Podcasts about Neurology

In part one of this two-part series, Dr. Jeff Ratliff and Dr. Brin E. Freund discuss the incidence of acute symptomatic seizures during CAR T-cell therapy.  Show reference:  https://www.neurology.org/doi/10.1212/WNL.0000000000213535   

Dr. Jeff Ratliff talks with Dr. Brin E. Freund about the evaluated incidence and risk factors for acute symptomatic seizures during CAR T-cell therapy. Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

Dr. Halley Alexander and Dr. Serena Yin discuss the effectiveness of an electronic medical record best practice alert in preventing iatrogenic interventions for patients with a diagnosis of PNES. Show references:  https://www.neurology.org/doi/10.1212/CPJ.0000000000200457 

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.

Professor Lorimer Moseley is neuroscientist, who specialises in the complexities and mind-boggling nature of pain - what it is, why it exists, how it works and when it can go wrong.For most of us, pain is a fundamental part of being alive, and staying alive and yet none of us will ever experience the exact same pain as someone else, which makes it incredibly difficult to understand.Every day, we stub our toes and burn our tongues. Some of us break bones and suffer from more serious illnesses and conditions.What you feel when your skin is broken or a ligament is torn is there to tell your brain to be careful, that something is wrong and needs to be protected.But what happens when doctors can't find any damage? When the tissues in your hips or the pictures of your brain seem perfectly fine, but still, there is agonising pain that refuses to leave you alone?Lorimer was a physiotherapist who came to this very specific neuroscience after his own experience with chronic pain, following a pretty gruesome sporting injury that by all accounts had been fixed by surgery.He realised that as he was learning more about how changes in the body are detected (like temperature and pressure), and communicated as pain to the brain through the central nervous system, his own chronic pain started to diminish.Since then, Lorimer has published hundreds of papers and several books on the topic, in his pursuit to help people also dig themselves out of the hellish cruelty of chronic pain.Further informationYou can find more resources from Professor Moseley about tackling persistent or chronic pain online at TameTheBeast.orgFind out more about the Conversations Live National Tour on the ABC website.The Executive Producer of Conversations in Nicola Harrison. This episode was produced by Meggie Morris and presented by Richard Fidler. It explores persistent pain, migraine, arthritis, neurology, psychology, distrust of the medical system, pain relief, hypersensitivity to pain, doctors who believe you, chronic conditions, endometriosis.

In the first episode of this new series, Dr. Andy Southerland discusses the June updates from the AAN's Capitol Hill Report (CHR). This month's CHR update includes a member story from Dr. José Posas.  Stay updated with what's happening on the hill by visiting aan.com/chr.  Learn how you can get involved with AAN advocacy. 

In this episode of the Brain & Life Podcast, co-host Dr. Katy Peters is joined by actors Micah Fowler, Kelsey Cardona, and Phoebe Rae Taylor. Micah shares how his Cerebral Palsy (CP) diagnosis differs from the character who he played on ABC's Speechless and his sister Kelsey explains the benefits of this representation that she's seen in real-time. Phoebe Rae then explains how she got her role in Disney's Out of my Mind and how acting has inspired her for the future. Dr. Peters is then joined by Dr. Ann Tilton, a Professor of Neurology and Pediatrics at LSU Health New Orleans with more than 30 years of experience in the field. Dr. Tilton explains what CP is, how it can differ from person to person, and what advancements the community can look forward to.   Additional Resources What is Cerebral Palsy?  Biking Gives Freedom to a Teen with Cerebral Palsy Becky Dilworth Skied and Raised a Family Despite Cerebral Palsy   Other Brain & Life Podcast Episodes on Similar Topics Scoring Goals with CP Soccer's Shea Hammond Gavin McHugh is Building an Acting Career and a Community with Cerebral Palsy RJ Mitte on Living Confidently with Cerebral Palsy   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: Micah Fowler @micahdfowler; Kelsey Cardona @thekelseycardona; Phoebe Rae Taylor @phoeberaetaylorx Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD

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

Dr. Aaron Zelikovich discusses a phase 3 trial that looked at the use of inebilizumab in generalized myasthenia gravis.  Show reference:  https://www.nejm.org/doi/full/10.1056/NEJMoa2501561

