only), typically arising from L2–L3. Course: traverses across the iliacus, passes under or through the inguinal ligament just medial to the ASIS, then enters the thigh. Sensory distribution: anterolateral thigh; anterior cutaneous division extends toward the knee. Etiology and Risk Factors: Common contributors: obesity, tight belts or clothing, pregnancy, prolonged sitting, diabetes, prior pelvic or hip surgery. Entrapment site: under the inguinal ligament near the ASIS (most frequent). Clinical Presentation: Symptoms: burning pain, tingling, numbness, dysesthesia localized to the anterolateral thigh. Provocation/relief: worse with standing or walking; relief with sitting or hip flexion. Neurologic exam: no motor weakness; no reflex changes. Diagnosis: Primarily clinical; Tinel's sign over the inguinal ligament may reproduce symptoms. EMG and nerve conduction studies are typically normal. Ultrasound: superficial nerve, generally easy to visualize, including in obese patients; can identify entrapment. Management Recommendations: First-line conservative care: weight loss; avoidance of tight belts/clothing; physical therapy; NSAIDs for inflammation. Pharmacologic options: gabapentin, pregabalin, duloxetine, tricyclic antidepressants; consider topical analgesic creams (e.g., lidocaine or anti-inflammatory combinations). Interventional approach: Ultrasound-guided nerve block is strongly recommended; the nerve lies lateral to the sartorius; real-time visualization enables precise, safe injection. Avoid fluoroscopic and blind approaches due to risk of further nerve trauma and post-procedure pain. Advanced interventions: Peripheral neuromodulation may provide benefit in select cases. Cryoablation has shown beneficial outcomes for the lateral femoral cutaneous nerve. Surgery is rarely required; options include neurolysis, decompression, or neurectomy as a last resort. Board Exam Preparation Emphasis: Key facts commonly tested: Involved nerve: lateral femoral cutaneous nerve. Nerve roots: L2–L3 (with population variants). Sensory-only nerve; absence of motor deficits. Compression site: under the inguinal ligament near the ASIS. First-line therapy: conservative measures; refractory cases: ultrasound-guided nerve block. Keywords to study: meralgia paresthetica; lateral femoral cutaneous nerve (also called lateral cutaneous nerve of the thigh). Practice Considerations: Severity: can be profoundly painful and disabling; often underappreciated. Referral: clinicians not trained in interventional techniques should refer patients to an interventionalist for diagnosis and treatment. Decisions and Recommendations Ultrasound guidance is the preferred modality for lateral femoral cutaneous nerve interventions, superseding fluoroscopic or blind approaches. Rationale: superior visualization, real-time feedback, and reduced risk of nerve trauma and post-procedural pain. Outreach and Resources NRAP Academy resources: Ultrasound training, regenerative medicine training, CME credits, and a comprehensive pain board question bank (ABA, ABPM, FIPP, osteopathic, and related exams). Clinical availability: Patient consultations for meralgia paresthetica offered in Brooklyn at www.AABPpain.com 718 436 7246 .

Meralgia Paresthetica Education and the Anesthesiology Boards This podcast episode from the NRAP Academy features Dr. David Rosenblum discussing Meralgia Paresthetica, a mononeuropathy affecting the lateral femoral cutaneous nerve. The condition involves entrapment or compression of this purely sensory nerve as it passes under the inguinal ligament near the anterior superior iliac spine, causing burning pain, tingling, and numbness in the anterior lateral thigh. Key clinical points covered include the nerve's L2-3 origin from the lumbar plexus, common causes such as obesity, tight clothing, pregnancy, and diabetes, and the absence of motor weakness or reflex changes. Diagnosis is primarily clinical, though ultrasound can visualize nerve entrapment effectively. Treatment approaches range from conservative management including weight loss, avoiding tight clothing, physical therapy, and neuropathic pain medications (gabapentinoids, duloxetine, tricyclics) to interventional procedures. Dr. Rosenblu strongly advocates for ultrasound-guided nerve blocks over fluoroscopic or blind approaches, citing better visualization and reduced risk of nerve trauma. Advanced treatments mentioned include peripheral neuromodulation and cryoablation for refractory cases. The episode emphasizes that this condition is commonly tested on pain management board examinations (ABA, ABPM, FIPP, osteopathic boards) and can be significantly more painful and disabling than typically appreciated. Upcoming Courses and Training Opportunities: Ultrasound training available at nrappain.org Regenerative medicine training courses Comprehensive Anestheisia and Question Bank for Pain Management board preparation covering ABA, ABPM, FIPP, and osteopathic examinations CME credits available through the platform Clinical consultation services available at Dr. Rosenblum's Brooklyn office for patients seeking treatment. Call 718 436 7246 or go to www.AABPpain.com    Meralgia Paresthetica Education and Clinical Guidance Overview: Focused on definition, anatomy, diagnosis, management, and board exam relevance for meralgia paresthetica. Anatomy and Pathophysiology: Nerve: lateral femoral cutaneous nerve (sensory only), typically arising from L2–L3. Course: traverses across the iliacus, passes under or through the inguinal ligament just medial to the ASIS, then enters the thigh. Sensory distribution: anterolateral thigh; anterior cutaneous division extends toward the knee. Etiology and Risk Factors: Common contributors: obesity, tight belts or clothing, pregnancy, prolonged sitting, diabetes, prior pelvic or hip surgery. Entrapment site: under the inguinal ligament near the ASIS (most frequent). Clinical Presentation: Symptoms: burning pain, tingling, numbness, dysesthesia localized to the anterolateral thigh. Provocation/relief: worse with standing or walking; relief with sitting or hip flexion. Neurologic exam: no motor weakness; no reflex changes. Diagnosis: Primarily clinical; Tinel's sign over the inguinal ligament may reproduce symptoms. EMG and nerve conduction studies are typically normal. Ultrasound: superficial nerve, generally easy to visualize, including in obese patients; can identify entrapment. Management Recommendations: First-line conservative care: weight loss; avoidance of tight belts/clothing; physical therapy; NSAIDs for inflammation. Pharmacologic options: gabapentin, pregabalin, duloxetine, tricyclic antidepressants; consider topical analgesic creams (e.g., lidocaine or anti-inflammatory combinations). Interventional approach: Ultrasound-guided nerve block is strongly recommended; the nerve lies lateral to the sartorius; real-time visualization enables precise, safe injection. Avoid fluoroscopic and blind approaches due to risk of further nerve trauma and post-procedure pain. Advanced interventions: Peripheral neuromodulation may provide benefit in select cases. Cryoablation has shown beneficial outcomes for the lateral femoral cutaneous nerve. Surgery is rarely required; options include neurolysis, decompression, or neurectomy as a last resort. Board Exam Preparation Emphasis: Key facts commonly tested: Involved nerve: lateral femoral cutaneous nerve. Nerve roots: L2–L3 (with population variants). Sensory-only nerve; absence of motor deficits. Compression site: under the inguinal ligament near the ASIS. First-line therapy: conservative measures; refractory cases: ultrasound-guided nerve block. Keywords to study: meralgia paresthetica; lateral femoral cutaneous nerve (also called lateral cutaneous nerve of the thigh). Practice Considerations: Severity: can be profoundly painful and disabling; often underappreciated. Referral: clinicians not trained in interventional techniques should refer patients to an interventionalist for diagnosis and treatment. Decisions and Recommendations Ultrasound guidance is the preferred modality for lateral femoral cutaneous nerve interventions, superseding fluoroscopic or blind approaches. Rationale: superior visualization, real-time feedback, and reduced risk of nerve trauma and post-procedural pain. Outreach and Resources NRAP Academy resources: Ultrasound training, regenerative medicine training, CME credits, and a comprehensive pain board question bank (ABA, ABPM, FIPP, osteopathic, and related exams). Clinical availability: Patient consultations for meralgia paresthetica offered in Brooklyn at www.AABPpain.com 718 436 7246 .

Meralgia Paresthetica Education and the PM&R Boards This podcast episode from the NRAP Academy features Dr. David Rosenblum discussing Meralgia Paresthetica, a mononeuropathy affecting the lateral femoral cutaneous nerve. The condition involves entrapment or compression of this purely sensory nerve as it passes under the inguinal ligament near the anterior superior iliac spine, causing burning pain, tingling, and numbness in the anterior lateral thigh. Key clinical points covered include the nerve's L2-3 origin from the lumbar plexus, common causes such as obesity, tight clothing, pregnancy, and diabetes, and the absence of motor weakness or reflex changes. Diagnosis is primarily clinical, though ultrasound can visualize nerve entrapment effectively. Treatment approaches range from conservative management including weight loss, avoiding tight clothing, physical therapy, and neuropathic pain medications (gabapentinoids, duloxetine, tricyclics) to interventional procedures. Dr. Rosenblu strongly advocates for ultrasound-guided nerve blocks over fluoroscopic or blind approaches, citing better visualization and reduced risk of nerve trauma. Advanced treatments mentioned include peripheral neuromodulation and cryoablation for refractory cases. The episode emphasizes that this condition is commonly tested on pain management board examinations (ABA, ABPM, FIPP, osteopathic boards) and can be significantly more painful and disabling than typically appreciated. Upcoming Courses and Training Opportunities: Ultrasound training available at nrappain.org Regenerative medicine training courses Comprehensive PM&R  Question Bank for Pain Management board preparation covering ABA, ABPM, FIPP, and osteopathic examinations CME credits available through the platform Clinical consultation services available at Dr. Rosenblum's Brooklyn office for patients seeking treatment   Meralgia Paresthetica Education and Clinical Guidance Overview: Focused on definition, anatomy, diagnosis, management, and board exam relevance for meralgia paresthetica. Anatomy and Pathophysiology: Nerve: lateral femoral cutaneous nerve (sensory only), typically arising from L2–L3. Course: traverses across the iliacus, passes under or through the inguinal ligament just medial to the ASIS, then enters the thigh. Sensory distribution: anterolateral thigh; anterior cutaneous division extends toward the knee. Etiology and Risk Factors: Common contributors: obesity, tight belts or clothing, pregnancy, prolonged sitting, diabetes, prior pelvic or hip surgery. Entrapment site: under the inguinal ligament near the ASIS (most frequent). Clinical Presentation: Symptoms: burning pain, tingling, numbness, dysesthesia localized to the anterolateral thigh. Provocation/relief: worse with standing or walking; relief with sitting or hip flexion. Neurologic exam: no motor weakness; no reflex changes. Diagnosis: Primarily clinical; Tinel's sign over the inguinal ligament may reproduce symptoms. EMG and nerve conduction studies are typically normal. Ultrasound: superficial nerve, generally easy to visualize, including in obese patients; can identify entrapment. Management Recommendations: First-line conservative care: weight loss; avoidance of tight belts/clothing; physical therapy; NSAIDs for inflammation. Pharmacologic options: gabapentin, pregabalin, duloxetine, tricyclic antidepressants; consider topical analgesic creams (e.g., lidocaine or anti-inflammatory combinations). Interventional approach: Ultrasound-guided nerve block is strongly recommended; the nerve lies lateral to the sartorius; real-time visualization enables precise, safe injection. Avoid fluoroscopic and blind approaches due to risk of further nerve trauma and post-procedure pain. Advanced interventions: Peripheral neuromodulation may provide benefit in select cases. Cryoablation has shown beneficial outcomes for the lateral femoral cutaneous nerve. Surgery is rarely required; options include neurolysis, decompression, or neurectomy as a last resort. Board Exam Preparation Emphasis: Key facts commonly tested: Involved nerve: lateral femoral cutaneous nerve. Nerve roots: L2–L3 (with population variants). Sensory-only nerve; absence of motor deficits. Compression site: under the inguinal ligament near the ASIS. First-line therapy: conservative measures; refractory cases: ultrasound-guided nerve block. Keywords to study: meralgia paresthetica; lateral femoral cutaneous nerve (also called lateral cutaneous nerve of the thigh). Practice Considerations: Severity: can be profoundly painful and disabling; often underappreciated. Referral: clinicians not trained in interventional techniques should refer patients to an interventionalist for diagnosis and treatment. Decisions and Recommendations Ultrasound guidance is the preferred modality for lateral femoral cutaneous nerve interventions, superseding fluoroscopic or blind approaches. Rationale: superior visualization, real-time feedback, and reduced risk of nerve trauma and post-procedural pain. Outreach and Resources NRAP Academy resources: Ultrasound training, regenerative medicine training, CME credits, and a comprehensive pain board question bank (ABA, ABPM, FIPP, osteopathic, and related exams). Clinical availability: Patient consultations for meralgia paresthetica offered in Brooklyn at www.AABPpain.com 718 436 7246 .

