Podcasts about neurologic

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, Jonathan Sackier welcomes Andrew Southerland, a distinguished neurologist and academic leader in the field of vascular neurology. They explore how machine learning is revolutionising prehospital stroke diagnosis, and how innovative strategies like telemedicine can reduce disparities in stroke care.   Timestamps: (00:00) – Introduction (03:00) – Neurologic lessons from the wild turkey (05:10) – Linking COVID-19 and stroke (10:28) – How can AI revolutionise prehospital stroke diagnosis? (18:39) – Stroke management in underserved populations (23:38) – Google Glass in medical education (29:06) – What is the i-corps programme? (33:24) – Wearable devices as diagnostic tools (37:08) – Andrew's three wishes for healthcare

Welcome to season 6 of Hope for the Agora Podcast.Karen Kleine Deters shares her story of journeying with FND -- Functional Neurologic Disorder.Functional neurologic disorder (FND) refers to a neurological condition caused by changes in how brain networks work, rather than changes in the structure of the brain itself, as seen in many other neurological disorders. Physical symptoms of FND are genuine but cannot be explained by changes in the brain structure. The exact cause of FND is unknown.Resources:National Institute of Neurological Disorders and Stroke (NINDS). Functional Neurological Disorder Information Page. https://www.ninds.nih.gov/health-information/disorders/functional-neurological-disorderStone, J., Carson, A., & Sharpe, M. (2005). Functional symptoms and signs in neurology: assessment and diagnosis. *Journal of Neurology, Neurosurgery & Psychiatry, 76*(Suppl I), i2–i12. https://jnnp.bmj.com/content/76/suppl_1/i2Support & Awareness OrganizationsFND Hope International – https://fndhope.orgThe Functional Neurological Disorder Society (FNDS) – https://www.fndsociety.orgMayo Clinic: Functional Neurological Disorder – https://www.mayoclinic.org/diseases-conditions/conversion-disorder/symptoms-causes/syc-20355197Podscasts and storiesNeurology Podcast by the American Academy of Neurology (AAN) – https://www.aan.com/podcastFND Portal Podcast (FND Hope International) – https://fndhope.org/fnd-portal-podcast

Text Light Pollution News!This month, host Bill McGeeney is joined by Mark Baker, founder of the Soft Lights Foundation, Nick Mesler, civil engineer, and, Isa Mohammed, President of the Caribbean Institute of Astronomy!See Full Show Notes, Lighting Tips and more at LightPollutionNews.com. Like this episode, share it with a friend!Bill's Picks:Why Soccer Players Are Training in the Dark, RM Clark, Wired. Light Pollution Control: Comparative Analysis of Regulations Across Civil and Common Law Jurisdictions, Laws. ‘Neurologic hazard': Group sues over Bay Bridge lights, Phil Mayer, KRON4. Outdoor light at night, air pollution and risk of incident type 2 diabetes, Environmental Research. Cartographic Visualisation of Light Pollution Measurements, Urban Science.  Support the showLike what we're doing? Your support helps us reach new audiences and help promote positive impacts. Why not consider becoming a Paid Supporter of Light Pollution News?

In part two of a two-part series, Dr. Justin Abbatemarco and Dr. Nicolás Lundahl Ciano-Petersen discuss the associated paraneoplastic syndromes they saw from a neurologic perspective. Show reference: https://www.neurology.org/doi/10.1212/NXI.0000000000200260 

In part one of a two-part series, Dr. Justin Abbatemarco and Dr. Nicolás Lundahl Ciano-Petersen break down Merkel cell carcinoma and discuss what all neurologists need to know about it. Show reference: https://www.neurology.org/doi/10.1212/NXI.0000000000200260 

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.

In this episode, Brain & Life Podcast co-hosts Dr. Daniel Correa and Dr. Katy Peters discuss some of their favorite articles from the most recent edition of Brain & Life magazine! They give tips to feel healthy during the holidays, discuss career changes after a neurologic condition diagnosis, and explain what Sunflower Syndrome is. Check out the articles and more here.   We invite you to participate in our listener survey! By participating in the brief survey, you will have the opportunity to enter your name and email address for a chance to win one of five $100 Amazon gift cards.   Additional Resources         Three People Share How They Changed Career Course After a Neurologic Disorder Diagnosis Smart Ways to Eat Well During the Holidays What Is Sunflower Syndrome? Thriving in the Kitchen with Chef Dan Jacobs Part One: Community Stories of Navigating a Rare Epilepsy Diagnosis   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

Dr. Shuvro Roy and Dr. Marisa Patryce McGinley discuss outpatient telemedicine utilization for neurologic conditions and identify potential disparities. Show reference: https://www.neurology.org/doi/10.1212/CPJ.0000000000200407

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.  

Dr. Derek Stitt and Dr. Reece Hass discuss the neuroanatomy of the cough reflex, the relationship between cough and pain, and specific neurological conditions that can lead to neurogenic cough. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000210064  

Dr. Derek Stitt talks with Dr. Reece Hass about the neuroanatomy of the cough reflex, the relationship between cough and pain, and specific neurological conditions that can lead to neurogenic cough. Read the related article in Neurology. Disclosures can be found at Neurology.org.

In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy welcomes Dr. Mike Studer, the author of "The Brain That Chooses Itself." Dr. Studer shares his extensive background as a physical therapist with 33 years of experience, focusing primarily on neurologic therapy while also engaging in pediatrics and geriatrics. They discuss behavioral economics and how it is a powerful tool that can be effectively utilized in physical therapy to create personalized care plans that motivate patients. By understanding how individuals make decisions, physical therapists can implement strategies such as nudges, gamification, and temptation bundling to enhance patient engagement and adherence to treatment plans.   Time Stamps:  [00:03:05] Unique consulting opportunities for PTs. [00:05:22] Behavioral economics in decision-making. [00:10:50] Temptation bundling in therapy. [00:14:55] Health span versus lifespan. [00:18:32] Lactate's effect on brain health. [00:21:52] The importance of choice in health. [00:27:35] Find your passion.   More About Dr. Studer: Mike Studer,PT, DPT, MHS, NCS, CEEAA, CWT, CSST, CBFP, CSRP, FAPTA, has been a PT since 1991, a board-certified in neurologic PT in 1995, and a private practice owner since 2005.  Dr. Studer has been an invited speaker covering 50 states, ten countries, and four continents, speaking on topics ranging from cognition and psychology in rehabilitation, aging, stroke, motor learning, motivation in rehabilitation, balance, dizziness, neuropathy, and Parkinson's Disease.  Dr. Studer co-founded and is co-owner of Spark Rehabilitation and Wellness in Bend, OR. He is an adjunct professor at adjunct professor at Touro University in Las Vegas as well as a part-time instructor at UNLV. Mike has led classes in the DPT program at Oregon State University (motor control) and frequently serves in a guest-lecture capacity at several other DPT and residency programs. In 2011, Mike was recognized as Clinician of the Year in the Neurologic and (in 2014) the Geriatric Academies of the APTA.  He received the highest honor available in PT in 2020, being distinguished as a Catherine Worthingham Fellow of the APTA in 2020, joining a group of under 300 persons at the time for the profession's history.  Mike's professional honors additionally reflect his service at the state and national level, including the Vice President of the Academy of Neurologic PT and the Mercedes Weiss award for service to the Oregon chapter of APTA.  He holds a trademark in dual-task rehabilitation and has a patent pending on the same. Over his career, Mike has presented courses in all 50 states, four continents, and 10 countries. He has authored over 35 articles and 6 book chapters and routinely has clinical research projects in affiliation with one of many universities. He is a consultant to Major League Baseball on the motor control of pitching and hitting. As a very fun and lighthearted note, Mike is the four-time and current WR holder for the fastest underwater treadmill marathon, a mark set most recently in January 2022.    Resources from this Episode: Mike's Website Mike on Instagram The Brain That Chooses Itself   Jane Sponsorship Information: Book a one-on-one demo here Mention the code LITZY1MO for a free month   Follow Dr. Karen Litzy on Social Media: Karen's Twitter Karen's Instagram Karen's LinkedIn   Subscribe to Healthy, Wealthy & Smart: YouTube Website Apple Podcast Spotify SoundCloud Stitcher iHeart Radio

Learn more about Fetch Long Beach and register here today!  Of French origin and raised in equatorial Africa and Canada, Anne Chauvet, DVM, DACVIM, CHT-V, graduated from the Uni­versity of Saskatchewan Western College of Veteri­nary Medicine, Saskatoon, in 1990. She completed a 1-year small animal rotating internship at the University of Illinois School, Urbana, and pursued a residency in neurology/neurosurgery at the university of California, Davis from 1991-1993. While on staff at the University of Wisconsin from 1994-1999, Madison, Chauvet creat­ed the Basic Science Course in Veterinary and Compar­ative Neurology & Neuro­surgery that is now known as “brain camp”. She later moved to Florida's gulf coast where she grew her practice until its sale in 2016. Since, Chauvet has worked in practice in both Canada and the United States. She is trained in rehabilitation and certified in hyperbaric medicine.  Over her career, Chauvet has obtained multiple business and veterinary awards, served on ACVIM and not-for-profit local committees and boards, lectured in multiple countries, authored and co-authored numerous articles and book chapters, created a educational video in rehabilitation for clients, and written a children's book. She embraces integrating medicine styles to support the need of the patient.