In this episode, Dr. Joy Kong sits down with hormone and integrative medicine specialist Dr. Sara Amirmehrabi of Chara Health to uncover what most doctors overlook: that many modern women's struggles with mood, memory, weight gain, and intimacy may be rooted in hormone imbalances—not just lifestyle or aging.As part of the Chara Health team, Dr. Sara Amir brings her functional, root-cause approach to hormone replacement therapy, helping patients reclaim energy, joy, and clarity. She and Dr. Joy dive deep into the latest science on perimenopause, estrogen receptors in the brain, and why a tailored HRT protocol can be life-changing for women at any age.Whether you're in your 30s and feeling off or postmenopausal and afraid to try hormones again, this episode offers science-backed hope. You'll also learn how regenerative medicine like stem cells and peptides can enhance and amplify the effects of hormone therapy—creating a true foundation for anti-aging and vitality.If you've ever been told “everything looks normal” but you know something's not right, this conversation is for you.Additional Resources:Visit My Clinic: Chara Health

Dr. Halley Alexander talks with Dr. Serena Yin about the effectiveness of an electronic medical record best practice alert in preventing iatrogenic interventions for patients with a diagnosis of psychogenic nonepileptic seizures. Read the related article in Neurology® Clinical Practice.  Disclosures can be found at Neurology.org. 

In the final installment of this three-part series, Dr. Elizabeth Zollos discusses another important diagnostic tool, visually evoked potentials or VEP.

Dr. Halley Alexander and Dr. Samuel W. Terman discuss patients' perceived seizure risk, seizure risk tolerance, and risk counseling techniques.  Show reference: https://www.neurology.org/doi/10.1212/CPJ.0000000000200475 

Is yoga actually more effective than aerobic exercise?Can it really reduce stress by up to 50% and should doctors be prescribing it?In this mind-expanding episode, Celest sits down with Dr Jonathan Rosenthal, physician, neuroscientist and founder of the Yoga & Neuroscience Conference, to explore what the latest research is revealing about the power of yoga. And spoiler: it's more than just flexibility.You'll learn:Why yoga is now being recommended in cancer treatment guidelinesWhat makes it more effective than exercise for stress, mood and even memoryThe game-changing studies comparing yoga to CBT, aerobic exercise and even “sham yoga”What the data says about yoga's unique blend of movement, breath and meditation and why that mattersThe surprising reason why doing yoga even when you don't enjoy it… still worksIf you've ever struggled to explain why yoga helps you feel better, this episode will give you the science to back it up.About JonathanDr Jonathan Rosenthal is a neurologist in New York, NY. Dr Rosenthal received his medical degree from New York University School of Medicine and completed his year in Internal Medicine and residency in Neurology at NYU Hospital, Bellevue Hospital, and the Manhattan VA. He completed his fellowship in clinical neurophysiology at Weill-Cornell Medicine Center, New York Presbyterian Hospital, and Memorial Sloan Kettering. Dr. Rosenthal subspecializes in clinical neurophysiology, with interests in intraoperative monitoring and EEG. Dr Rosenthal has 4 publications and over 100 citings. He is also interested in yoga and meditation as interventions in medicine and hosts the Neuroscience and Yoga Conference.Follow Dr Rosenthal on Instagram.Learn more with Alba Yoga Academy⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Learn more about our Yoga Teacher Training here.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Watch our extensive library of YouTube videos.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow Hannah on Instagram.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow Celest on Instagram ⁠⁠⁠⁠⁠