Continuing our discussion on Prophecy and Spiritual Gifts. If you appreciate my work please consider a donation to: "paypal.me/newdayglobal" Thank You!

In this episode of the SwineTime podcast, staff veterinarian and Pipestone Holdings owner Dr. Spencer Wayne is joined by fellow veterinarian and partner Dr. Joseph Yaros for a practical discussion on one of the most critical aspects of swine production: identifying sick pigs early and responding appropriately.The conversation centers on real-world, barn-level observations that help producers and caretakers detect health challenges before they turn into larger performance or mortality issues. Dr. Yaros emphasizes that early recognition and timely intervention are essential to protecting pig health, animal welfare, and overall production efficiency. To simplify daily pig assessments, Dr. Yaros introduces the “SANTA” acronym, an easy-to-remember framework for evaluating individual pigs: Stance – Pigs standing with drooped heads, low ears, or a dull posture may be showing early signs of illness.Appetite – Slab-sided pigs or those lacking proper belly fill often indicate reduced feed intake and should be monitored or treated.Neurologic signs – Head tilt, circling, paddling, or failure to move normally when approached can signal serious health concerns.Thumping (respiratory distress) – Heavy breathing, coughing, or abdominal “thumping” suggests respiratory disease that may require prompt intervention.Ambulation – Lameness, stiffness, or difficulty rising can indicate pain, injury, or infection.The discussion then expands from individual pigs to overall barn health using the “WINTER” acronym, which focuses on two key indicators: water intake and energy level. Dr. Yaros explains that declines in water consumption often occur days before visible health problems and should be tracked consistently. Low energy in the barn—such as reduced noise or poor response when entering a room—can also be an early warning sign of health challenges.The episode also provides practical rules of thumb for treatment thresholds, helping producers decide when individual pig treatments are appropriate versus when water or feed medications should be considered. Special attention is given to enteric disease in young pigs, where rapid dehydration and rising mortality make swift action essential.Throughout the episode, Drs. Wayne and Yaros stress the importance of proactive communication with your veterinarian, using tools like daily records, photos, videos, and water intake data to guide decision-making. This SwineTime episode delivers actionable insights to help producers improve pig health monitoring, reduce losses, and maintain strong herd performance.

Episode 210: Heat Stroke BasicsWritten by Jacob Dunn, MS4, American University of the Caribbean. Edits and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice. Definition:Heat stroke represents the most severe form of heat-related illness, characterized by a core body temperature exceeding 40°C (104°F) accompanied by central nervous system (CNS) dysfunction. Arreaza: Key element is the body temperature and altered mental status. Jacob: This life-threatening condition arises from the body's failure to dissipate heat effectively, often in the context of excessive environmental heat load or strenuous physical activity. Arreaza: You mentioned, it is a spectrum. What is the difference between heat exhaustion and heat stroke? Jacob: Unlike milder heat illnesses such as heat exhaustion, heat stroke involves multisystem organ dysfunction driven by direct thermal injury, systemic inflammation, and cytokine release. You can think of it as the body's thermostat breaking under extreme stress — leading to rapid, cascading failures if not addressed immediately. Arreaza: Tell us what you found out about the pathophysiology of heat stroke?Jacob: Pathophysiology: Under normal conditions, the body keeps its core temperature tightly controlled through sweating, vasodilation of skin blood vessels, and behavioral responses like seeking shade or drinking water. But in extreme heat or prolonged exertion, those mechanisms get overwhelmed.Once core temperature rises above about 40°C (104°F), the hypothalamus—the brain's thermostat—can't keep up. The body shifts from controlled thermoregulation to uncontrolled, passive heating. Heat stroke isn't just someone getting too hot—it's a full-blown failure of the body's heat-regulating system. Arreaza: So, it's interesting. the cell functions get affected at this point, several dangerous processes start happening at the same time.Jacob: Yes: Cellular Heat InjuryHigh temperatures disrupt proteins, enzymes, and cell membranes. Mitochondria start to fail, ATP production drops, and cells become leaky. This leads to direct tissue injury in vital organs like the brain, liver, kidneys, and heart.Arreaza: Yikes. Cytokines play a big role in the pathophysiology of heat stroke too. Jacob: Systemic Inflammatory ResponseHeat damages the gut barrier, allowing endotoxins to enter the bloodstream. This triggers a massive cytokine release—similar to sepsis. The result is widespread inflammation, endothelial injury, and microvascular collapse.Arreaza: What other systems are affected?Coagulation AbnormalitiesEndothelial damage activates the clotting cascade. Patients may develop a DIC-like picture: microthrombi forming in some areas while clotting factors get consumed in others. This contributes to organ dysfunction and bleeding.Circulatory CollapseAs the body shunts blood to the skin for cooling, perfusion to vital organs drops. Combine that with dehydration from sweating and fluid loss, and you get hypotension, decreased cardiac output, and worsening ischemia.Arreaza: And one of the key features is neurologic dysfunction.Jacob: Neurologic DysfunctionThe brain is extremely sensitive to heat. Encephalopathy, confusion, seizures, and coma occur because neurons malfunction at high temperatures. This is why altered mental status is the hallmark of true heat stroke.Arreaza: Cell injury, inflammation, coagulopathy, circulatory collapse and neurologic dysfunction. Jacob: Ultimately, heat stroke is a multisystem catastrophic event—a combination of thermal injury, inflammatory storm, coagulopathy, and circulatory collapse. Without rapid cooling and aggressive supportive care, these processes spiral into irreversible organ failure.Background and Types:Arreaza: Heat stroke is part of a spectrum of heat-related disorders—it is a true medical emergency. Mortality rate reaches 30%, even with optimal treatment. This mortality correlates directly with the duration of core hyperthermia. I'm reminded of the first time I heard about heat stroke in a baby who was left inside a car in the summer 2005. Jacob: There are two primary types: -nonexertional (classic) heat stroke, which develops insidiously over days and predominantly affects vulnerable populations like children, the elderly, and those with chronic illnesses during heat waves; -exertional heat stroke, which strikes rapidly in young, otherwise healthy individuals, often during intense exercise in hot, humid conditions. Arreaza: In our community, farm workers are especially at risk of heat stroke, but any person living in the Central Valley is basically at risk.Jacob: Risk factors amplify vulnerability across both types, including dehydration, cardiovascular disease, medications that impair sweating (e.g., anticholinergics), and acclimatization deficits. Notably, anhidrosis (lack of sweating) is common but not required for diagnosis. Hot, dry skin can signal the shift from heat exhaustion to stroke. Arreaza: What other conditions look like heat stroke?Differential Diagnosis:Jacob: Presenting with altered mental status and hyperthermia, heat stroke demands a broad differential to avoid missing mimics. -Environmental: heat exhaustion, syncope, or cramps. -Infectious etiologies like sepsis or meningitis must be ruled out. -Endocrine emergencies such as thyroid storm, pheochromocytoma, or diabetic ketoacidosis (DKA) can overlap. -Neurologic insults include cerebrovascular accident (CVA), hypothalamic lesions (bleeding or infarct), or status epilepticus. -Toxicologic culprits are plentiful—sympathomimetic or anticholinergic toxidromes, salicylate poisoning, serotonin syndrome, malignant hyperthermia, neuroleptic malignant syndrome (NMS), or even alcohol/benzodiazepine withdrawal. When it comes to differentials, it is always best to cast a wide net and think about what we could be missing if this is not heat stroke. Arreaza: Let's say we have a patient with hyperthermia and we have to assess him in the ER. What should we do to diagnose it?Jacob: Workup:Diagnosis is primarily clinical, hinging on documented hyperthermia (>40°C) plus CNS changes (e.g., confusion, delirium, seizures, coma) in a hot environment. Arreaza: No single lab confirms it, but targeted testing allows us to detect complications and rule out alternative diagnosis. Jacob: -Start with ECG to assess for dysrhythmias or ischemic changes (sinus tachycardia is classic; ST depressions or T-wave inversions may hint at myocardial strain). -Labs include complete blood count (CBC), comprehensive metabolic panel (electrolytes, renal function, liver enzymes), glucose, arterial blood gas, lactate (elevated in shock), coagulation studies (for disseminated intravascular coagulation, or DIC), creatine kinase (CK) and myoglobin (for rhabdomyolysis), and urinalysis. Toxicology screen if history suggests. Arreaza: I can imagine doing all this while trying to cool down the patient. What about imaging?-Imaging: chest X-ray for pulmonary issues, non-contrast head CT if neurologic concerns suggest edema or bleed (consider lumbar puncture if infection suspected). It is important to note that continuous core temperature monitoring—via rectal, esophageal, or bladder probe—is essential, not just peripheral skin checks. Arreaza: TreatmentManagement:Time is tissue here—initiate cooling en route, if possible, as delays skyrocket morbidity. ABCs first: secure airway (intubate if needed, favoring rocuronium over succinylcholine to avoid hyperkalemia risk), support breathing, and stabilize circulation. -Remove the patient from the heat source, strip clothing, and launch aggressive cooling to target 38-39°C (102-102°F) before halting to prevent rebound hypothermia. -For exertional cases, ice-water immersion reigns supreme—it's the fastest method, with immersion in cold water resulting in near-100% survival if started within 30 minutes. -Nonexertional benefits from evaporative cooling: mist with tepid water (15-25°C) plus fans for convective airflow. -Adjuncts include ice packs to neck, axillae, and groin; -room-temperature IV fluids (avoid cold initially to prevent shivering); -refractory cases, invasive options like peritoneal lavage, endovascular cooling catheters, or even ECMO. -Fluid resuscitation with lactated Ringer's or normal saline (250-500 mL boluses) protects kidneys and counters rhabdomyolysis—aim for urine output of 2-3 mL/kg/hour. Arreaza: What about medications?Jacob: Benzodiazepines (e.g., lorazepam) control agitation, seizures, or shivering; propofol or fentanyl if intubated. Avoid antipyretics like acetaminophen. For intubation, etomidate or ketamine as induction agents. Hypotension often resolves with cooling and fluids; if not, use dopamine or dobutamine over norepinephrine to avoid vasoconstriction. Jacob: What IV fluid is recommended/best for patients with heat stroke?Both lactated Ringer's solution and normal saline are recommended as initial IV fluids for rehydration, but balanced crystalloids such as LR are increasingly favored due to their lower risk of hyperchloremic metabolic acidosis and AKI. However, direct evidence comparing the two specifically in the setting of heat stroke is limited. Arreaza: Are cold IV fluids better/preferred over room temperature fluids?Cold IV fluids are recommended as an adjunctive therapy to help lower core temperature in heat stroke, but they should not delay or replace primary cooling methods such as cold-water immersion. Cold IV fluids can decrease core temperature more rapidly than room temperature fluids. For example, 30mL/kg bolus of chilled isotonic fluids at 4 degrees Celsius over 30 minutes can decrease core temperature by about 1 degree Celsius, compared to 0.5 degree Celsius with room temperature fluids. Arreaza: Getting cold IV sounds uncomfortable but necessary for those patients. Our favorite topic.Screening and Prevention:-Heat stroke prevention focuses on public health and individual awareness rather than routine testing. -High-risk groups—elderly, children, athletes, laborers, or those on impairing meds—should acclimatize gradually (7-14 days), hydrate preemptively (electrolyte solutions over plain water), and monitor temperature in exertional settings. -Communities during heat waves need cooling centers and alerts. -For clinicians, educate patients with CVD or obesity about early signs like dizziness or nausea. -No formal "screening" exists, but vigilance in EDs during summer surges saves lives. -Arreaza: I think awareness is a key element in prevention, so education of the public through traditional media like TV, and even social media can contribute to the prevention of this catastrophic condition.Jacob: Ya so heat stroke is something that should be on every physician's radar in the central valley especially in the summer time given the hot temperatures. Rapid recognition is key. Arreaza: Thanks, Jacob for this topic, and until next time, this is Dr. Arreaza, signing off.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! References:Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2016 Apr;50(4):607-16. doi: 10.1016/j.jemermed.2015.09.014. Epub 2015 Oct 31. PMID: 26525947. https://pubmed.ncbi.nlm.nih.gov/26525947/.Platt, M. A., & LoVecchio, F. (n.d.). Nonexertional classic heat stroke in adults. In UpToDate. Retrieved September 7, 2025, from https://www.uptodate.com/contents/nonexertional-classic-heat-stroke-in-adults. (Key addition: Emphasizes insidious onset in at-risk populations and the role of urban heat islands in exacerbating classic cases.) Heat Stroke. WikEM. Retrieved December 3, 2025, from https://wikem.org/wiki/Heat_stroke. (Key additions: Details on cooling rates for immersion therapy, confirmation that anhidrosis is not diagnostic, and fluid titration to urine output for rhabdomyolysis prevention.)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