Creutzfeldt-Jakob disease or CJD is a rare neurological condition that may initially look like dementia and that is ultimately fatal. It's caused by something called a prion, which is smaller than a virus. Now a new study demonstrates that a skin … Diagnosing some neurologic diseases may now use a skin biopsy, Elizabeth Tracey reports Read More »

In this episode of the Brain & Life podcast, co-host Dr. Katy Peters is joined by Christina Coates, president and founding member of an organization called Hypertrophic Olivary Degeneration Association (HODA). Christina shares about her own journey with hypertrophic olivary degeneration and how she was inspired to found HODA and build an advocacy community. Dr. Peters is then joined by Dr. Vikram Shakkottai, professor of neurology at UT Southwestern Medical Center in Dallas, Texas and Dedman Family Distinguished Chair in Neurologic Disease. Dr. Shakkottai discusses cerebellar ataxia, hypertrophic olivary degeneration, how these disorders are treated, and what upcoming research there is to look forward to.   We invite you to participate in our listener survey! By participating in the brief survey, you will have the opportunity to enter your name and email address for a chance to win one of five $100 Amazon gift cards.   Additional Resources HODA - Working to make HOD History Forming a Foundation Bolsters Hope After a Rare Diagnosis Advice for Caregivers of People with Rare Diseases What is ataxia and cerebellar or spinocerebellar degeneration?   Other Brain & Life Episodes on this Topic Neurofibromatosis Advocacy and Community Building with the Gilbert Family Foundation Making a Lasting Impact with The Brain Donor Project's Tish Hevel We Are Brave Together with Jessica Patay Strength in Unity: Advocating and Advancing Research for Brain Tumors   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:   Guests: Christina Coates @hodassoc; Dr. Vikram Shakkottai @utswmedcenter Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD  

One of the great medical accomplishments of our time is the evolution of precision medicine. The ability to understand a patient's unique genetic profile has become more accessible to our patients, and now, there are multiple mechanisms for using that information to overcome disease. One of the specialties leading the way in precision medicine is pediatric neurology. According to the World Health Organization, more than one in three people are affected by some type of neurological condition. They are a leading cause of ill health and disability worldwide. This subset of precision medicine will not only help us decrease those numbers but also allow us to treat some of these conditions in ways we have never done before. To detail this exciting work, we're joined by two experts. Scott Demarest, MD, and Julie Parsons, MD, are both pediatric neurologists at Children's Hospital Colorado and faculty at the University of Colorado School of Medicine. Dr. Demarest focuses on rare epilepsy conditions, and Dr. Parsons specializes in neuromuscular disease. Dr. Demarest is the Clinical Director of the Precision Medicine Institute at Children's Colorado. Some highlights from this episode include:  Understanding precision neurology within the context of precision medicine  Why precision neurology positively impacts diagnosis and treatment options  How families are more easily accessing important genetic testing  The role primary care providers play with caring for these rare diseases  For more information on Children's Colorado, visit: childrenscolorado.org.    

In this episode, Dr Camidge sits down with Douglas Ney, MD, a professor of neurology and neurosurgery, program director of the Neurology Residency Program, and vice-chair of Education in the Department of Neurology at the University of Colorado Cancer Center in Aurora.  Drs Camidge and Ney discuss Dr Ney's journey to becoming a neurologic oncologist, how the management of primary brain tumors differs from that of brain metastases in his practice, and his experience as a physician with Tourette syndrome.

Dr. Rae Bacharach talks with Dr. Manon Auffret about her NeuroByte titled, "How to Respond to a Request for Hastened Death from a Person Living with Neurologic Illness".  Show reference: https://learning.aan.com/courses/74069

Dr. Farrah Mateen and Dr. Katrin Seeher discuss the significant global burden of neurologic conditions, which affects over 3.4 billion people worldwide, and the strategies the WHO is implementing to improve care and awareness. Show reference: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00038-3/fulltext#seccestitle10  

Dr. Farrah Mateen talks with Dr. Katrin Seeher about the significant global burden of neurologic conditions, which affects over 3.4 billion people worldwide, and the strategies the WHO is implementing to improve care and awareness. Read the related article in The Lancet Neurology. Disclosures can be found at Neurology.org.  

Welcome to today's podcast, where Pam and I are joined by Dr. Donese Worden. Dr. Worden is a world renowned expert in integrative healthcare. Her recent focus is on the metabolic treatment of cancer and neurologic diseases using hyperbaric oxygen therapy, specialized ketogenic diets and other natural approaches. She consults internationally and is personal physician to motivational speak, Les Brown. She's here to share her insights on the wellness industry, her innovative work in cancer care, and how naturopathy can work alongside conventional treatments for better outcomes. So whether you are someone with a chronic disease, a scary diagnosis, or you are just someone who wants to learn ways to stay healthy as you age, stay tuned as we dive into her unique approach to healing.

In this episode, Tammy Boyd, Chief Revenue Officer at Lakeside Neurologic, discusses the organization's holistic approach to neurorehabilitation, the challenges of staffing and payer systems, and key growth opportunities in post-acute care.

In this episode, Tammy Boyd, Chief Revenue Officer at Lakeside Neurologic, discusses the organization's holistic approach to neurorehabilitation, the challenges of staffing and payer systems, and key growth opportunities in post-acute care.