In this episode, Robin Carhart-Harris, PhD joins to elucidate the intersection of psychedelics and neuroplasticity. Dr. Carhart-Harris is the Ralph Metzner Distinguished Professor in Neurology and Psychiatry at the University of California, San Francisco. Robin founded the Centre for Psychedelic Research at Imperial College London in April 2019, was ranked among the top 31 medical scientists in 2020, and in 2021, was named in TIME magazine's ‘100 Next' – a list of 100 rising stars shaping the future. Dr. Carhart-Harris begins by discussing the impact of psychedelics on neuroplasticity and mental health. He explains neuroplasticity as the brain's ability to change, emphasizing its role in mood disorders and substance use and describes how stress atrophies the brain, leading to mental illness. Dr. Carhart-Harris differentiates between neuroplasticity and neurogenesis, noting that while neurogenesis is limited in adults, neuroplasticity can be influenced by psychedelics like ketamine, psilocybin, and MDMA. In closing, he also discusses the entropic brain hypothesis, suggesting that increased brain entropy leads to richer subjective experiences.    In this episode, you'll hear: The relationship between neuroplasticity and “canalization”  Why homeostatic neuroplasticity may promote mental wellbeing Differences between ketamine, MDMA, and serotonergic psychedelics in terms of neuroplasticity The details of the entropic brain hypothesis Psychedelics' effect on the default mode network The frontiers of research into psychedelics and neuroplasticity  Quotes: “So changeability is what plasticity is. And neuroplasticity—that's the ability of the brain to change. Okay, and how is neuroplasticity related to mood disorders like depression and anxiety or substance use disorder or something like that? Well, that's a great question cause we don't have it entirely nailed down. But one of the most reliable findings in biological psychiatry is that stress atrophies the brain.” [2:47] “The main thing with ketamine is that the window of increased plasticity is brief… That makes sense because that reflects how ketamine seems to work therapeutically—that it provides relief somewhat short-term, unless it is twinned with, say, psychotherapy or you do repeat administration and get someone out of the rut they were in.” [22:15] “We've seen in people with depression, brain networks can become quite segregated from each other—they are ordinarily, they're quite functionally separate and distinct—but that modularity might be a bit elevated in depression. But what we've seen with psilocybin therapy is that separateness between systems, that segregated quality of organization of brain networks, brain systems actually decreases after psilocybin therapy for depression. I'll put it another way: the brain looks more globally interconnected after psilocybin therapy for depression and the magnitude of that… correlates with improvements.” [39:19]   Links: Carhart-Harris Lab website Dr. Carhart-Harris on X Dr. Carhart-Harris' 2025 article: “Neuroplasticity and psychedelics: A comprehensive examination of classic and non-classic compounds in pre and clinical models” Dr. Carhart-Harris' 2012 article: “Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin” Dr. Carhart-Harris' 2010 article with Karl Friston: “The default-mode, ego-functions and free-energy: a neurobiological account of Freudian ideas” Psychedelic Medicine Association Porangui

Dr. Halley Alexander talks with Dr. Samuel W. Terman about patients' perceived seizure risk, seizure risk tolerance, and risk counseling techniques.  Read the related article in Neurology® Clinical Practice.  Disclosures can be found at Neurology.org. 

Dr. Katie Krulisky and Dr. Leah Blank discuss the impact of outpatient follow-up on readmission rates for older adults with epilepsy or seizures.  Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213638 

In this week's episode, Brain & Life Podcast hosts Dr. Daniel Correa and Dr. Katy Peters discuss some of their favorite articles in the most recent edition of Brain & Life Magazine. They discuss how families are leading the charge in rare disease advocacy, how people living with neurologic conditions can be prepared for natural disasters, and what brain fog really is. If you would like to read these articles and more, be sure to subscribe to Brain & Life Magazine or read the issue online!   Brain & Life Articles Mentioned How a Brain Injury Survivor is Offering Others Help and Hope How Families Are Leading the Charge in Rare Disease Advocacy Natural Disasters Can Be More Dangerous for People with Neurological Conditions—Here's How You Can Prepare What Is Brain Fog?   Other Brain & Life Podcast Episodes on These Topics Actor Cameron Boyce's Legacy and Raising Awareness About SUDEP Raising Awareness for a Rare Cancer with Love4Lucas President Hide Harashima Advocacy and Assistive Technology with Former Representative Jennifer Wexton Actress Yvette Nicole Brown Discusses the Caregiving Journey We Are Brave Together with Jessica Patay   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

In the final part of this three-part series, Dr. Justin Abbatemarco and Dr. Sumanth Reddy discuss his team's findings on the treatment approach presented in this paper.  Show reference: https://www.neurology.org/doi/10.1212/NXI.0000000000200397  