In the final episode of this seven-part series, Dr. Jon Stone and Dr. Gabriela Gilmour wrap up the conversation discussing future directions.  Show citations: Functional Neurological Disorder Society Finkelstein SA, Carson A, Edwards MJ, et al. Setting up Functional Neurological Disorder Treatment Services: Questions and Answers. Neurol Clin. 2023;41(4):729-743. doi:10.1016/j.ncl.2023.04.002  Show transcript:  Dr. Gabriela Gilmour: This is Gabriela Gilmour with the Neurology Minute. Jon Stone and I are back for our final episode of our seven-part series on functional neurological disorder. Today, we will discuss future directions for the field of FND. So Jon, where do you see the field of FND going in terms of diagnosis and treatment? Dr. Jon Stone: So we've seen a tremendous increase in interest in FND, particularly in the last five years since we started the FND Society. I think there's much more awareness of making rule-in diagnoses compared to before. There's much more positivity about treatment and I think people who experience their own patients doing very well with treatment makes them want to see that again. But we've got a long way to go. I think the diagnostic ruling features that we talked about in an earlier episode are still largely clinical. I think we could really benefit from seeing those becoming more laboratory supported, particularly for research, particularly for looking at FND comorbidity and other neurological conditions like MS and Parkinson's. So I think we might see more of that, AI helping us with that maybe, but things like quantifying some of the physical signs that we use. In terms of treatment, I think it's great all the different ideas about treatment that we've had and we know that the rehabilitation therapy for FND benefits from a more FND focused approach. But we have to be honest as well and say that the treatments, there's still large numbers of patients who are not improving. And so we do need to think about other ways to help people. People are interested in treatments, modalities such as using virtual reality, people looking at medications such as psychedelics or things like that. We've got to be careful with that obviously in peoples where their brains don't work properly. But I think we can do better than we are and people are exploring those options interestingly. Dr. Gabriela Gilmour: Yeah. And I think on the note of treatment, as we've sort of spoken through this podcast series, we've talked about places or environments where there's already services set up for patients. And so I think another major goal for the future for the FND Society is to build more services and have more expertise and knowledge across the world. What would you tell neurologists to do or how would you support them if they don't have other health professionals to help in their local environment? Dr. Jon Stone: Well, I'm aware that that's probably what most neurologists feel like. That they can recognize FND, but they don't have people to refer to or therapists who know about FND. So I certainly share that frustration. What I would say has happened locally here in Edinburgh, and also I see this in other centers as well. If you just start referring patients, helping to send patients to your colleagues who want to have therapy, educating your colleagues, then the people around you can develop that expertise that's needed. You don't necessarily need a whole new team. If you're an enthusiastic neurologist interested in FND, be careful about doing it just on your own because I think there's a lot of good you can do, but it'd be quite easy to burn out there without some help. So I think it's a slow process of gathering together interested health professionals. Ideally, of course, you want to have a psychologist to do therapy, a psychiatrist for more detailed assessments of complex patients, physio, OT, speech and language therapy. Once you get that, what I find is that then locally, they will start to teach each other because this is work that most people in rehabilitation actually enjoy when they know how to do it. They like seeing people with FND. They like the fact that this is a disorder that will often be static for many years or a long time anyway, and where therapy can actually change that trajectory. So just sort of hang in there. There are articles you can read about more details about how to set up services and think about that as well. Dr. Gabriela Gilmour: Well, thank you so much, Jon, for joining me for this series. This is our final episode of the Neurology Minute series on Functional Neurological Disorder. And thank you to all of our listeners. Dr. Jon Stone: Thank you very much, Gabriela.  

In part six of this seven-part series on FND, Dr. Jon Stone and Dr. Gabriela Gilmour discuss the prognosis of functional neurologic disorders.  Show citation:  Gelauff J, Stone J. Prognosis of functional neurologic disorders. Handb Clin Neurol. 2016;139:523-541. doi:10.1016/B978-0-12-801772-2.00043-6  Show transcript:  Dr. Jon Stone: This is Jon Stone with the Neurology Minute. Gabriela Gilmour and I are back to continue with part six of our seven-part series on FND. Today we're going to talk about prognosis. What's the outlook for people with FND? It's obviously a question that patients and relatives desperate to know the answer. Gabriela, what do you say to your patients with FND when they say, "What's going to happen to me? Dr. Gabriela Gilmour: That's a difficult question because the prognosis is variable and I'll talk in a moment about what we know about prognosis from the literature. But I think when patients ask me what's going to happen, I try to instill hope because we do know that this is a condition that can improve and it can improve, especially when patients have access to rehabilitation programs or psychotherapy or other treatment plans. So I try to emphasize that piece and emphasize hope when I'm talking about that with my patients. But if we sort of take a step back and we look at what is the overall prognosis from what we know in the literature with FND, fundamentally, FND for many is a chronic and often relapsing condition. As I mentioned, it can certainly improve with rehabilitation. A challenge is that most of our published studies on the prognosis of FND really come from a time when we knew a lot less about the condition and we had fewer treatment options. So these studies are somewhat difficult to apply today, but in these studies, we see that at least without treatment, most patients are the same or worse at follow-up. However, now we're starting to develop more rehabilitation programs and we have more evidence that shows that people certainly improve with rehabilitation and with therapy. There are some factors that I try to emphasize to patients as being good prognostic factors when I'm talking with them. These may be things like younger age, a shorter duration between symptom onset and diagnosis and patient agreement with the diagnosis or the perception of having control over their illness. When these types of things are present, I try to highlight them to, again, help build that hope for recovery. The one thing that I would also add maybe a bit of a different question, but I think is important to mention is that we as neurologists still have a lot to provide to our patients, even those who may not see much recovery in their symptoms and live with chronic illness. It's really important to consider that regular check-ins. In these check-ins, we can monitor for changing perpetuating factors. We can facilitate social services, mobility aids that help overall quality of life. We can still offer a lot to our patients. The other piece that I would mention too is that our patients are at risk of iatrogenic harm. So there is definitely a role for the neurologist to look at, are there medications that might not be indicated that are causing harm? Are there other things that we can communicate clearly with other care providers to make sure that we reduce that risk for our patients? Dr. Jon Stone: So it's about balancing some realism, but also making sure the patient doesn't lose hope. A good outcome isn't always necessarily that symptoms gone away. It might be similar to other chronic neurological conditions that we look after where we're okay with an outcome where the patient still has symptoms if they understand their condition and can learn to live with it better. We'll be back for our final Neurology Minute episode on FND with myself and Gabriela Gilmour talking about future directions in FND. Thanks for listening.