Basic knowledge of the common CNS manifestations of rheumatologic diseases and sarcoidosis is important. In the context of many systemic inflammatory diseases, CNS disease may be a presenting feature or occur without systemic manifestations of the disease, making familiarity with these diseases even more important. In this episode, Kait Nevel, MD speaks with Jennifer A. McCombe, MD, author of the article “Neurologic Manifestations of Rheumatologic Disorders,” in the Continuum® August 2024 Autoimmune Neurology issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. McCombe is an associate professor in the Division of Neurology, Department of Medicine at the University of Alberta, Edmonton in Alberta, Canada. Additional Resources Read the article: Neurologic Manifestations of Rheumatologic 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: @headacheMD Guest: @Div_Dubey Transcript Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology.  Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME.   Dr Nevel: Hello. This is Dr Kait Nevel. Today, I'm interviewing Dr Jennifer McCombe about her article on neurosarcoidosis and neurologic involvement of rheumatological disorders, which appears in the August 2024 Continuum issue on autoimmune neurology. Welcome to the podcast, and I would love to have you introduce yourself to the audience.   Dr McCombe: Well, thank you, and thank you for having me. As you said, my name is Jen McCombe. I'm a neurologist in Edmonton, Alberta, Canada, where I spend kind of a third of my time in teaching roles (I coordinate the undergraduate block for our medical school there), I spend about a third of my time in a neuroinflammatory clinic in Edmonton, Alberta, and then about a third of my time doing clinical research.   Dr Nevel: Wonderful. Well, thank you so much for being here today and for chatting with me about your article on this topic.   Dr McCombe: Thank you for having me.   Dr Nevel: To start off, can you share with the listeners a little bit about your career path?   Dr McCombe: Absolutely. Yeah. So, I've had, uh, a bit of a circuitous career path. I did my medical school in Queens (which is in Eastern Canada, in Kingston, Ontario) and then went back to Edmonton, Alberta, for my residency (in Canada, we have a five-year residency program, so a little bit different than the US), but finished my residency and then did a master's degree in Public Health at Johns Hopkins while completing clinical research in HIV, actually, and did this thing we call the Clinical Scholar Training Program – so, kind of like a fellowship, but a little bit more, you know, research and academic-based. So, when I first started, I was focused more on neuroinfectious diseases, and that's kind of what my career path looked like at the time - but, actually, shortly after I finished my residency program, I also had my first child, and he, unfortunately, developed opsoclonus-myoclonus syndrome, and at the time (this was in 2010), it was a rather rare condition, so, I ended up finding myself having to become a bit of a neuroinflammatory disease specialist at the same time. So, at that point, I transitioned into working in the neuroinflammatory clinic with some mentorship but was getting all of the kind of weird and wonderful referrals and diagnostic dilemmas from my colleagues who recognized I kind of developed some expertise, and so decided (actually, mid-career) to take a sabbatical, and in 2021, completed a fellowship in autoimmune neurology at the Mayo Clinic. So, I finished that quite recently and then went back, and now I'm feeling much more, I guess, confident, too. Sometimes, you wonder about, you know, the choices you're making. I recognize most of the conditions I'm dealing with don't have, in fact, any evidence for their treatment, and that was confirmed when I went to the Mayo Clinic and found that, really, it was just trying to gain an understanding of the disease process to make a rational choice to medications and treatments. So, now, I'm back and kind of trying to focus a little bit more on some clinical research in that area since I've kind of solidified that expertise.   Dr Nevel: Wow. Well, thank you for sharing with us your career path and how, you know, unexpected life events kind of changed your interests or molded your interests (changed kind of the things that you became expert in, you know), and being fluid in your career path and willing to kind of take a break and reassess and get additional training. That's really inspiring to, I think, to me, and probably to a lot of listeners, that you can always, you know, develop more expertise in the more niche area or additional area no matter where you are in your stage of life or career path.   Dr McCombe: Yeah.   Dr Nevel: So, can you tell us a little bit more about - you know, you shared with us kind of autoimmune inflammatory disorders and how you became interested in that, neurosarcoidosis, specifically (you know the article focuses on that), and what's your background in neurosarcoidosis, how you became interested in that specifically and in neurologic manifestations of rheumatologic disorders?   Dr McCombe: I started in our neuroinflammatory clinic over a decade ago, and, you know, at the time, a lot of the expertise in any of these neuroinflammatory disorders was quite spread out over the country, and so, as I kind to alluded to before, often some of the more complicated patients where there wasn't necessarily clear-cut evidence or even, you know, a fellowship path to get there, I would end up getting referrals for - and so, I developed quite a cohort of patients with central nervous system primarily, but other types of neuroinflammatory and autoimmune neurologic diseases, and part of that cohort was a rather large (and still growing) group of patients with neurosarcoidosis. And so, I kind of developed some practical expertise, although, as you can see in the article (and as I'm sure you all know), the approach to the treatment is extremely variable. One of the most telling things is when we were at the Mayo Clinic, one of my co-fellows actually pulled all of the neurologists in neuroinflammation at all of the Mayo Clinic sites and asked them, you know, what is your treatment approach to a patient with neurosarcoidosis, and I think got twelve completely different responses as to the medications chosen and the length of time for the tapers and things like that. So, you know, it is very much a part of neurologic disease treatment that we still really don't have great evidence for, and although we do have some kind of rational choices that we can make based on other types of evidence, so -   Dr Nevel: Yeah.   Dr McCombe: And I enjoy working with patients with these types of diseases where we can kind of work together to come up with a treatment plan that makes sense for them and also makes sense based on whatever evidence we do have at this time.   Dr Nevel: Yeah. So, moving on to the article a little bit, knowing that this is a area of neurology where there's a lot of, you know, maybe personal expertise and experience but not a ton of data or evidence to necessarily guide our standardization to our treatments and approach, what do you think is the most important clinical takeaway from your article for our listeners?   Dr McCombe: Well, I mentioned before I coordinate the neuro block for our undergraduate program here, so I've developed over the years (I've been doing that for a number of years) a curriculum that's all based on, kind of, that approach to - and I like to do it that way because it's very practical. I like the students to be able to basically take their class notes and then go to the emergency department on their first shift as a clerk and, you know, use their approach to headache that I've developed for them to kind of take a clinical history and examine a patient with that sort of problem. And so, similar to that, I tried to do an approach to, you know, a couple of the more common presentations that would make you think of a rheumatologic condition or neurosarcoidosis in looking at the approach to CNS vasculitis and the approach to, uh, pachymeningitis - and these are difficult differentials for lots of neurologists, because it really relies on a lot of medicine knowledge, and we graduate from our residencies slightly more confident in our medicine knowledge, because we get a lot of that in our residencies. But as neurologists, as we go through our careers, we get much more confident in our areas of specialty, and at least for myself and many of my colleagues, much less confident in other things like general medicine. And so, it's difficult, because you have to face your areas of potentially less confident knowledge and really think about that in the differential - and so, I think, you know, I put those two big “approach to” sections in there, because they're the most relevant for the conditions that I was covering. But, I think also what I would say to a learner or a more experienced neurologist who might be reading the article, kind of pick out the little things that you might add to your own kind of approach to - you know, when you see that person with an ataxia, remember that Sjogren syndrome is one of the things you might consider that could be a treatable cause, or you want to see a sensory neuronopathy, don't just think paraneoplastic – again, Sjogren syndrome. So, kind of pick out those little pearls and add them to your approach to that patient that we all see, and I think that would be my biggest takeaway.   Dr Nevel: Yeah. Thank you. So, kind of like, keep this information from the article in mind so that you keep rheumatologic disorders in mind as a possibility when you're approaching a patient with whatever neurologic symptoms they're presenting with. So, what do you think is challenging? You kind of already mentioned a little bit, you know, just that it stretches us maybe into the medicine arena and so maybe stretches our medical knowledge, especially as we become more subspecialized or focused in neurology - but what is challenging about identifying, diagnosing neurologic symptoms as being related or due to an underlying rheumatologic disorder?   Dr McCombe: Absolutely. Yeah. Well, as you said, you know, it forces us to kind of face that medicine stuff that we might not be as comfortable with, but I think what else is challenging is that, sometimes, those medical clues aren't there. For the rheumatologic disorders for the most part, they are. Sjogren's is potentially a little bit different in that, potentially, the symptoms are less obvious or a little bit more subtle. But, in particular, with neurosarcoidosis, there's a distinct proportion of the patients that won't, in fact, have any systemic complications of their underlying disease, and so, you have to think about it even when the clues aren't there. That's why you have to add it to those kind of differential diagnoses where it might be considered, because those systemic clues that we all rely on when we do our review of systems and we ask about rashes and joint pain and lung issues, and these sorts of things may not be there - and so, you still have to think about it even when it might be completely isolated to the central nervous system.   Dr Nevel: What is our understanding of why some patients with rheumatologic disorders develop neurologic involvement? Do we have an understanding? Do we know why some patients do and some patients don't? I know that's, you know, kind of, uh - that's a tough question, but that was something that I thought of as I was reading your article, like, why does this happen to some people?   Dr McCombe: Absolutely. I mean, I think, potentially, it's a little bit more clear for some of them, like rheumatoid arthritis, because, typically, if you develop a CNS complication of this, it's, in fact, just because you've had the disease for a very long time, and often, it's uncontrolled, and so you think about the disease “spreading” now to the central nervous system - but for other conditions, like neurosarcoidosis, it is much less clear, and even if you look at the epidemiologic patterns for that, it makes it even more muddied in that in some populations, it appears that they develop more central nervous system disease, whereas in others, less. And so, why that is the case and why certain individuals might develop this complication of these diseases I think is yet to be seen.   Dr Nevel: Yeah, that's always the crux of things if we can figure out the why, then maybe we could prevent it, right?   Dr McCombe: Million-dollar question always.   