In this episode of Health Matters, we discuss what causes dizziness with Dr. Louise Klebanoff, a neurologist with NewYork-Presbyterian and Weill Cornell Medicine. Dr. Klebanoff explains the different types of dizziness, such as lightheadedness, vertigo, and gait instability. We also cover how to differentiate between these types, the potential causes, and  when to seek medical attention.___Dr. Louise Klebanoff, MD has been named the Chief of General Neurology and the Vice Chair of Operations for the Department of Neurology at Weill Cornell Medical College. She is also an Assistant Attending Neurologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.  Dr. Klebanoff received her medical degree from Georgetown University Medical Center, graduating first in her class, and went on to complete a residency in Neurology and a fellowship in Critical Care Neurology at NewYork-Presbyterian Hospital/Columbia University Medical Center.Prior to joining the Weill Cornell faculty, Dr. Klebanoff served as Attending Neurologist at Beth Israel Medical Center, where she also held leadership roles on various committees and served as the first female president of the Medical Board.Dr. Klebanoff is board certified in Psychiatry and Neurology. She is a member of the Alpha Omega Alpha honor society, the American Medical Association and the American Academy of Neurology.___Health Matters is your weekly dose of health and wellness information, from the leading experts. Join host Courtney Allison to get news you can use in your own life. New episodes drop each Wednesday.If you are looking for practical health tips and trustworthy information from world-class doctors and medical experts you will enjoy listening to Health Matters. Health Matters was created to share stories of science, care, and wellness that are happening every day at NewYork-Presbyterian, one of the nation's most comprehensive, integrated academic healthcare systems. In keeping with NewYork-Presbyterian's long legacy of medical breakthroughs and innovation, Health Matters features the latest news, insights, and health tips from our trusted experts; inspiring first-hand accounts from patients and caregivers; and updates on the latest research and innovations in patient care, all in collaboration with our renowned medical schools, Columbia and Weill Cornell Medicine. To learn more visit: https://healthmatters.nyp.org