In part five of this seven-part series on FND, Dr. Jon Stone and Dr. Gabriela Gilmour discuss treatment options.  Show citation:  Gilmour, G.S., Nielsen, G., Teodoro, T. et al. Management of functional neurological disorder. J Neurol 267, 2164–2172 (2020). https://doi.org/10.1007/s00415-020-09772-w  Gilmour GS, Langer LK, Bhatt H, MacGillivray L, Lidstone SC. Factors Influencing Triage to Rehabilitation in Functional Movement Disorder. Mov Disord Clin Pract. 2024;11(5):515-525. doi:10.1002/mdc3.14007  Stone J, Carson A. Multidisciplinary Treatment for Functional Movement Disorder. Continuum (Minneap Minn). 2025;31(4):1182-1196. doi:10.1212/cont.0000000000001606 Tolchin B, Goldstein LH, Reuber M, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. doi:10.1212/WNL.0000000000214466  Show transcript:  Dr. Jon Stone: Hello, this is Jon Stone with the Neurology Minute. Gabriela Gilmour and I are back to continue with part five of our seven-part series on FND. Today we'll be discussing treatment. Gabriela, talk us through what the rehabilitation or therapy approaches exist for FND now. Dr. Gabriela Gilmour: I would start actually even before jumping into rehabilitation and therapy to again emphasize something that we talked about in the last episode, which is that rehabilitation very much starts at our first visits with our patients when we examine for positive signs and show these to our patients and explain what they mean. So education about FND is really a fundamental treatment step, and I think we as neurologists have so much to offer to our patients in these visits. Next, when we're thinking about rehabilitation for FND, this often includes some combination of physical rehabilitation and psychological therapy and really should be individualized to each patient. So multidisciplinary or integrated therapy approaches are the gold standard and treatment strategies with these are really guided by our evolving understanding of the mechanisms of FND. So for example, this means using strategies like distraction, motor visualization, relaxation and mindfulness to target that underlying mechanism of FND. And then we use psychological therapies to also address perpetuating factors. So as we have discussed in this series, patients often experience many symptoms. So we also want to think about those other symptoms in our treatment plan, whether that be chronic pain or sleep disturbance or treating comorbid psychiatric or neurological illness. When we think about the subtypes of FND, there is some research into specific strategies for each. So psychotherapy, in particular, cognitive behavioral therapy is the focus for functional dissociative seizures with strategies aimed at attack prevention. Whereas for functional movement disorder, motor retraining physiotherapy has the most evidence. One big thing that I want to emphasize though is that rehabilitation for FND really relies on patient self-management and patient engagement. So I often explain to my patients that I can't retrain their brain, but I can help support them in this process and doing this for themselves. Dr. Jon Stone: So when you meet a patient with FND, how do you decide whether therapy is going to be helpful for them? I think people often have a tendency to say, "Oh, it's FND right off you go to psychotherapy or physiotherapy," but is that always the right option? How should we try and help our patients to decide if it's the right time for them to do these treatments? Dr. Gabriela Gilmour: Yeah, I think that that's something that's really maybe not unique, but something that's really important to FND and to treatment planning and FND. When we're supporting our patients as they embark on a treatment pathway, we really want to set them up for success. And so this really does rely on a robust triage process. So unlike other neurological conditions where you have X disease, therefore, why is the treatment? For FND, we've got a host of different types of treatments, and we want to individualize that and we want to time it right. Fundamentally, we really want to select the right treatment for our patients, and that relies on us understanding what symptoms are most bothersome to our patients, and we want to then provide that treatment at the right time. And I think right time is really what I would emphasize as being so, so important. So this means that patients are ready for active participation and rehabilitation, they're enthusiastically opted in. They think that treatment's going to help, and there aren't major barriers that are going to impact their ability to participate fully, so things like severe pain that could get in the way. And this is a conversation that I have really openly with my patients, and I really try to let them guide the timing. They will let me know, "Hey, I'm a teacher, and I'm in school right now. Now is not the right time for me to embark on this, but what about in June or July?" And then we revisit and regroup at that time. So really I do let my patients guide this process, but I would say that there are a subset of patients that don't need these more advanced rehabilitation type programs. Maybe are spontaneously improved or are able to implement some of their own self-management strategies on their own and have a significant improvement in symptoms already. Dr. Jon Stone: We need to make it easy for our patients to tell us when it's not the right time, but also, there's no one-size-fits-all, basically. Dr. Gabriela Gilmour: Absolutely. Dr. Jon Stone: So we'll be back for more Neurology Minute to continue our discussion on FND. We'll be talking about prognosis. Thanks for listening.

In part four of this seven-part series on FND, Dr. Jon Stone and Dr. Gabriela Gilmour discuss the diagnostic explanation.  Show citation:  Stone J. Functional neurological disorders: the neurological assessment as treatment. Pract Neurol. 2016;16(1):7-17. doi:10.1136/practneurol-2015-001241  Gilmour GS, Lidstone SC. Moving Beyond Movement: Diagnosing Functional Movement Disorder. Semin Neurol. 2023;43(1):106-122. doi:10.1055/s-0043-1763505  Podcast transcript:  Dr. Gabriela Gilmour: This is Gabriela Gilmour with the Neurology Minute. Jon Stone and I are back to continue with part four, of seven, of our series on functional neurological disorder. Today we will focus on the diagnostic explanation. So many patients have never heard of FND before receiving this diagnosis. Can you share how you explain the diagnosis to your patients? Dr. Jon Stone: So I'm aware that many neurologists do find this difficult. And I have to say, having thought about it for 20 years or so now, I think the answer is, don't be weird. Do what you normally do with any condition, when you explain it to patients. I think what goes wrong is that people see FND as something weird and other, and they start to do weird things like telling people that their scans are normal, or telling them what they don't have before they've started to tell them what they do. If you go with the normal rules of explanation, first of all, starting by giving it a name that you prefer, so you've got FND, or try and be specific if you can. You've got functional seizures, functional movement disorder. Give it a name to start with. Don't sort of spend a long time beating around the bush before you do that. Talk a bit about why you've made the diagnosis, because that's what you normally do. So if someone's got a weak leg, show them their Hoover's sign. I think actually showing people their physical signs is probably one of the most powerful things you can do, brings the diagnosis away from the scanner and into the clinic room. And also, they can see in front of them the potential for improvement. So it feeds forward into treatment. Yes, you might need to explain why they don't have some other conditions that they're worried about, but you can leave discussions about why it's happened for later. I think what tends to go wrong is people jump into that too early. So the bottom line, just do what you normally do and things generally go a lot more smoothly. Dr. Gabriela Gilmour: And when you're providing the diagnostic explanation, it can be really helpful to link the patient's experience and their symptoms to the diagnosis. And so, I wonder how you integrate that piece into your diagnostic explanation, or how you tailor your explanation to an individual patient. Dr. Jon Stone: Yeah, I think tailoring is really important here. And this is where obviously if you've done your assessment, so helpful to ask the patient is, "Well, what do you think's wrong? What things were you worried about? " Some people say, "Look, I'm really worried I've got MS." Or some people say, "I haven't got FND. I've read about that. " Or sometimes people are wondering if they've got FND. So, you've got to try and tailor it to what the person is expecting and particularly previous experiences. If they're telling you how angry they were about doctors A, B, and C, then obviously you want to use that and try not to end up with the same outcome. Why would there be a problem with this diagnosis? It's because they haven't heard about it, because they've got misconceptions about it. Do they feel that this diagnosis would be saying it's all in their mind or something like that? You might need to be explicit about that. But I think this links into how, it's not just about the diagnostic label, it's about a formulation, which is something we don't think about much in neurology. So there's a label for what's wrong, but in FND, a formulation, why have you got FND, in your particular case, is what we're sort of moving on to there based on the story that you've heard. Dr. Gabriela Gilmour: Yeah. And I think in my experience and in working with trainees, really just practicing, saying it, is so important and saying it in a way that feels honest and correct to you as a clinician. Dr. Jon Stone: Yeah, absolutely. Dr. Gabriela Gilmour: So we will be back for more Neurology Minute episodes to continue our discussion on FND. Next, we're going to be talking about treatment. Thanks for listening.