Dr Nevel: Always. So, what do you find the most intriguing about neurologic involvement of rheumatologic disorders?   Dr McCombe: Well, I think one of the things that, really, I mean, for neurosarcoidosis in particular, so many patients do so well, and that's what I really like about it. You know, you see patients who present with an incredible burden of disease radiologically, and yet, don't look nearly as sick as they should when they're sitting in front of you. And then, you start them on therapies and some of them do so well, and even those with relatively devastating deficits, or moderate disease who do have neurologic symptoms, have a remarkable improvement in their neurologic symptoms with treatment. And so, that's always something that's quite rewarding when you get to see these patients in follow-up, and they're generally quite thankful because they're doing so well. And it's different from many of the neurologic diseases that we treat. I mean, in autoimmune neurology, we're lucky because we do have a number of diseases that are quite treatable and patients can have wonderful outcomes. But, you know, it's always scary when we see patients with devastating neurologic signs and it's great to see improvement with treatment. And so, that really draws me to it.   Dr Nevel: Yeah, absolutely. That's really rewarding when you're able to help somebody get better in such a profound way.   Dr McCombe: Mm hmm.   Dr Nevel: What is one common misconception about neurologic manifestations of rheumatologic disorders? Or what do you think is not well understood by treating clinicians?   Dr McCombe: I think probably one of the things I see the most is, sometimes, an undertreatment of the patient. And so, I see patients who, you know, other clinicians may have seen and have made the diagnosis, and perhaps it's a lack of confidence in the diagnosis and so they kind of want somebody else with a subspecialty to kind of confirm the diagnosis, but that treatment hasn't been initiated despite pathological confirmation on biopsy of another tissue. And these patients, like I alluded to before, they do well, but you need to treat them and you need to treat them adequately, and when their symptoms are quite impairing, you need to treat them adequately now. And so I think, sometimes, that delay in starting a second-line therapy and relying on steroids for too long - those sorts of things can really expose a patient to a lot of different side effects and to a lot of different complications that they may not have had, too. So, that's why I spent some time focusing on the treatment, because I think just gaining a little bit of comfort with some of these more common second-line medications is a good thing, because starting those early, I think, makes sense because you can really save the patient a lot. And then, the other thing, too, is that when you're using steroids, think about all of the systemic things that you're causing - think about the increased risk of infection and the fact that you need to prophylax for certain infections, think about bone health, think about protecting the lining of someone's stomach - so not only kind of thinking about your disease in isolation and what you need to do for treatment, but that you need to ensure that you're appropriately prescribing the patient all of the things they need to do to protect themselves during these times.   Dr Nevel: Yeah. I think that's so important. And I'm glad that you brought that up, because I think, unfortunately, many of us have seen a patient who ended up having PJP pneumonia (or something like that) because they weren't put on antibiotic coverage for prolonged steroid use or, you know, bone health - all of that is really important to think about. So, this may be entering a territory where there's no, you know, great evidence, but you mentioned, you know, starting kind of that maintenance or second-line agent - when do you decide to do that in patients? And maybe we can focus (since it gets a little broad), but, you know, in a patient with neurosarcoidosis, let's say - when you're starting the steroids, when do you decide, okay, this person is also going to need a maintenance therapy? Is that something that you do at the beginning when you're starting the steroids, or is that something that you think about later on depending on how their course goes?   Dr McCombe: Yeah. In my practice, I do it at the outset - again, because I'm quite focused on, you know, as soon as I get them on it, getting people off steroids - and so I start essentially almost all of my patients on it unless there's some other contraindication or complication to their disease. And because I deal with central nervous system complications in the vast majority of my patients, I'm starting a TNF-a inhibitor as well as methotrexate, and that's because I see a lot of patients with cord disease and significant brain disease, and so I want to treat them kind of more aggressively from the outset. And so, typically, they'll be on steroids, um, a TNF-a inhibitor, as well as methotrexate, and then I just back off, actually, as they do well. And so, I try to taper the steroids quite quickly over the course of just a number of weeks, or kind of two to three months at most. I maintain the TNF-a inhibitor, and then in some patients, depending on how they're doing, I might eventually stop the methotrexate. Some patients tolerate it so well that we don't for a number of months - other patients want to try to minimize their medications as quick as they can. So, that's my personal practice. In the province where I live, we don't have to worry about access to these medications, and so I understand that that might be an issue in some centers where people practice and have different access and different funding. Of course, I live in a country where we have universal healthcare, and in our province, I have very good access to these medications and they're funded from my patients regardless of socioeconomic status, and so I have the luxury of making these choices and I understand that other people might not, but that's my personal practice and I find it works quite well in the vast majority of patients.   Dr Nevel: Yeah. And you bring up a really good point that, you know, access to some of these medications for patients with CNS manifestations of sarcoidosis, neurosarcoidosis, sometimes can be challenging to treating the patient with medications that you feel like would be best for them. But that's wonderful that you don't have those access issues where you live. How long do you typically continue the TNF-a inhibitor in patients, since you mentioned, you know, tapering off the steroids, tapering off the methotrexate, potentially depending on patient tolerance and course. What's your approach to the TNF-a inhibitor?   Dr McCombe: Yeah, so, of course I follow them clinically, and then radiologically as well, and it's really satisfying if you can see the resolution of their symptoms as well as resolution of the abnormalities and the MRI, so I let that guide me a little bit. But, in most patients, I keep them on therapy for about one to two years, and then at that point, see if I can cease it in some patients. And I, again, continue to follow them radiologically and clinically after I cease it so that I can ensure that I'm catching their disease more quickly if it does come back and then can just reinitiate therapy, but in lots of patients you're able to stop the medication and they have persisting, kind of, disease freedom after that, and so they don't need to be on anything.   Dr Nevel: Yeah, great. And I'm almost hesitant to focus so much on neurosarcoidosis. (It was the rheumatologic manifestation that you talked about the most in your article.) I'm going to put in a plug for everybody to read your article so that they can read about neurologic manifestations of rheumatoid arthritis, Sjogren's, lupus, Behcet's - many more things. But focusing on neurosarcoidosis, it can be difficult in my experience to definitively diagnose, and people who have neurosarcoidosis particularly, and people who don't seem to have any systemic manifestations or, you know, imaging findings consistent with sarcoidosis - can you share your approach with us? And you outlined this in your article nicely, too, but your personal approach to patients with suspected neurosarcoidosis, and how you make that clinical decision to treat somebody with possible neurosarcoidosis, somebody who maybe you're not able to get pathologic evidence on?   Dr McCombe: Absolutely. Yeah, those ones are difficult. And, you know, whenever possible (as I mentioned in my article), I think pathological evidence of a diagnosis is important, because then when you find yourself a year down the road and a treatment path and you have uncertainty, it's much more difficult to consider continuing medications that can have quite a number of side effects when you're not absolutely certain about that diagnosis. But, in some patients, you know, I've had patients who might have nondiagnostic biopsies (if you attempt to do a biopsy), or they have disease in a site that really just isn't amenable to biopsy, or they have some other reason they can't have a biopsy. So, how I approach that is that, you know, if you think about possible neurosarcoidosis similar to any other nondiagnosed, you know, blow out-like lesion (for lack of a better term) in the CNS, if it's steroid-responsive, I think that kind of going down a path of treating it as a steroid-responsive lesion is kind of the approach that I take - so the diagnosis in the chart might be possible neurosarcoidosis, but in the back of my mind, I'm just thinking of kind of a steroid-responsive nondiagnostic or idiopathic lesion. So, I then follow that up typically with something like methotrexate (so, a more broader- spectrum immunosuppressant-type medication), and if the methotrexate is able to maintain the response that the steroids initiated, then eventually get them off the steroids. And so, you know, if I think about my patients that I've treated in the past, if they have a diagnosis of possible neurosarcoidosis, I probably don't start a TNF-a inhibitor as quickly in them, because in the back of my mind, I'm always wondering what type of inflammatory lesion this is, but that steroid responsiveness really helps me decide to start a second-line or maintenance therapy and then, typically, in those patients, as I mentioned, I'll start something like methotrexate a little bit more soon.   Dr Nevel: Yeah, great. Thanks for sharing that with us. So, what do you think comes next in this field? What excites you? Where do you think our next kind of development or understanding or breakthrough, whether it's diagnostic or treatment-wise?   Dr McCombe: I think, in the field, you know, any immunologic diseases, we've been really gaining a much better understanding of pathophysiology, and that's honestly what excites me the most, when you can know precisely what part of the immune system is at play here (whether it's, you know, complement-mediated or antibody-mediated) and then being able to then rationally choose medications based on a really clear understanding of the disease is something that I think is kind of novel in a way. For so many years, we would use kind of big broad-spectrum immunosuppression - even in multiple sclerosis, still, we use medications that, historically, we've found to be helpful - but we don't have a great understanding sometimes of why the medicines work. So, kind of going at it from the other way, where we're actually determining what is the exact pathophysiology of disease and then making a rational approach to a therapy, or choosing a therapy based on that, I think is what excites me the most, and I think we'll gain a better understanding of even a broader swath of diseases and be able to make those choices more often. That's what I like about this field.   Dr Nevel: Great. Well, thank you so much for sharing that - and looking forward to the future in this area of neurology. And thanks so much for talking with me today and sharing your story and your expertise and knowledge.   Dr McCombe: Well, thank you for having me. It's been fun.   Dr Nevel: And I encourage all the listeners to read your article. Again, today, I've been interviewing Dr Jennifer McCombe, whose article on neurosarcoidosis and neurologic involvement of rheumatologic disorders appears in the most recent issue of Continuum on autoimmune neurology. 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 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.