Recently, sophisticated myelographic techniques to precisely subtype and localize CSF leaks have been developed and refined. These techniques improve the detection of various types of CSF leaks thereby enabling targeted therapies. In this episode, Katie Grouse, MD, FAAN, speaks with Ajay A. Madhavan, MD, author of the article “Radiographic Evaluation of Spontaneous Intracranial Hypotension” in the Continuum® June 2025 Disorders of CSF Dynamics 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. Madhavan is assistant professor of radiology at the Mayo Clinic in Rochester, Minnesota. Additional Resources Read the article: Radiographic Evaluation of Spontaneous Intracranial Hypotension 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 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 Grouse:  This is Dr Katie Grouse. Today I'm interviewing Dr Ajay Madhavan about his article on Radiographic Evaluation of Spontaneous Intracranial Hypotension, which he wrote with Dr Levi Chazen. This article appears in the June 2025 Continuum issue on disorders of CSF dynamics. Welcome to the podcast, and please introduce yourself to our audience. Dr Madhavan:  Hi, thanks a lot, Katie. Yeah, so I'm Ajay Madhaven. I'm a neuroradiologist at the Mayo Clinic in Rochester, Minnesota. I did all my training here, so, I've been here for a long time. And I have a lot of interest in spinal CSF leaks, and I do a lot of that work. And so I'm really excited to be talking about this article with you. Dr Grouse:  I'm really excited too. And in fact, it's such a pleasure to have you here talking today on this topic. I know a lot's changed in this field, and I'm sure many of our listeners are really interested in learning about the developments and imaging techniques to improve detection and treatment of CSF leaks, especially since maybe we've learned about this in training. I want to start by asking you what you think is the most important takeaway from your article. Dr Madhavan:  Yeah, that's a great question. I think---and you kind of already alluded to it---I think the main thing is, I hope people recognize that this field has really changed a lot in the last five to ten years, through a lot of multi-institutional collaboration and also collaboration between different specialties. We've learned a lot about different types of spinal CSF leaks, how we can recognize the disease, particularly the types of myelography that we need to be using to accurately localize and treat these leaks. Those are the things that have really evolved in the last five to ten years, and they've really helped us improve these patients' lives. Dr Grouse:  Can you remind us of the different common types of spinal leaks that can cause spontaneous intracranial hypotension? Dr Madhavan:  Yeah, so there are a number of different spinal CSF leaks, types, and I would say the three most common ones that really most people should try to be aware of and cognizant of are: first, ventral dural tears. So those are, like, just physical holes in the dura. And they're usually caused by little bone spurs that come from the vertebral columns. So, they're often patients who have some degenerative changes in their spine. And those are really very common. Another type of spinal CSF leak that we commonly see is a lateral dural tear. So that's like the same thing in a slightly different location. So instead of being in the front, it's off to the side of the dura laterally. And so, it's also just a hole in the dura. And then the third and most recently discovered type of spinal CSF leak is a CSF-venous fistula. So those are direct connections between the subarachnoid space and little paraspinal vein. And it took us a long time to even realize that this was a real pathology. But now that it's been recognized, we've found that this is actually quite common. So those three types of leaks are probably the three most common that we see. And there's certainly others out there, but I would say over 90% of them fall into one of those three categories. Dr Grouse:  That's a great review, thank you. Just as another quick review, as we talk more about this topic, can you remind us of some of the most common or typical brain imaging findings that you'll see in cases of spontaneous intracranial hypotension? Dr Madhavan:  Yeah, absolutely. So, when you do a brain MRI in a patient who has spontaneous intracranial hypotension, you will usually, though not always, see typical brain MRI abnormalities. And I kind of think of those as falling into three different categories. So, the first one I think of is dural enhancement or thickening. So that's enlargement or engorgement of the dura, the pachymeninges, and enhancement on postgadolinium imaging. So, that's kind of the first category. The second is that, when you lose spinal fluid volume, other things often expand to take up the space. So, for example, you can get distension or enlargement of the dural venous sinuses, and sometimes you can also get subdural food collections or hematomas. They can arise spontaneously. And I kind of think of those as, you know, you, you've lost the cerebrospinal fluid volume and something else is kind of filling up the space. And then the third category is called brain sagging. And that's a constellation of findings where the posterior fossa structures and the pituitary gland in the cell have become abnormal because you've lost the fluid that normally cushions those structures and causes them to float up. For example, the brain stem will sag down, the distance between the mammillary body and the ponds may become reduced. The suprasellar cistern space may be reduced such that the optic chiasm becomes very close to the pituitary gland, and the prepontine cistern may also become reduced in size. And there are various measurements that can be used to determine whether something is subtly abnormal. But just generally speaking, those are really the three categories of brain MRI abnormalities you'll see. Dr Grouse:  That was a great review. And of course, I think in many times when we are thinking about or suspecting this diagnosis, we may be lucky to find those imaging findings to reinforce a diagnosis. Because as it turns out, after reading your article, I was really surprised to find out that in as many as 19% of cases we actually see normal brain imaging, which really was a surprise to me, I have to say. And I think that this really encompasses why spontaneous intercranial hypotension is such a difficult diagnosis to make. I think a lot of us struggle with how far to take the workup when, you know, spontaneous intercranial hypotension is clinically suspected, but multiple imaging studies are normal. Do you have any guidance on how to approach these more difficult