In part three of this seven-part series on FND, Dr. Jon Stone and Dr. Gabriela Gilmour discuss causes of functional neurologic disorder.  Show citation:  Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-550. doi:10.1016/S1474-4422(21)00422-1 Show transcript:  Dr. Gabriela Gilmour: This is Gabriela Gilmour with the Neurology Minute. Jon Stone and I are back to continue with part three of our seven-part series on functional neurological disorder. Today, we will focus on the causes of FND. So Jon, there have been many advances in our understanding of the mechanism of FND in the last 10, 15 years. And so what do we know about this now? Dr. Jon Stone: I think the key message I want to get across here is that whereas previously we had a very psychiatric, purely psychiatric view of FND, it used to be called conversion disorder, what we've got now is a multi-perspective view of the mechanisms, which mean that we can understand FND at a kind of neural level or brain circuit level, but we can also still retain the importance of psychological factors, traumatic events. And I think it's also important to separate out, as you've done here with a question, what's the mechanism? How is the symptom happening versus why is it happening? Which often people don't do. So for this question, how is it happening? How is it that somebody, for example, gets a weak leg? Well, at a very simple level, their brain is disconnecting from their leg and that's what dissociation is. And you can explain that to patients at sort of brain circuit level. We've learned that there are disruptions probably in the circuits in our brain that relate to that sense of agency, the parts of our brain that tell us that our bodies belong to us. And people are particularly interested in an area called the temporary parietal junction. And at a higher broader level, people are particularly interested in the idea that FND is a disorder that you would expect to happen based on our understanding of the brain as a predictive organ. So if the brain spends its time predicting things, maybe in FND what's gone wrong is this is very strong prediction that the leg is weak or that there's a tremor or that a seizure's about to happen that overrides sensory input telling our brain otherwise. Dr. Gabriela Gilmour: And I guess to follow into that, you mentioned what is going on. So now can you talk a little bit about why somebody might develop FND or the etiology of FND? Dr. Jon Stone:  I think this helps clinically as well as neurologists, because we can talk about mechanism as we would, for example, with MS as inflammation, but why is there inflammation? So okay, the brain's gone wrong, but why has it gone wrong? And there we need a much more complex view of multiple range of risk factors, predisposing, precipitating, and perpetuating that we know are associated with FND, but vary a lot from person to person. So no one person's the same. If you've had traumatic experiences in the past, that will make you more prone to dissociation. If you've had other functional disorders, if you have almost certainly some forms of genetics make people predisposed. And then as we said in the last episode, having another neurological condition, so having migraine aura, a physical injury, an infective illness, these are powerful reasons to trigger neurological symptoms. And it's not so much why they happen. It's more why do they get there and get stuck? We all probably have transient functional symptoms actually, but why they get stuck in people with FND for various reasons to do with the way their brains work or their past experiences, or sometimes what happens to them in medical systems. So developing a very open idea about why someone might have FND really helps you, I think, explain that back to patients and produce individual sort of formulations of the problem. Dr. Gabriela Gilmour: Yeah. And I often say to my patients, "I don't know exactly why you, why today have this." And that's true in medicine in general. We actually often don't know why anybody develops any medical condition with a few exceptions, but we know about risk factors really. Dr. Jon Stone: Absolutely. It's one of the reasons I hate the term medically unexplained. Actually, I think FND is perhaps more explained in some ways than some of the other conditions like multiple sclerosis and ALS that we actually deal with where we really don't know why they happen. Dr. Gabriela Gilmour: Well, we will be back for more Neurology Minute episodes to continue our discussion on FND. Thanks for listening. 

In part two of this seven-part series on FND, Dr. Jon Stone and Dr. Gabriela Gilmour discuss pitfalls in the diagnostic process.  Show citation:  Finkelstein SA, Popkirov S. Functional Neurological Disorder: Diagnostic Pitfalls and Differential Diagnostic Considerations. Neurol Clin. 2023;41(4):665-679. doi:10.1016/j.ncl.2023.04.001   

Send us a textMorning Prayer (Body of Christ; TBI, Alzheimer's, ALS, Huntington's, Parkinson, and other neurologic diseases)  #prayer #morningprayer #pray #jesus #god #holyspirit #aimingforjesus #healing #peace #love #bible #ALS #huntingtonsdisease #parkinson #alzheimer #lewybodydementia #lewy#neurologicaldisorders Thank you for listening, our heart's prayer is for you and I to walk daily with Jesus, our joy and peace aimingforjesus.com YouTube Channel https://www.youtube.com/@aimingforjesus5346 Instagram https://www.instagram.com/aiming_for_jesus/ Threads https://www.threads.com/@aiming_for_jesus X https://x.com/AimingForJesus Tik Tok https://www.tiktok.com/@aiming.for.jesus

In part one of this seven-part series on FND, Dr. Jon Stone and Dr. Gabriela Gilmour discuss the process of diagnosing FND.  Show citation:  Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64. Published 2022 Jan 24. doi:10.1136/bmj.o64 

Stephanie C. DeMasi, MD, joins CHEST® Journal Podcast Moderator, Matt Siuba, DO, MS, to discuss her research comparing neurologic outcomes between lower and higher oxygen saturation targets following cardiac arrest.  DOI: 10.1016/j.chest.2025.04.027 Disclaimer: The purpose of this activity is to expand the reach of CHEST content through awareness, critique, and discussion. All articles have undergone peer review for methodologic rigor and audience relevance. Any views asserted are those of the speakers and are not endorsed by CHEST. Listeners should be aware that speakers' opinions may vary and are advised to read the full corresponding journal article(s) for complete context. This content should not be used as a basis for medical advice or treatment, nor should it substitute the judgment used by clinicians in the practice of evidence-based medicine. 

Active or not active, that is the question. In this week's episode we interview Alexandra Villa-Forte, MD, MPH, a staff physician in the Center for Vasculitis Care and Research at Cleveland Clinic and a leading vasculitis expert, on a pragmatic approach to recognizing disease activity in patients with ANCA vasculitis. ·       Intro 0:01 ·       Welcome Alexandra Villa-Forte, MD, MPH 0:10 ·       Dr. Brown sketches a potential patient that may be seen in practice 0:40 ·       How are you monitoring patients' kidneys? 1:28 ·       How reliable are ‘no casts' results in urinalysis tests? 4:15 ·       What is happening in the glomeruli? 5:23 ·       The importance of monitoring the urinalysis of patients with ANCA vasculitis 7:06 ·       Symptoms to watch for when tapering off medications 7:43 ·       Different scenarios with lung symptoms 9:35 ·       Evaluating patients with GPA; looking at the nose, ear and sinuses 12:20 ·       Neurologic symptoms in ANCA vasculitis 14:24 ·       Laboratory monitoring 15:52 ·       Should ANCA titers be a part of routine vasculitis monitoring? 17:05 ·       What is your approach using PJP prophylaxis in ANCA-associated vasculitis? 18:05 Thank you, Dr. Villa-Forte! 20:25 We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.   Disclosures: Brown reports no relevant financial disclosures. Healio was unable to confirm relevant financial disclosures for Villa-Forte at the time of publication.

In this episode, Amy Johnson, DVM, DACVIM (LAIM & Neurology), joined us to talk about noninfectious neurologic diseases in horses, specifically CVSM and eNAD/EDM. She discussed clinical signs, diagnostics, management options, and more.This episode of Disease Du Jour is brought to you by Equithrive.GUESTS AND LINKS - EPISODE 166Host: Carly Sisson (Digital Content Manager) of EquiManagement | Email Carly (CSisson@equinenetwork.com)Guest: Dr. Amy Johnson, DVM, DACVIM (LAIM & Neurology)Podcast Website: Disease Du JourThis episode of Disease Du Jour podcast is brought to you by Equithrive.Connect with the Host: Carly Sisson (Digital Content Manager) of EquiManagement | Email Carly (CSisson@equinenetwork.com)

In today's episode, we had the pleasure of speaking with Alexander Drilon, MD, about the phase 1/2 ARROS-1 trial (NCT05118789) investigating zidesamtinib (NVL-520) in TKI-pretreated patients with advanced ROS1-positive non–small cell lung cancer (NSCLC). Dr Drilon is chief of the Early Drug Development Service at Memorial Sloan Kettering Cancer Center in New York, New York. In our exclusive interview, Dr Drilon discussed the efficacy data and implications of the ARROS-1 trial, highlighted the unique mechanism of action of zidesamtinib, noted the high central nervous system (CNS) response rates and favorable safety profile associated with the agent, and emphasized the potential for zidesamtinib to become a standard first-line therapy in the NSCLC treatment paradigm, especially for patients with prior TKI resistance or CNS disease.

In this episode, Amy Johnson, DVM, DACVIM (LAIM & Neurology), joined us to talk about noninfectious neurologic diseases in horses, specifically CVSM and eNAD/EDM. She discussed clinical signs, diagnostics, management options, and more.This episode of Disease Du Jour is brought to you by Equithrive.GUESTS AND LINKS - EPISODE 166Host: Carly Sisson (Digital Content Manager) of EquiManagement | Email Carly (CSisson@equinenetwork.com)Guest: Dr. Amy Johnson, DVM, DACVIM (LAIM & Neurology)Podcast Website: Disease Du JourThis episode of Disease Du Jour podcast is brought to you by Equithrive.Connect with the Host: Carly Sisson (Digital Content Manager) of EquiManagement | Email Carly (CSisson@equinenetwork.com)

I'm Dr. Daniel Cameron. In my practice, I often see patients with chronic pain, and I want to explore whether chronic Lyme disease could be part of the puzzle behind America's growing pain epidemic.A recent paper by Jovkovich in Pain reported that chronic pain prevalence in U.S. adults rose from 21% in 2019 to 24% in 2023—affecting 60 million people. Only about 13% of this increase was linked to long COVID. The rest remains unexplained.Overlap Between Lyme Pain and National Pain TrendsThe types of pain described—back, neck, joint, headache, abdominal, and widespread musculoskeletal pain—mirror what I see in chronic Lyme patients. Lyme pain is often multi-system, migratory, unpredictable, and can flare with fatigue and stress. It includes:Musculoskeletal pain: Joint and tendon pain, often misdiagnosed as fibromyalgia.Neurologic pain: Headaches resistant to migraine therapy, burning or electrical-shock sensations, small fiber neuropathy.Abdominal/pelvic pain: Frequently linked with autonomic dysfunction.Why Lyme Gets MissedTesting limitations: Standard CDC two-tier testing is more reliable in acute cases, leaving many chronic patients without positive results.Mislabels: Fibromyalgia, chronic fatigue syndrome, or “pain of unknown origin.”COVID-era factors: More outdoor exposure, missed diagnoses due to care delays, absent rash or visible tick bite.Geography and DemographicsThe pain hotspots in the Pain study—Northeast, Upper Midwest, Pacific coast—are also Lyme-endemic regions. Affected populations included working adults, outdoor enthusiasts, rural and suburban residents, aligning closely with Lyme risk groups.Strongest Evidence: Treatment ResponsePerhaps the clearest sign is clinical: when patients with undiagnosed Lyme receive targeted antibiotic or co-infection therapy, their chronic pain often improves or resolves.Bottom line: Chronic Lyme disease may be an overlooked contributor to America's pain crisis. The symptoms overlap, the geography matches, and patients often respond to treatment. To better address the 60 million Americans in pain, we need to update diagnostic strategies, look beyond tick rash and positive tests, and include Lyme disease in the differential.