Send us a Text Message (please include your email so we can respond!)Episode 47! In this episode we talk about a prospective observational study examining cognitive motor dissociation by Bodien et al published in the New England Journal of Medicine and then we pair that talking about the guidelines for death by neurologic criteria published in SCCM! An episode of somber but important topics!Cognitive Motor Dissociation (pubmed): https://pubmed.ncbi.nlm.nih.gov/39141852/Cognitive Motor Dissociation (NEJM): https://www.nejm.org/doi/10.1056/NEJMoa2400645 DBNC Guidelines (pubmed): https://pubmed.ncbi.nlm.nih.gov/37921516/DBNC Guidelines (CCM): https://journals.lww.com/ccmjournal/fulltext/2024/03000/the_2023_american_academy_of_neurology,_american.3.aspx If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

Have you ever been confused about the concept of brain death, or struggled to explain brain death to a patient's family or your fellow clinicians? Join the Behind the Knife Surgical Palliative Care team and our special guest, neurologist & neurointensivist Dr. Sarah Wahlster, as we explore the 2023 Pediatric & Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline and what this updated guideline means for our practice in surgical palliative care! Hosts: Dr. Katie O'Connell (@katmo15) is an Associate Professor of Surgery at the University of Washington in the division of Trauma, Burn, and Critical Care Surgery. She is a trauma surgeon, palliative care physician, Director of Surgical Palliative Care, and founder of the Advance Care Planning for Surgery Clinic at Harborview Medical Center in Seattle, WA. Dr. Virginia Wang is a PGY-3 General Surgery resident at the University of Washington. Guest: Dr. Sarah Wahlster (@SWahlster) is an Associate Professor of Neurology at the University of Washington. She is a neurologist, neurointensivist, and Program Director of the Neurocritical Care Fellowship at Harborview Medical Center in Seattle, WA. Learning Objectives: ·      Understand the concept of assent and how it can be helpful in communicating with families of patients who have sustained brain death ·      Explain the main steps required for diagnosis of brain death (prerequisites, clinical exam, apnea testing, ancillary testing) ·      Understand key differences between the 2023 guideline and previous (2010 & 2011) guidelines ·      Be able to name the 3 accepted modalities of ancillary testing for brain death ·      Know basic communication best practices with families of patients who have sustained brain death from the surgical palliative care perspective (consistency of language & messaging; avoidance of phrases such as “life-sustaining treatment”, “comfort-focused measures”) References: 1.     Greer, D. M., Kirschen, M. P., Lewis, A., Gronseth, G. S., Rae-Grant, A., Ashwal, S., Babu, M. A., Bauer, D. F., Billinghurst, L., Corey, A., Partap, S., Rubin, M. A., Shutter, L., Takahashi, C., Tasker, R. C., Varelas, P. N., Wijdicks, E., Bennett, A., Wessels, S. R., & Halperin, J. J. (2023). Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline. Neurology, 101(24), 1112–1132. https://doi.org/10.1212/WNL.0000000000207740 2.     Lewis, A., Kirschen, M. P., & Greer, D. (2023). The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline: A Comparison With the 2010 and 2011 Guidelines. Neurology. Clinical practice, 13(6), e200189. https://doi.org/10.1212/CPJ.0000000000200189 3.     AAN Interactive Brain Death/Death by Neurologic Criteria Evaluation Tool – https://www.aan.com/Guidelines/BDDNC 4.     AAN Brain Death/Death by Neurologic Criteria Checklist – https://www.aan.com/Guidelines/Home/GetGuidelineContent/1101 5.     Kirschen, M. P., Lewis, A., & Greer, D. M. (2024). The 2023 American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine Pediatric and Adult Brain Death/Death by Neurologic Criteria Determination Consensus Guidelines: What the Critical Care Team Needs to Know. Critical care medicine, 52(3), 376–386. https://doi.org/10.1097/CCM.0000000000006099 6.     Greer, D. M., Shemie, S. D., Lewis, A., Torrance, S., Varelas, P., Goldenberg, F. D., Bernat, J. L., Souter, M., Topcuoglu, M. A., Alexandrov, A. W., Baldisseri, M., Bleck, T., Citerio, G., Dawson, R., Hoppe, A., Jacobe, S., Manara, A., Nakagawa, T. A., Pope, T. M., Silvester, W., … Sung, G. (2020). Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. JAMA, 324(11), 1078–1097. https://doi.org/10.1001/jama.2020.11586 7.     Lele, A. V., Brooks, A., Miyagawa, L. A., Tesfalem, A., Lundgren, K., Cano, R. E., Ferro-Gonzalez, N., Wongelemegist, Y., Abdullahi, A., Christianson, J. T., Huong, J. S., Nash, P. L., Wang, W. Y., Fong, C. T., Theard, M. A., Wahlster, S., Jannotta, G. E., & Vavilala, M. S. (2023). Caseworker Cultural Mediator Involvement in Neurocritical Care for Patients and Families With Non-English Language Preference: A Quality Improvement Project. Cureus, 15(4), e37687. https://doi.org/10.7759/cureus.37687 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Chiropractor Kim Bruno furthered her training with the Institute of Functional Medicine, ILADS, Horowitz Lyme Master Classes and holds a board-certification as a Certified Clinical Nutritionist. She owned a private practice for 17 years and was the functional medicine medical director for the largest immunology clinic in Colorado. She comes to us today as the Senior Medical Science liaison for Vibrant Wellness Labs. Today we discuss their panel of 48 neurologically-oriented antibodies: the Neural Zoomer Plus. We start by discussing the lab technology itself, which is somewhat unique in the testing world- it's an 'Immunochip', also called a protein-peptide microarray as viewed through chemiluminescence which can be more sensitive than historical Eliza testing. The sensitivity (the ability to find the needle in the haystack) ranges from 95-98% and the specificity (it's definitely a needle, and not a pin or nail or something similar that is not actually a needle) is 96-100%. The range is because each analyte has its own metrics. Here, we take a tangent into describing the limitations of Eliza & Western Blot testing, especially in light of tick-borne testing for Lyme disease & co-infections. Then we touch on PCR- polymerase chain reaction testing and the use of glass beads to break up biofilms in test samples for even more accurate results.   Our next chapter (around 14:30) focuses on the immune system itself. Listen in for some helpful analogies for the immunoglobulins-IgM for ‘marines vs IgG for ‘ground troops', IgA with affiliation with mucus membranes like the gut or respiratory linings, and IgE for anaphylactic allergic reaction. This gives the total pool from which the Neural Zoomer Plus antibodies are pulling from as a sort of clinical calibration to weigh the presence of the specific antibodies.   At 22:20, we dive into the Neural Zoomer Plus test itself. Dr Bruno shares her brilliant ‘hierarchy of consideration' for putting these antibodies into a context. While she states outright ‘this is not a diagnostic test', the larger truth is that this test cannot be used for diagnosis by clinicians who don't have the scope to make diagnostic conclusions, for example dieticians or health coaches. For our purposes at Neuroveda Health, we absolutely use this test for clinical decision making and diagnosis. Dr Bruno calls out molecular mimicry against pathogens or even foods or toxins that can confuse the immune system. We consider the Cunningham Panel (recently renamed the Autoimmune Brain Panel), which has been used longer for PANDAS evaluation. And we walk through each category of antibody included on this test.   We finish with a discussion about treatment approaches based on results from this test, including the Neuroveda Health approach to evaluating and addressing neuroimmune disease. FOR MORE INFORMATION: To look at a sample report of this test: https://hello.vibrant-wellness.com/hubfs/Sample%20Reports/MK-0072-01NeuralZoomerPlusSampleReport.pdf To find out more about the Neural Zoomer Plus test: https://www.vibrant-wellness.com/test/NeuralZoomerPlus To get testing, contact us to schedule an appointment with a clinician at Neuroveda Health: - Phone: 206-379-1213 - Email Reception@neurovedahealth.com To find out more about our clinic (and request a call back): https://www.neurovedahealth.com/

In this week's podcast, Neurology Today's editor-in-chief discusses data on the complex interaction between body composition, vascular health, and neurodegenerative disease, Tenecteplase in an extended treatment window and stroke-related disability, and gene expression in cormorbid cancer and stroke.

In the final part of this two-part series, Dr. Andy Southerland and Dr. Lidia Moura discuss strategies on how clinicians can mitigate bias when using large language models. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000209497 

We're coming together to talk about the connection the brain has to the immune system under the effects of excess #stress and #weight gain.Two amazing experts — Dr. Fatima Cody Stanford @askdrfatima at Harvard Medical School and Dr. Ellen Mowry at @hopkinsmedicine join us Monday for #BrainChat with #thenerdyneurologist to get into it.Stress unfortunately isn't avoidable, and impacts Black women disproportionally in the United States, similarly to MS.Together, we're spreading awareness by talking about how the brain physically reacts to stress, weight gain, and MS.

In part one of the part-two series, Dr. Andy Southerland and Dr. Lidia Moura discuss the major findings related to large language models (LLMs) for neurologic care. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000209497 

Dr. Andy Southerland talks with Dr. Lidia Moura about the implications of large language models (LLMs) for neurologic care. Read the related article in Neurology. Disclosures can be found at Neurology.org.

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

Welcome back to The Peds NP Acute Care Faculty series! This collaborative series was created and peer-reviewed by national experts and leaders in acute care PNP education. In the push for competency-based education where faculty verify the skills of what a learner can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach in a conversational way so that you can learn the nuances of clinical skills before you reach the bedside.  This episode discusses a standardized approach to delivering bad news, founded in the literature. The SPIKES protocol is the most well recognized approach to create an environment, assess patient and family knowledge and preferences, deliver the news compassionately, and empathize prior to a summary. With examples of phrasing you can offer at each step, you'll gain the skills necessary to deliver bad news.  Authors (alphabetical): Becky Carson, DNP, APRN, CPNP-PC/AC, Ann Felauer, DNP, APRN, CPNP-PC/AC, Belinda Large, DNP, APRN, CPNP-PC/AC, and Robynn Stamm, DNP, APRN, CPNP-PC/AC   References: Brouwer, M. A., Maeckelberghe, E. L. M., van der Heide, A., Hein, I. M., & Verhagen, E. A. A. E. (2021). Breaking bad news: what parents would like you to know. Archives of disease in childhood, 106(3), 276–281. https://doi.org/10.1136/archdischild-2019-318398 Buckman R. (1984). Breaking bad news: why is it still so difficult?. British medical journal (Clinical research ed.), 288(6430), 1597–1599. https://doi.org/10.1136/bmj.288.6430.1597 Buckman R. (2001). Communication skills in palliative care: a practical guide. Neurologic clinics, 19(4), 989–1004. https://doi.org/10.1016/s0733-8619(05)70057-8 Institute of Medicine (US) Committee on Palliative and End-of-Life Care for Children and Their Families, Field, M. J., & Behrman, R. E. (Eds.). (2003). When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Chapter 4 communication, goal setting, and care planning. National Academies Press (US).  Kaplan M. (2010). SPIKES: a framework for breaking bad news to patients with cancer. Clinical journal of oncology nursing, 14(4), 514–516. https://doi.org/10.1188/10.CJON.514-516  Ptacek, J. T., & Eberhardt, T. L. (1996). Breaking bad news. A review of the literature. JAMA, 276(6), 496–502. Sisk, B., Frankel, R., Kodish, E., & Harry Isaacson, J. (2016). The Truth about Truth-Telling in American Medicine: A Brief History. The Permanente journal, 20(3), 15–219. https://doi.org/10.7812/TPP/15-219 Varkey B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 30(1), 17–28. https://doi.org/10.1159/000509119  