I'm Dr. Daniel Cameron, and today I'm addressing a question I often see in my practice: What are the risk factors for chronic Lyme disease?Chronic Lyme SymptomsSome patients do not fully recover from Lyme disease. They experience a broad range of symptoms, including ongoing fatigue, pain, sleep problems, neurologic changes, emotional strain, and disruption of daily life. These challenges can affect school, parenting, and work responsibilities.Common chronic Lyme manifestations include:Musculoskeletal: chronic arthritis, muscle pain, stiffness, and tendon inflammation.Neurologic and psychiatric: brain fog, memory issues, neuropathy, sensory changes, depression, irritability, mood swings, and PANS. Post-treatment Lyme disease syndrome (PTLDS) is often debated, but I view it as a potential ongoing infection rather than simply a syndrome.Cardiovascular/dysautonomia: POTS, Lyme carditis, arrhythmias, chest pain, and dizziness.Other manifestations: sensory overload (light, sound, heat, cold, or smell sensitivity), sometimes related to dysautonomic issues.Risk Factors for Chronic Lyme DiseaseWhile formal assessments are ongoing, in my practice I see several consistent contributors:Severe initial infection such as neurologic Lyme meningitis or carditis.Treatment delays, sometimes months or years.Early systemic involvement at onset—widespread fatigue, pain, neurological symptoms, or functional loss.Co-infections such as Babesia and other tick-borne pathogens.Reinfections and relapses, which can increase the likelihood of chronic complications.Key Takeaways for CliniciansScreen patients carefully for these risk factors.Monitor for co-infections, especially in high-risk or relapsing patients.Do not dismiss persistent symptoms, even if a formal diagnosis has not yet been established.Advice for PatientsSeek early treatment—timing matters.If symptoms persist, pursue a second opinion or find a physician experienced in managing chronic manifestations of Lyme disease.Watch for co-infections, especially Babesia, which may complicate recovery and even mimic other conditions (e.g., menopause).Advocate for comprehensive care for yourself and your family.Thank you for joining me. Please leave your questions and comments below—I read them all and respond where I can.

In this episode of The Crux True Survival Story Podcast, hosts Kaycee McIntosh and Julie Henningsen unravel the harrowing tale of 7-year-old Calena Areyan Gruber, who miraculously survived a catastrophic accident during sailing camp in Biscayne Bay, Miami. The story highlights the resilience and incredible survival instincts of a child caught in an underwater disaster caused by a massive commercial barge. The episode also delves into the tragic loss of three other young sailors, the regulatory failures in maritime safety, and the urgent need for reform to prevent similar tragedies. The podcast underscores the unpredictable nature of life and the extraordinary capabilities of human survival, particularly in children. 00:00 Introduction to the Crux True Survival Story Podcast 00:31 Setting the Scene: A Tragic Day in Miami Bay 09:53 The Collision: A Catastrophic Event 12:34 Kalina's Extraordinary Survival 16:18 The Aftermath: Rescue and Recovery 24:23 Calls for Maritime Safety Reforms 28:46 Reflections on Youth Sailing Safety 31:23 Conclusion and Listener Engagement who miraculously survived a catastrophic accident during sailing camp in Biscayne Bay, Miami. The story highlights the resilience and incredible survival instincts of a child caught in an underwater disaster caused by a massive commercial barge. The episode also delves into the tragic loss of three other young sailors, the regulatory failures in maritime safety, and the urgent need for reform to prevent similar tragedies. The podcast underscores the unpredictable nature of life and the extraordinary capabilities of human survival, particularly in children. 00:00 Introduction to the Crux True Survival Story Podcast 00:31 Setting the Scene: A Tragic Day in Miami Bay 09:53 The Collision: A Catastrophic Event 12:34 Calena's Extraordinary Survival 16:18 The Aftermath: Rescue and Recovery 24:23 Calls for Maritime Safety Reforms 28:46 Reflections on Youth Sailing Safety 31:23 Conclusion and Listener Engagement Miami Bay Miracle Podcast - References and Sources Primary Incident Sources ABC News "2 children dead after barge strikes sailboat from youth sailing program: Officials" July 29, 2025 https://abcnews.go.com/US/miami-beach-sailboat-capsized-youth-sailing-program/story?id=124149834 CBS Miami "Two children dead after sailboat and barge collision off Miami Beach, officials say" August 5, 2025 https://www.cbsnews.com/miami/news/two-children-killed-sailboat-barge-collision-off-miami-beach/ CNN "Third girl dies after sailboat and barge collision in Miami" August 3, 2025 https://www.cnn.com/2025/08/03/us/miami-boat-accident-crash-death CBS Miami "Third girl dies after sailboat crash with barge near Miami Beach, family and officials confirm" August 4, 2025 https://www.cbsnews.com/miami/news/10-year-old-miami-beach-boat-crash-victim-ari-buchman-died/ Survivor and Family Information Fox Business "Miami sailboat crash survivor's family issues statement after deadly incident" August 2025 https://www.foxbusiness.com/lifestyle/miami-sailboat-crash-survivor-stared-death-face-lawyer-says NBC 6 South Florida "Parents of Calena Gruber, Miami sailing camp tragedy survivor, speak" August 2025 https://www.nbcmiami.com/news/local/family-of-7-year-old-miami-sailing-camp-tragedy-survivor-speaks/3672444/ PEOPLE Magazine "Family of 7-Year-Old Girl Who Survived Miami Boat Crash That Killed 3 Say It's a 'Miracle She's Alive'" August 2025 https://www.yahoo.com/news/articles/family-7-old-girl-survived-100808752.html Miami Herald via Sun Sentinel "'It's a miracle she's alive.' Girl injured in boat crash was trapped under barge" August 4, 2025 https://www.sun-sentinel.com/2025/08/04/girl-seriously-injured-after-biscayne-bay-barge-sailboat-crash-recovering-family-says/ Legal and Investigation Coverage WLRN "Attorney for survivor of deadly sailboat crash calls tragedy 'preventable'" August 5, 2025 https://www.wlrn.org/law-justice/2025-08-04/attorney-for-survivor-of-deadly-sailboat-crash-calls-tragedy-preventable Local 10 WPLG "Lawsuit IDs owner of barge in deadly Biscayne Bay crash with youth sailing camp boat" August 8, 2025 https://www.local10.com/news/local/2025/08/08/lawsuit-ids-owner-of-barge-in-deadly-biscayne-bay-crash-with-youth-sailing-camp-boat/ Leesfield & Partners "Leesfield & Partners Representing Family of Girl, 7, Injured in Miami Beach Deadly Sailboat Crash" August 5, 2025 https://www.floridainjurylawyer-blawg.com/leesfield-partners-representing-family-of-girl-7-injured-in-miami-beach-deadly-sailboat-crash/ Boating Safety Statistics U.S. Coast Guard Boating Safety "2023 Recreational Boating Statistics" 2024 https://www.uscgboating.org/library/accident-statistics/Recreational-Boating-Statistics-2023-Ch2.pdf American Boating Association "Boating Fatality Facts" May 30, 2025 https://americanboating.org/boating_fatality.asp Children's Safety Network "Boating Safety" https://www.childrenssafetynetwork.org/infographics/boating-safety Child Drowning and Near-Drowning Research Children's Safety Network "The Facts On Childhood Drowning" https://www.childrenssafetynetwork.org/infographics/facts-childhood-drowning American Red Cross "Drowning Prevention & Facts" https://www.redcross.org/get-help/how-to-prepare-for-emergencies/types-of-emergencies/water-safety/drowning-prevention-and-facts.html Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine "Neurologic long term outcome after drowning in children" August 15, 2012 https://sjtrem.biomedcentral.com/articles/10.1186/1757-7241-20-55 NeuroLaunch "Near-Drowning's Psychological Impact: Long-Term Effects and Recovery" September 15, 2024 https://neurolaunch.com/psychological-effects-of-near-drowning/ Maritime Safety and Regulation Information NOAA Fisheries "Understanding Vessel Strikes" https://www.fisheries.noaa.gov/insight/understanding-vessel-strikes Frontiers in Marine Science "A Global Review of Vessel Collisions With Marine Animals" April 14, 2020 https://www.frontiersin.org/journals/marine-science/articles/10.3389/fmars.2020.00292/full Witness Accounts and Community Response Sailing Anarchy Forums "Two children dead after barge hits sailboat in Biscayne Bay" July 28, 2025 https://forums.sailinganarchy.com/threads/two-children-dead-after-barge-hits-sailboat-in-biscayne-bay.252661/ WLRN "Sailboat crash victims ages 7 and 13, says Coast Guard. Two other kids in critical condition" July 29, 2025 https://www.wlrn.org/south-florida/2025-07-29/biscayne-bay-sailboat-crash-victims-ages-7-and-13-two-other-kids-hospitalized-in-critical-condition Key Facts Confirmed by Multiple Sources: Incident Details: Date: July 28, 2025 Time: Approximately 11:15 AM Location: Between Hibiscus Island and Monument Island, Biscayne Bay, Miami Beach Victims: 6 total (5 children ages 7-13, 1 adult counselor age 19) Casualties: Deceased: Mila Yankelevich (7), Erin Ko Han (13), Arielle Buchman (10 - died August 4) Survivors: Calena Areyan Gruber (7), one unnamed child, adult counselor (19) Survivor Information: Calena Areyan Gruber from Seattle Parents: Karina Gruber Moreno and Enrique Areyan Viqueira Attorney: Justin B. Shapiro, Leesfield & Partners Released from Jackson Memorial Hospital: August 1, 2025 Injuries: Lacerations and contusions throughout body Trapped under 60-foot barge before swimming to safety Legal/Investigation: Coast Guard and Florida Fish and Wildlife Commission investigating Barge owned by Waterfront Construction (Jorge Rivas) Tugboat under 26 feet (no licensed captain required) Multiple lawsuits filed alleging negligence

Dr. Trey Bateman and Dr. David T. Jones discuss how the StateViewer system leverages FDG-PET imaging and machine learning to improve diagnostic accuracy and clinical decision-making for Alzheimer disease and related disorders. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213831 

Dr. Trey Bateman talks with Dr. David T. Jones about how the StateViewer system leverages FDG-PET imaging and machine learning to improve diagnostic accuracy and clinical decision-making for Alzheimer disease and related disorders. Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

Welcome to "PICU Doc on Call," the podcast where real cases meet real expertise at the bedside! Join Dr. Monica Gray, Dr. Pradip Kamat, and Dr. Rahul Damania as they unravel the mysteries of pediatric critical care. In today's episode, our team dives into the compelling case of a previously healthy seven-year-old girl who arrives with seizures, right arm weakness, and sudden respiratory failure. Together, they'll break down the diagnosis and management of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease, also known as MOGAD. This autoimmune demyelinating disorder can challenge even the most seasoned clinicians. Tune in as our experts walk you through the clinical features, essential diagnostic workup, and the critical importance of early immunosuppressive therapy. Whether you're at the bedside or on the go, this episode is packed with practical pearls and a multidisciplinary approach to recognizing and treating acute pediatric neuroimmunological emergencies in the PICU. Let's get started!Show Highlights:Presentation of a complex pediatric case involving a seven-year-old girl with new-onset seizures and acute respiratory failureDiscussion of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) as an autoimmune demyelinating disorderOverview of the clinical presentation and diagnostic criteria for autoimmune encephalitisImportance of a broad differential diagnosis, including infectious and autoimmune causes, in pediatric patients with seizures and neurological deficitsDiagnostic approach involving MRI, lumbar puncture, and antibody testing for MOGADManagement strategies for MOGAD, including stabilization, seizure control, and immunosuppressive therapyNeurocritical care considerations for monitoring and treating elevated intracranial pressureLong-term management challenges and the need for multidisciplinary care in pediatric patients with MOGADDiscussion of potential outcomes and the risk of relapse in children with MOGAD.Emphasis on the importance of early and comprehensive diagnostic testing to avoid misdiagnosisReferences:Fuhrman & Zimmerman - Pediatric Critical Care 6th Edition, Chapter 64Gole S, Anand A. Autoimmune Encephalitis. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK578203/Salama S, Khan M, Pardo S, Izbudak I, Levy M. MOG antibody-associated encephalomyelitis/encephalitis. Mult Scler. 2019 Oct;25(11):1427-1433. doi: 10.1177/1352458519837705. Epub 2019 Mar 25. PMID: 30907249; PMCID: PMC6751007Lancaster E. The Diagnosis and Treatment of Autoimmune Encephalitis. J Clin Neurol. 2016 Jan;12(1):1-13. doi: 10.3988/jcn.2016.12.1.1. PMID: 26754777; PMCID: PMC4712273.Fisher KS, Illner A, Kannan V. Pediatric neuroinflammatory diseases in the intensive care unit. Semin Pediatr Neurol. 2024 Apr;49:101118. Doi: 10.1016/j.spen.2024.101118. Epub 2024 Feb 1. PMID: 38677797.Hébert J, Muccilli A, Wennberg RA, Tang-Wai DF. Autoimmune Encephalitis and Autoantibodies: A Review of Clinical Implications. J Appl Lab Med. 2022 Jan 5;7(1):81-98. Doi: 10.1093/jalm/jfab102. PMID: 34996085.Lopez JA, Denkova M, Ramanathan S, Dale RC, Brilot F. Pathogenesis of autoimmune demyelination: from multiple sclerosis to neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody-associated disease. Clin Transl Immunology. 2021 Jul 26;10(7):e1316. doi: 10.1002/cti2.1316. PMID: 34336206; PMCID: PMC8312887.

Editor's Summary by Linda Brubaker, MD, and Preeti Malani, MD, MSJ, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from July 26-August 1, 2025.

Episode 198: Fatigue.  Future doctors Redden and Ibrahim discuss with Dr. Arreaza the different causes of fatigue, including physical and mental illnesses. Dr. Arreaza describes the steps to evaluate fatigue. Some common misconceptions are explained, such as vitamin D deficiency and “chronic Lyme disease”. Written by Michael Ibrahim, MSIV, and Jordan Redden, MSIV, Ross University School of Medicine. Edits and comments by Hector Arreaza, MDYou are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Dr. Arreaza: Today is a great day to talk about fatigue. It is one of the most common and most complex complaints we see in primary care. It involves physical, mental, and emotional health. So today, we're walking through a case, breaking down causes, red flags, and how to work it up without ordering the entire lab catalog.Michael:Case: This is a 34-year-old female who comes in saying, "I've been feeling drained for the past 3 months." She says she's been sleeping 8 hours a night but still wakes up tired. No recent illnesses, no weight loss, fever, or night sweats. She denies depression or anxiety but does report a lot of work stress and taking care of her two little ones at home. She drinks 2 cups of coffee a day, doesn't drink alcohol, and doesn't use drugs. No medications, just a multivitamin. Regular menstrual cycles—but she's noticed they've been heavier recently.Jordan:Fatigue is a persistent sense of exhaustion that isn't relieved by rest. It's different from sleepiness or muscle weakness.Classification based on timeline:    •   Acute fatigue: less than 1 month    •   Subacute: 1 to 6 months    •   Chronic: more than 6 monthsThis patient's case is subacute—going on 3 months now.Dr. Arreaza:And we can think about fatigue in types:    •   Physical fatigue: like muscle tiredness after activity    •   Mental fatigue: trouble concentrating or thinking clearly (physical + mental when you are a medical student or resident)    •    Pathological fatigue: which isn't proportional to effort and doesn't get better with restAnd of course, there's chronic fatigue syndrome, also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is a diagnosis of exclusion after 6 months of disabling fatigue with other symptoms.Michael:The differential is massive. So, we can also group it by systems.Jordan:Let's run through the big ones.Endocrine / Metabolic Causes    • Hypothyroidism: A classic cause of fatigue. Often associated with cold intolerance, weight gain, dry skin, and constipation. May be subtle and underdiagnosed, especially in women.    • Diabetes Mellitus: Both hyperglycemia and hypoglycemia can cause fatigue. Look for polyuria, polydipsia, weight loss, or blurry vision in undiagnosed diabetes.    • Adrenal Insufficiency: Think of this when fatigue is paired with hypotension, weight loss, salt craving, or hyperpigmentation. Can be primary (Addison's) or secondary (e.g., due to long-term steroid use).Michael: Hematologic Causes    • Anemia (especially iron deficiency): Very common, especially in menstruating women. Look for fatigue with pallor, shortness of breath on exertion, and sometimes pica (craving non-food items).     • Vitamin B12 or Folate Deficiency: B12 deficiency may present with fatigue plus neurologic symptoms like numbness, tingling, or gait issues. Folate deficiency tends to present with megaloblastic anemia and fatigue.    • Anemia of Chronic Disease: Seen in patients with chronic inflammatory conditions like RA, infections, or CKD. Typically mild, normocytic, and improves when the underlying disease is treated.Michael: Psychiatric Causes    • Depression: A major driver of fatigue, often underreported. May include anhedonia, sleep disturbance, appetite changes, or guilt. Sometimes presents with only somatic complaints.    • Anxiety Disorders: Mental fatigue, poor sleep quality, and hypervigilance can leave patients feeling constantly drained.    • Burnout Syndrome: Especially common in caregivers, healthcare workers, and educators. Emotional exhaustion, depersonalization, and reduced personal accomplishment are key features.Jordan: Infectious Causes    • Epstein-Barr Virus (EBV):Mononucleosis is a well-known cause of fatigue, sometimes lasting weeks. May also have sore throat, lymphadenopathy, and splenomegaly.    • HIV:Consider it in high-risk individuals. Fatigue can be an early sign, along with weight loss, recurrent infections, or night sweats.    • Hepatitis (B or C):Can present with chronic fatigue, especially if liver enzymes are elevated. Screen at-risk individuals.    • Post-viral Syndromes / Long COVID:Fatigue that lingers for weeks or months after viral infection. Often, it includes brain fog, muscle aches, and post-exertional malaise.Important: Chronic Lyme disease is a controversial term without a consistent clinical definition and is often used to describe patients with persistent, nonspecific symptoms not supported by objective evidence of Lyme infection. Leading medical organizations reject the term and instead recognize "post-treatment Lyme disease syndrome" (PTLDS) for persistent symptoms following confirmed, treated Lyme disease, emphasizing that prolonged antibiotic therapy is not effective. Research shows no benefit—and potential harm—from extended antibiotic use, and patients with unexplained chronic symptoms should be thoroughly evaluated for other possible diagnoses.Michael: Cardiopulmonary Causes    •   Congestive Heart Failure (CHF): Fatigue from poor perfusion and low cardiac output. Often comes with dyspnea on exertion, edema, and orthopnea.    •   Chronic Obstructive Pulmonary Disease (COPD): Look for a smoking history, chronic cough, and fatigue from hypoxia or the work of breathing.    •   Obstructive Sleep Apnea (OSA): Daytime fatigue despite adequate hours of sleep. Patients may snore, gasp, or report morning headaches. High suspicion in obese or hypertensive patients.Jordan:Autoimmune / Inflammatory Causes    •   Systemic Lupus Erythematosus (SLE): Fatigue is often an early symptom. May also see rash, arthritis, photosensitivity, or renal involvement.    •   Rheumatoid Arthritis (RA): Fatigue from systemic inflammation. Morning stiffness, joint pain, and elevated inflammatory markers point to RA.    •   Fibromyalgia: A chronic pain syndrome with widespread tenderness, fatigue, nonrestorative sleep, and sometimes cognitive complaints ("fibro fog").Cancer / Malignancy    •   Leukemia, lymphoma, or solid tumors: Fatigue can be the first symptom, often accompanied by weight loss, night sweats, or unexplained fevers. Consider when no other cause is evident.Michael:Medications:Common culprits include:    ◦   Beta-blockers: Can slow heart rate too much.    ◦   Antihistamines: Sedating H1 blockers like diphenhydramine.    ◦   Sedatives or sleep aids: Can cause grogginess and daytime sedation.    •   Substance Withdrawal: Fatigue can be seen in withdrawal from alcohol, opioids, or stimulants. Caffeine withdrawal, though mild, can also contribute.Dr. Arreaza:Whenever we evaluate fatigue, we need to keep an eye out for red flags. These should raise suspicion for something more serious:    •   Unintentional weight loss    •   Night sweats    •   Persistent fever    •   Neurologic symptoms    •   Lymphadenopathy    •   Jaundice    •   Palpitations or chest painThis patient doesn't have these—but that doesn't mean we stop here.Dr. Arreaza:Those are a lot of causes, we can evaluate fatigue following 7 steps:Characterize the fatigue.Look for organic illness.Evaluate medications and substances.Perform psychiatric screening.Ask questions about quantity and quality of sleep.Physical examination.Undertake investigations.So, students, do we send the whole lab panel?Michael:Not necessarily. Labs should be guided by history and physical. But here's a good initial panel:    •   CBC: To check for anemia or infection    • TSH: Screen for hypothyroidism    • CMP: Look at electrolytes, kidney, and liver function    • Ferritin and iron studies    • B12, folate    • ESR/CRP for inflammation (not specific)    • HbA1c if diabetes is on the radarJordan:And if needed, consider:    • HIV, EBV, hepatitis panel    • ANA, RF    • Cortisol or ACTH stimulation testImaging? Now that's rare—unless there are specific signs. Like chest X-ray for possible cancer or TB, or sleep study if you suspect OSA.Dr. Arreaza:Unaddressed fatigue isn't just inconvenient. It can impact on quality of life, affect job performance, lead to mood disorders, delay diagnosis of serious illness, increase risk of accidents—especially driving. So, don't ignore your patients with fatigue!Jordan:And some people—like women, caregivers, or shift workers—are especially at risk.Michael:The cornerstone of treatment is addressing the underlying cause.Jordan:If it's iron-deficiency anemia—treat it. If it's depression—get mental health involved. But there's also: Lifestyle Support: Better sleep hygiene, light physical activity, mindfulness or CBT for stress, balanced nutrition—especially iron and protein, limit caffeine and alcoholDr. Arreaza:Sometimes medications help—but rarely. And for chronic fatigue syndrome, the current best strategies are graded exercise therapy and CBT, along with managing specific symptoms. Beta-alanine has potential to modestly improve muscular endurance and reduce fatigue in older adults, but more high-quality research is needed.SSRI: fluoxetine and sertraline. Iron supplements: Even without anemia, but low ferritin [Anecdote about low ferritin patient]Jordan:This case reminds us to take fatigue seriously. In her case, it may be multifactorial—work stress, caregiving burden, and possibly iron-deficiency anemia. So, how would we wrap up this conversation, Michael?Michael:We don't need to order everything under the sun. A focused history and exam, targeted labs, and being alert to red flags can guide us.Jordan:And don't forget the basics—sleep, stress, and nutrition. These are just as powerful as any prescription.Dr. Arreaza:We hope today's episode on fatigue has given you a clear framework and some practical tips. If you enjoyed this episode, share it and subscribe for more evidence-based medicine!Jordan:Take care—and get some rest~___________________________Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:DynaMed. (2023). Fatigue in adults. EBSCO Information Services. https://www.dynamed.com (Access requires subscription)Jason, L. A., Sunnquist, M., Brown, A., Newton, J. L., Strand, E. B., & Vernon, S. D. (2015). Chronic fatigue syndrome versus systemic exertion intolerance disease. Fatigue: Biomedicine, Health & Behavior, 3(3), 127–141. https://doi.org/10.1080/21641846.2015.1051291Kroenke, K., & Mangelsdorff, A. D. (1989). Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome. The American Journal of Medicine, 86(3), 262–266. https://doi.org/10.1016/0002-9343(89)90293-3National Institute for Health and Care Excellence. (2021). Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: Diagnosis and management (NICE Guideline No. NG206). https://www.nice.org.uk/guidance/ng206UpToDate. (n.d.). Approach to the adult patient with fatigue. Wolters Kluwer. https://www.uptodate.com (Access requires subscription)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