Neurologic infections become emergencies when they lead to a rapid decline in a patient's function; however, neurologic infections are often challenging to recognize. In this episode, Aaron Berkowitz, MD, PhD, FAAN, speaks with Alexandra S. Reynolds, MD, author of the article “Neuroinfectious Emergencies,” in the Continuum® June 2024 Neurocritical Care issue. Dr. Berkowitz is a Continuum® Audio interviewer and professor of neurology at the University of California San Francisco, Department of Neurology and a neurohospitalist, general neurologist, and a clinician educator at the San Francisco VA Medical Center and San Francisco General Hospital in San Francisco, California. Dr. Reynolds is an associate professor in the departments of neurosurgery and neurology at Icahn School of Medicine at Mount Sinai Health System in New York, New York. Additional Resources Read the article: Neuroinfectious Emergencies 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: @AaronLBerkowitz Transcript Full transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the Journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the show notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the show notes. AAN members, stay tuned after the episode to hear how you can get CME for listening.     Dr Berkowitz: This is Dr Aaron Berkowitz, and today, I'm interviewing Dr Alexandra Reynolds about her article on neuroinfectious emergencies, which is part of the June 2024 Continuum issue on neurocritical care. Welcome to the podcast, Dr Reynolds. Um, would you mind, please, introducing yourself to our audience?   Dr Reynolds: Sure. Thank you for the invitation. I'm Alex Reynolds, and I am a neurointensivist at Mount Sinai Hospital in New York City.   Dr Berkowitz: Fantastic. Thanks for joining us. Dr Reynolds has written a really comprehensive article with lots of clinical pearls for the evaluation of patients with neurologic infections. So, to start off, when should we consider a neurologic infection as the cause of a patient's neurologic symptoms?   Dr Reynolds: That is a, really, much more complicated question than I think you recognize. I feel like a lot of it has to do with the risk factors of the patient. So, certainly, you know, a lot of times, we think about a patient who comes in with fever and altered mental status, and that's sort of the patient we're thinking about as having an intracranial infection – but, I do think there are a lot of risk factors that, sort of, may push us in that direction even if the patient doesn't have a fever or even if the patient doesn't seem like meningitis (for example). So, you know, a lot of patients nowadays are immunosuppressed, either because of infections or because of the therapies that we're using as immunosuppressants (so, autoimmune diseases, transplants, bone marrow patients). And then, I think, any patient who has had an intracranial procedure or a spinal procedure, we sort of just have to have in the back of our mind that surgical procedures come, by definition, with risk of infection (and so, that's always something to think about). And then, certainly, anything in terms of endemic risk factors (so a patient who has come from a country that has an endemic infection), we need to just be a little bit more broad about what we're thinking about in that patient population.   Dr Berkowitz: That's very helpful. You mentioned something I wanted to pick up on. We always think fever, of course we're going to be thinking about a neurologic infection, but some types of neurologic infections and in some patient populations, it's possible to have an infection of the nervous system with no fever, sometimes even no white count. What other clues should be considered, or when would you think about pursuing infection even in patients who don't have a fever or an elevated white count?   Dr Reynolds: So, certainly, in patients who have imaging that's a little abnormal. I think, oftentimes, the patients that I've seen with sort of indolent infections have a subdural collection that just doesn't look quite right or doesn't make sense with the clinical history (you know, you can have P. acnes infections that go on for months that people really don't necessarily notice) - so any imaging, oftentimes on MRI, you'll see, sort of, diffusion restriction where you don't really expect to see it. So, those sorts of patients might be ones where if the story is just not really fitting, you might want to think about infection. So, I think it's also important to remember that patients who have procedures elsewhere in the body can sort of seed themselves, and either by direct spread or by hematogenous spread, those infections can kind of seed the CNS - so, patients with valve procedures in the heart, patients who have intraabdominal procedures, there really is no reason that those infections can't travel to the CNS as well. And so, I was sort of always taught, you know, if the story doesn't make sense, then you have to consider infection, even if the patient doesn't have a white count or fever. So, I think just having, sort of, that suspicion in the back of your mind that if you can't really make sense of the story, then consider an infection.   Dr Berkowitz: Yeah. So, obviously, fever, white count, those would clue us in that a patient with new neurologic symptoms (signs) may have an infection as a cause. But, as you said, they may not be present in patients who have had any type of neurosurgical procedure (or you've just taught us even non-neurosurgical procedures elsewhere in the body) that could have led to bacteremia. And then, you mentioned earlier, also patients who are immunocompromised may develop a neurologic infection without fever or white count, and our threshold is certainly lower to pursue that possibility in that population as well. Other points on that before we move on?   Dr Reynolds: I had an attending that told me if you're thinking about a lumbar puncture, you better just do it – so, I think those are wise words to sort of live by. If you're thinking about an infection, you better just work it up.   Dr Berkowitz: Yeah. I think that's right. I heard something similar that if you're standing around on rounds debating whether the patient should get a lumbar puncture, probably, if you've talked about it that much, you should probably do it. I think we've heard the same things in different places. Along those lines of who needs a lumbar puncture, many patients with systemic infections can develop a headache, even if it's just from systemic infection (you don't necessarily have meningitis and cephalitis), and many patients, particularly older patients, develop confusion in the course of systemic infections, like pneumonia and urinary tract infections. And as neurologists, we are often consulted on these patients because they are confused, they are febrile, they may have an elevated white count, and people start to wonder, Could this patient have meningitis? Could this patient have encephalitis? In many cases, at least in my experience (I'm curious to hear your experience), it turns out that these patients have a systemic infection and the confusion and/or headache are related to that systemic infection, not a primary neurologic infection - but based on that topic we just discussed about, if you've talked about lumbar puncture enough, probably best to do it. How do you think about these patients who are, for example, admitted to a medical service for fever and confusion, may or may not have had a systemic source identified, but the suspicion is there? How do you think about which of those patients need a lumbar puncture, or what clues you into thinking to have a higher concern for meningitis, encephalitis, abscess, other neurologic infections in this context?   Dr Reynolds: It's such a good question, because I think, especially as we get older, you know, even things like nuchal rigidity might be hard to assess in a patient who's sort of started to fuse their spine - so, I think it can be really challenging. I think, you know, always go back to basics. Is there any new laterality that doesn't really make sense? Is there a sort of disconnect between imaging and how the patient looks? And it can be so confounded, because these are patients who are also on antibiotics (which themselves can be neurotoxic), and so, it can be really hard to sort of parse that out. But, I do think that there are some less invasive things you can try to do first to sort of help risk stratify your patient. So, you know, certainly, getting a CAT scan and just making sure that everything looks as you would expect it to look - there's no, sort of, hydro out of proportion to what you might expect. I've definitely seen patients who have meningitis that we caught because they have just a little bit of pus in the ventricles that was interpreted as intraventricular hemorrhage. And you sort of just have to sit there and think, like, Does that make sense, or is it an infection? EEG can be helpful, too, if it's lateralizing. You know, I think we don't think as much about HSV in the hospital. But, certainly, if you have something lateralizing on your EEG that just doesn't make sense, I think that could sort of push you in that direction as well. But, again, I think in most cases, unless the patient's very thrombocytopenic or coagulopathic, the risk of an LP sort of doesn't really outweigh the benefit of feeling confident that you haven't missed something, because I think, you know, one of the big points of this article is that if you catch these CNS infections early, people can actually do really well, and, really, most of the morbidity and mortality is from missing the infection - so we've been trying to move away from LP-ing everybody on admission, but I do think that you should be tapping some people that are not infected, because then you're probably catching everyone who is.   Dr Berkowitz: It's great to hear your approach, and I think that aligns with my thinking as well. I do want to ask as a follow-up to that question (I've asked this of internists I work with and other neurologists) - I totally agree with everything you said in the sense that, you know, we are consulted by our internists, we presume that they haven't found a reason that the patient is febrile and confused from a systemic standpoint, and that's why we're being consulted. There are, obviously, many patients who are febrile and confused in the hospital where neurology has not been called because there's other obvious reasons, as you have mentioned. However, as you said, if the patient has some immunocompromise, maybe there's some features that are suggestive in the history or nuchal rigidity - as you said, harder in older patients - but there's something there that you sort of think, maybe we should just do a lumbar puncture just to make sure we sort of settle this because we keep thinking about it. The question is, in your experience, when you've gotten a lumbar puncture more as a rule-out, or you think, I think this is the patient's pneumonia and they're confused because they're delirious in the hospital (sort of toxic metabolic encephalopathy), have you ever been surprised? Talking to an internist colleague, I've said, I feel like I haven't actually seen that much bacterial meningitis in the U.S., fortunately, thanks to vaccination. And, usually, the patient is coming in with a pretty profound syndrome of meningitis or encephalitis. But, as far as patients in the hospital with a fever, where you're thinking, "This is kind of a rule-out, so just make sure, even though I don't think I'm going to find meningitis in a patient who is immunocompetent”, have you ever been surprised and found meningitis encephalitis when you didn't expect to find it? Or, what's been your experience when you, as you said, tap these patients because you'd rather get a few normal ones in there to make sure you never missed the abnormal?   Dr Reynolds: I would say the few times that I've been surprised were not with fully immunocompetent patients. You know, someone with a splenectomy who otherwise looks immunocompetent, someone with pretty advanced cancer - those are examples where you wouldn't necessarily have thought about it as being immunocompromised, but they are. Certainly, I think patients with advanced cancer can, really - they're much higher risk than I used to think about. The more I've taken care of them, the more I've realized how sensitive they are to infections and how quickly that can spread, even if they're not actively getting chemotherapy. But, I would say in general, for the truly immunocompetent patient, I would say I haven't really diagnosed anything super exciting.   Dr Berkowitz: Yeah, that's good to hear. I love to, on these Continuum Audio interviews, poll experts in other institutions who trained other places and, you know, learn from different patient populations if your experience resonates with mine and others I've spoken to. Yeah, that sounds similar to my experience as well, yeah, if the patient is immunocompromised - and as you said, we maybe need to broaden that from being truly profoundly immunocompromised by congenital immunodeficiency or HIV or immunomodulatory therapy to have a slightly broader perspective on what could constitute immunocompromise - and, of course, we'd have an extremely low threshold to perform a lumbar puncture in such patients, as you said. You reminded me of a case I was trying to remember the details (which I don't) – it was a patient, actually, with a temporal lobe glioblastoma that had been resected and had some recurrence and was worsening, and it looked like it was tumor recurrence/progression. And I don't - wasn't my patient, I just sort of heard about it - but I don't know which attending or resident or fellow decided that the patient should get a lumbar puncture, and the patient actually developed HSV encephalitis of the temporal lobe, where the glioblastoma was.   Dr Reynolds: Wow.   Dr Berkowitz: Patients with cancer, especially with all the new immunotherapies - and even without them, as you said - this is a state in which people may be vulnerable to infections and ones you might not immediately think of. So, those are some great pearls. Speaking of pearls, you have a really fantastic section in your article on neurologic complications of CNS infections. In other words, you've already diagnosed the meningitis, encephalitis, abscess, or otherwise, and all the other neurologic complications that can occur in the course of this illness. So, it'd be great to talk with you a little bit about that here. So, if a patient is diagnosed with infectious meningitis or encephalitis (we've made that diagnosis by the clinical picture, the lumbar puncture findings, and/or the neuroimaging), we're following them along, we think we have them on appropriate therapy, (antimicrobial therapy), and their neurologic status worsens - what's the differential diagnosis for this worsening? What are some things we can think about? How do we look for them on exam? How do we work them up?   Dr Reynolds: Yeah. It's funny, because, you know, the topic of this is neuroinfectious emergencies, and when I first heard about it, I was like, “Every neuroinfection is an emergency”, and I think part of the reason I felt that way is because as a neuro ICU physician, I see the complications a lot more. You know, I think, from a meningitis and encephalitis standpoint, certainly cerebral edema (whether it be focal or global) is sort of your biggest concern. If you've used your adjunctive steroid therapy at the beginning before you've started antibiotics, you know the idea is that might help – and, certainly, it should help with potential hearing loss as a result of meningitis - but I would say cerebral edema or development of abscesses because of delayed antibiotic initiation is certainly a concern. If a patient's getting lethargic, hydrocephalus can often be a concern - and that may be obstructive hydrocephalus or communicating hydrocephalus – either way, that is a situation where, really, the patient may need, depending on the etiology of the hydrocephalus, either another lumbar puncture (for example, in the case of cryptococcal meningitis) or an external ventricular drain placement (which would bring them to the ICU in cases where there is an obstructive component). So, I do think hydrocephalus is hard to diagnose. My go-to is to sort of check tone in the legs every day, because a lot of times, patients with developing hydro will start to have really high tone in their legs - so, that's sort of my go-to physical exam finding, although, obviously, hydrocephalus can present as just sort of generalized lethargy or even, you know, worsening nausea and vomiting, for example. And then, I think, you know, if someone starts to be localizing on exam, I think that can be concerning not only for abscess, but potentially for ischemic stroke related to a vasculopathy, for example, or hemorrhage in the context of mycotic aneurysm formation, for example - and, so, I do think there is a role, if a patient starts to become lateralizing, for emergent imaging. And generally, we should be able to see most of the stuff on just a plain CAT scan to start. You know, certainly, localizing stuff can also be as a result of seizures, but I think that that's sort of a diagnosis of exclusion, and rapidly imaging a patient with new focal signs is probably the way to go before putting them on EEG.   Dr Berkowitz: Very helpful pearls. So, um, shifting gears a little bit, right before we began our conversation, you were telling me you had done some work in Malawi, and you were reflecting on some of the differences in epidemiology of neuroinfectious disease and resources available to diagnose neuroinfectious disease. So, I'm sure it would be very interesting for our listeners to hear a little bit about the perspective you bring to the diagnosis and treatment of patients with neurologic infections from your experience in Malawi.   Dr Reynolds: Yeah. So, I was lucky enough as a trainee to be able to go to Malawi for a few weeks with my neuroinfectious disease attending, and I think that it's pretty striking (the difference that we see in lower income countries, compared to the U.S.). I think a lot of the disease processes that we sort of take for granted as being easily treatable are not necessarily easily treatable, not only because of lack of access to medications and antibiotics, but also because of sort of a stigma that might be associated with the workup. So, for example, a lot of people were very hesitant to consent to lumbar puncture, because they had seen that their friends and family members who had gotten lumbar punctures ultimately died, and it didn't seem necessarily clear that the reason that they had died was from the primary infection itself. So, I think that really being attuned to disparities not only abroad, but even - you know, working in New York City, I can say that there are definitely disparities in terms of access to care and health equity, and, certainly, the timing of your presentation almost necessarily will change the outcome, and people who are presenting to the hospital later because of infections that were sort of ignored or because of lack of access to healthcare, those patients, really, by definition, end up doing worse - and so, I think that that is really a big thing to think about in our resource-rich areas, think about these infections.   Dr Berkowitz: Well, thank you for sharing those valuable and important perspectives both from Malawi and from your work in New York City.   Dr Reynolds: Thank you.   Dr Berkowitz: Well, thank you so much, Dr Reynolds, for joining me today on Continuum Audio. I've enjoyed our discussion and learned a lot from it. Again, today, we've been interviewing Dr Alexandra Reynolds, whose article on neuroinfectious emergencies appears in the most recent issue of Continuum on neurocritical care. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to all of our listeners for joining today.   Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, please consider subscribing to the journal. There's a link in the episode notes. We'd also appreciate you following the podcast and rating or reviewing it. AAN members, go to the link in the episode notes and complete the evaluation to get CME for this episode. Thank you for listening to Continuum Audio.