In this episode of the American Shoulder and Elbow Surgeons Podcast, host Dr. Peter Chalmers interviews Dr. Thibault Lafosse about his approach to periscapular neurologic lesions. 

Laura Head, MT-BC, NMT-F, shares how she helps individuals with neurologic conditions regain speech, movement, and cognitive function through the power of rhythm and melody. From stimulating neuroplasticity to co-treating alongside other therapists, Laura explains how personalized, evidence-based music interventions can transform recovery. From gait training to memory exercises, learn how client-preferred music and interdisciplinary collaboration can transform the recovery process. Tune in to explore the science behind the sound—and why music is more than just a mood booster in neurorehab. Support the showNew episodes drop every other Thursday everywhere you listen to podcasts.

In this episode, editor-in-chief Joseph E. Safdieh, MD, FAAN, highlights articles studies showing persistent fatigue after TIA, the neurologic complications of measles, and the impact of the dismantling of a CDC surveillance program of epilepsy.

In this episode we discuss the topic of dual tasking. We explore: The definition of dual tasking How we can utilise dual tasking in sports, orthopaedic and return to work with our patients Dosage & delivery of dual tasking Dual tasking vs multitasking  Want to learn more about dual tasking? Dr Mike Studer recently did a brilliant Masterclass with us called “Uniting Cognitive and Physical Fitness with Dual Tasking” where he goes into further depth on this topic. 

In this episode, editor-in-chief Joseph E. Safdieh, MD, FAAN, highlights articles studies showing persistent fatigue after TIA, the neurologic complications of measles, and the impact of the dismantling of a CDC surveillance program of epilepsy.

Aarti Sarwal, MD, FAAN, FNCS, FCCM, professor of neurology at Virginia Commonwealth University Health System, explores the nuanced intersection of neurology and critical care, offering practical insights for clinicians across disciplines. Dr. Sarwal shares her perspective on the unique challenges of managing neurocritically ill patients, particularly when impairment presents challenges in administering a neurologic examination. She emphasizes that “the brain is the barometer of critical illness,” urging clinicians to prioritize daily neurologic evaluations and integrate neuromonitoring even in non-neurologic ICU populations. Listeners will gain an overview of tools such as continuous EEG, transcranial Doppler, emboli monitoring, and multimodal neuromonitoring platforms, including the role of neuro-ultrasound in expanding point-of-care capabilities. This episode also highlights the need for multidisciplinary collaboration and a shared decision-making model that extends across the continuum of care—from early ICU admission to post-discharge recovery. Listeners will appreciate Dr. Sarwal's reflections on neuroprognostication and the ethical dimensions of care withdrawal, particularly the danger of therapeutic nihilism in patients whose outcomes are uncertain. Referencing a 2023 review she coauthored (Crit Care Med. 2023;51:525-542), Dr. Sarwal outlines a practical framework for neuromonitoring that integrates structural, electrical, vascular, and metabolic insights. This conversation provides a timely and inclusive look at the future of neurocritical care—where technology, teamwork, and training converge to support better patient outcomes.

We dive into the recognition and management of blast crisis. Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Blast_Crisis.mp3 Download Leave a Comment Tags: Hematology, Oncology Show Notes Topic Overview Blast crisis is an oncologic emergency, most commonly seen in chronic myeloid leukemia (CML). Defined by: >20% blasts in peripheral blood or bone marrow. May include extramedullary blast proliferation. Without treatment, median survival is only 3–6 months. Pathophysiology & Associated Conditions Usually occurs in CML, but also in: Myeloproliferative neoplasms (MPNs) Myelodysplastic syndromes (MDS) Transition from chronic to blast phase often reflects disease progression or treatment resistance. Risk Factors 10% of CML patients progress to blast crisis. Risk increased in: Patients refractory to tyrosine kinase inhibitors (e.g., imatinib). Those with Philadelphia chromosome abnormalities. WBC >100,000, which increases risk for leukostasis. Clinical Presentation Symptoms often stem from pancytopenia and leukostasis: Anemia: fatigue, malaise. Functional neutropenia: high WBC count, but increased infection/sepsis risk. Thrombocytopenia: bleeding, bruising. Leukostasis/hyperviscosity effects by system: Neurologic: confusion, visual changes, stroke-like symptoms. Cardiopulmonary: ARDS, myocardial injury. Others: priapism, limb ischemia, bowel infarction.

This week's episode of Brain & Life Podcast was recorded live at the American Academy of Neurology's annual meeting! Hosts Dr. Daniel Correa and Dr. Katy Peters were joined by Joel Salinas, MD, MBA, MSc, FAAN, Andrea Lendaris, MD, MS, Andrew M. Southerland, MD, FAAN, and Eric J. Seachrist, MD to share what it's like living and practicing neurology with their own neurological condition(s) and neurodiverse perspectives, and explore how their experiences serve as a window into the patient and community perspective.   Additional Resources Neurology®Podcast Switching Roles: A Neuro-oncologist Reflects on his Own Experience with a Brain Tumor   We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? ·       Record a voicemail at 612-928-6206 ·       Email us at BLpodcast@brainandlife.org   Social Media:   Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD

The podcast explores comprehensive recommendations for managing patients with non-cardiac implantable electrical devices during surgical procedures, emphasizing preoperative assessment, device interaction prevention, and safety protocols.• Types of devices include vagal nerve stimulators, deep brain stimulators, and spinal cord stimulators• Preoperative evaluation is crucial for identifying devices and contacting managing clinicians• Algorithm provided for assessing potential interactions with electrocautery, MRI, and neuromonitoring • Diathermy is absolutely contraindicated in patients with non-cardiac implantable devices• Critical information needed includes device type, manufacturer, lead locations, and latest interrogation results• Recent urgent safety alert issued about medication vial coring risks with specific interim recommendationsIf you have any questions or comments, please email us at podcast@apsf.org. Visit apsf.org for detailed information and check out the show notes for links to all topics discussed.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/252-managing-neurologic-stimulators-a-critical-guide-for-safe-anesthesia/© 2025, The Anesthesia Patient Safety Foundation

Dr. Connie Tomaino, music therapist and co-founder of the Institute for Music and Neurologic Function, discusses how music therapy is used to treat neurologic conditions and explains what we know about the power of music to heal the brain.

Dr. Justin Abbatemarco talks with Dr. Nicolás Lundahl Ciano-Petersen about the clinical and immunologic profile of patients with paraneoplastic neurologic syndromes associated with Merkel cell carcinoma. Read the related article in Neurology: Neuroimmunology & Neuroinflammation. Disclosures can be found at Neurology.org.

Dr. Shuvro Roy talks with Dr. Marisa Patryce McGinley about outpatient telemedicine utilization for neurologic conditions and identify potential disparities. Read the related article in Neurology: Clinical Practice.  Disclosures can be found at Neurology.org.