In this enlightening discussion, we have an open conversation with physical therapist Lauren Young, PT, DPT, CSRS, NCS, who reached out to Claire with a number of questions. She was willing to come on the podcast so everyone can benefit from the information. Lauren started a mobile neuro practice in February 2024 and is looking to develop group wellness classes to increase access to specialty services.  Claire answers the following questions: 1. How do you make exercise classes accessible for all levels of abilities in a group setting? 2. How did you start your wellness program, particularly regarding staffing and class structure? 3. How do you structure her membership model and pricing? 4. Looking back, is there anything Claire wishes she had done differently when first starting?  Key takeaways include: 1. Renting space from existing gyms or studios is a smart way to start without heavy upfront costs. 2. Structuring classes for different ability levels is crucial for safety and effectiveness. 3. A monthly membership model provides consistent revenue and commitment from clients. 4. Pricing should reflect the premium nature of specialized services, even if it feels uncomfortable at first. 5. Slow, steady growth allows for learning and adaptation as the business evolves. This conversation offers a wealth of practical advice for PTs looking to expand into wellness programming for neurological patients, emphasizing the importance of adaptability, client-focused services, and sustainable business practices. Find out more about Lauren Young here: NeuroElite Physical Therapy  www.NeuroElitePT.com @NeuroElitePT (Instagram)  Have a neuro biz and want a place to ask questions of other biz owners? Request to join the NeuroBiz Besties free Slack group here

Rita and Linda work with many clients and see all kinds of cat behavior issues. Although it's rare, there are times where the anxiety in that cat is so extreme, they often wonder if a neurological consult might help. However, many clients hear "neurologist" and think it's going to be insanely expensive. So, they invited Dr. Karen Kline, who specializes in neurological conditions, to know talk to chat about the various problems we might see, and how they are addressed. Dr. Kline took the fear out of the neurological consult and shared so much great information and education. We know you won't want to miss this one! EPISODE NOTES: Dr. Karen Kline - Feline Neurologic Anomalies

Dr. Shuvro Roy and Dr. Alexander Gill discuss his paper  "Neurologic Outcomes in People with Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder Exposed To Immune Checkpoint Inhibitors." Show reference:  https://www.aan.com/conferences-community/summer-conference/abstracts/ This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

In this episode, we review the high-yield topic of⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠The Neurologic Exam⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Neurology section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message

Dr. Kim Waddell is an Assistant Professor in Physical Medicine and Rehabilitation at the University of Pennsylvania's Perelman School of Medicine as well as a faculty member with the Center for Health Incentives and Behavioral Economics, a Senior Fellow in the Leonard Davis Institute of Health Economics, and Research and Innovation Manager in the Penn Medicine Nudge Unit at the University of Pennsylvania. In addition, Kim is a Research Health Scientist at the VA Center for Health Equity Research and Promotion. Kim's research focuses on behavior change and how to help motivate people to make decisions that are more aligned with their longer term goals. She is particularly interested in physical activity and using approaches from behavioral science to motivate adults who have had a stroke or have Parkinson's disease to increase their daily activity. Another area that Kim is interested in is designing clinical decision support systems and ways to improve decision making to make sure that people are getting the right amount of the right kind of rehabilitation after stroke. When she's not working, Kim tries to go running as often as possible to clear her head and disconnect from technology. She also enjoys cooking, particularly trying new recipes, as well as watching local sports teams and traveling. Kim received her BS in Health Science from Truman State University and her Master's degree in Occupational Therapy from the University of North Carolina at Chapel Hill. She then attended Washington University in St. Louis where she earned her PhD in Movement Science and her Master's degree in Clinical Investigation. Kim conducted postdoctoral research at the VA and Penn before joining the faculty there. Recently, she was awarded the 2024 Academy of Behavioral Medicine Research's Early-Stage Investigator Award, and in our interview, she shares more about her life and science.

Dr. Derek Stitt and Dr. Adam de Havenon discuss the burden of neurologic health care and incident neurologic diagnoses in the year after COVID-19 vs influenza.  Show reference: https://doi.org/10.1212/wnl.0000000000209248  This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

In this episode, we'll delve into a variety of Perioperative Neurologic Complications, exploring topics such as substance abuse, dementia, emergence delirium, post-operative visual loss, and peripheral nerve injuries.We'll discuss how these complications can impact our anesthetic plan, patient positioning, and the specific considerations we need to address to ensure the best possible care for our patients. Join us as we navigate through these crucial aspects of perioperative care, focusing on the nuances that can make all the difference in patient outcomes.Support the Show.To access all of our content, download the CORE Anesthesia App available here on the App Store and here on Google Play. Want to connect? Check out our instagram or email us at info@coreanesthesia.com

Dr. Derek Stitt talks with Dr. Adam de Havenon about the burden of neurologic health care and incident neurologic diagnoses in the year after COVID-19 vs influenza. Read the related article in Neurology.  This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information. Disclosures can be found at Neurology.org.

Leslie, the Animal Communicator, speaks with Auditor Jessica's horse Cinder. Dr. Tena Ursini from the University of Tennessee's College of Veterinary Medicine joins us with a crash course on Neurologic Issues is horses and some mighty weird news. Listen in…HORSES IN THE MORNING Episode 3380 – Show Notes and Links:The HORSES IN THE MORNING Crew: Glenn the Geek, Jamie Jennings, produced by Coach JennGuest: Leslie from I Speak to Animals and Auditor Jessica SackettGuest: Dr. Tena Ursini | LinkedInFollow Horse Radio Network on TwitterAdditional support for this podcast provided by Daily Dose Equine, State Line Tack, and Listeners Like You!Time Stamps:4:16 - Daily Whinnies13:20 - Leslie from I Speak to Animals and Auditor Jessica Sackett 28:11 - Dr. Tena Ursini42:00 - Weird News

Leslie, the Animal Communicator, speaks with Auditor Jessica's horse Cinder. Dr. Tena Ursini from the University of Tennessee's College of Veterinary Medicine joins us with a crash course on Neurologic Issues is horses and some mighty weird news. Listen in…HORSES IN THE MORNING Episode 3380 – Show Notes and Links:The HORSES IN THE MORNING Crew: Glenn the Geek, Jamie Jennings, produced by Coach JennGuest: Leslie from I Speak to Animals and Auditor Jessica SackettGuest: Dr. Tena Ursini | LinkedInFollow Horse Radio Network on TwitterAdditional support for this podcast provided by Daily Dose Equine, State Line Tack, and Listeners Like You!Time Stamps:4:16 - Daily Whinnies13:20 - Leslie from I Speak to Animals and Auditor Jessica Sackett 28:11 - Dr. Tena Ursini42:00 - Weird News

Dr. Justin Abbatemarco and Prof. Xavier Ayrignac discuss the importance of considering alternative diagnoses for CTLA4 deficiencies.  Show reference: https://www.neurology.org/doi/10.1212/wnl.0000000000207609

Dr. Justin Abbatemarco talks with Prof. Xavier Ayrignac about the importance of considering alternative diagnoses for CTLA4 deficiencies.  Read the related article in Neurology.

Looking 4 Healing Radio with Dr. Bryan Ardis, Nichola Burnett, Dr. Jana Schmidt, and Dr. Henry Ealy – To have sex or not to have sex…that is the question. I can't wait to hear what the Healing Homies have to say on this one! Listen in as the Healing Homies share and simplify their decades of success working with all types of diseases by focusing on the healing power of nature as God intended for us all...

A discussion of the neurological complications of systemic cancer treatments, with Drs. Kevin Yan and Mary Barden.Note: This podcast is intended solely as an educational tool for learners, especially neurology residents. The contents should not be interpreted as medical advice.Further Reading:Taylor JW. Neurologic Complications of Conventional Chemotherapy and Radiation Therapy. Continuum (Minneap Minn). 2023 Dec 1;29(6):1809-1826. doi: 10.1212/CON.0000000000001358. PMID: 38085899.Wang N. Neurologic Complications of Cancer Immunotherapy. Continuum (Minneap Minn). 2023 Dec 1;29(6):1827-1843. doi: 10.1212/CON.0000000000001362. PMID: 38085900.