cases? Dr Madhavan:  So, that's a really good question. And you know, it's- as you can imagine, that's a topic that comes up in most meetings where people discuss this, and it's been a continued challenge. And so, like you said, about 19 or 20% of patients who have this disease can have a, a normal brain MRI. And we've tried to do some work to figure out why that is and how we can identify patients who still have the disease. And I can just provide, I guess, some tips that have helped me in my clinical practice. One thing is, if I ever see a patient with a normal brain MRI where this disease is clinically suspected---for example, maybe they have orthostatic headaches or other very typical symptoms and we don't know why, but their brain MRI is normal---the first thing I do is I try to look back at their old imaging. So many times, these patients who present to us at Mayo, who, when we do their MRI scan here, their brain MRI looks normal… if you really look back at imaging that they've had done elsewhere---maybe even two to three years prior---at the time their symptoms started, they actually had some abnormalities. So, I might see that a patient, two years ago, had dural enhancement that spontaneously resolved; but now they still have symptoms of SIH and they may still have a CSF leak that we can find and treat, but their brain MRI has, for whatever reason, normalized. So, I always start by looking back at old imaging, and I found that to be very helpful. The other thing is, if you see a patient with a normal brain MRI, it's also important to look at their spine MRI because that can provide clues that might suggest that they could still have a spinal CSF leak. And the two things I look for on the spine MRI: one, if there's any extradural CSF. So, spinal fluid outside of where it's supposed to be within the confines of the subarachnoid space. And you know, really, if you see extradural CSF, you know they probably have a spinal fluid leak somewhere. Even if their brain MRI is normal, that just gives you the information that there is a dural tear probably somewhere. And so, in those patients we'll definitely still proceed to myelography or other testing, even if they have a normal brain MRI. And then the last thing I look for is whether or not they have prominent meningeal diverticula. Patients with CSF venous fistulas almost always have one or more prominent diverticula on their spine along the nerve root sleeves. And that's probably because most of these fistulas come from nerve root sleeve diverticula. We don't completely understand the pathogenesis of CSF venous fistulas, but they're clearly associated with meningeal diverticula. So, if I see a patient who has a normal brain MRI, but I see on their spine MRI that they have many meningeal diverticula that are relatively prominent, that makes me more inclined to be a little bit more aggressive in doing myelography to find a CSF leak. And then I look at other demographic features, too. So, for example, elevated BMI and older age are associated with CSF venous fistulas. So, that can help you determine whether or not it's warranted to go on to more advanced imaging, too. So those are all just a variety of different things that we've used to help us. Dr Grouse:  Thank you for sharing that. I wanted to go on to say that, you know, reading your article, of course, as you mentioned, you alluded to the fact there's lots of new imaging modalities out there. It was very illuminating and just an excellent resource for the options that exist and when they're useful. You did a great job summarizing it. And I encourage our readers to check out your article, to refresh themselves, update themselves on what's happened in this space. And of course, we can't summarize them all today, but I was wondering if you could possibly walk us through a hypothetical case of a patient who comes in with a history very suspicious for SIH? How would you approach this patient? Say you have gotten imaging that suggested that there is a spinal fluid leak and now you have to figure out where it is. Dr Madhavan:  Yeah. So, you know, I think the most typical scenario it'll be a patient who has been seen by one of my excellent neurology colleagues and they've done a brain MRI and they've made the diagnosis through a combination of clinical information and brain MRI finding. And then the next thing we'll do always is, we'll obtain a spine MRI. So, I think of the purpose of the spine MRI as to determine what type of spinal fluid leak they have. On the spine MRI, if you see extradural CSF, those patients essentially always will have a dural tear. And it may be a ventral dural tear or a lateral dural tear. But if you see extradural CSF, that is pretty much what they have. And conversely, if you don't see extradural CSF---if you just see, for example, many meningeal diverticula, but you don't see anything else particularly abnormal---most of those patients have a CSF venous fistula, just common things being common. So I use the spine MRI to determine what type of leak they have. And then the next thing I think about is, okay, I'm going to do a myelogram on this patient. How do I want to position them? Because it turns out that positioning is probably the most important factor for finding these spinal fluid leaks. You have to have the patient positioned correctly to find the leak that you're trying to localize. And so, if I suspect they have a ventral dural tear, I will always position those patients prone for their myelogram. And I might do one of many different types of myelograms. And, you know, the article talks about things like digital subtraction myelography and dynamic CT myelography. And you can find any of these leaks with any of those techniques, but you just have to have the patient positioned correctly. So, if I think I have a ventral dural tear, I'll put them prone for the myelogram. If I think they have a lateral dural tear, I'll put them in the cubitus position for the myelogram. And also, if they- if I think they have a CSF-venous fistula, I'll also put them in the decubitus position. Obviously if you're putting them in the decubitus position, you have to decide whether it's going to be left or right side down. So that may require a two-day exam. Sometimes you don't have to; in many cases, we're able to just do everything in one day. But those are all the different factors I think about when I'm trying to determine how I'm going to work those patients up further. So, I really use the spine MRI chiefly to think about what type of leak they're going to have and how I'm going to plan the myelogram. Dr Grouse:  That's really great. And it's, I think, really nice to emphasize how much the positioning matters in all this, which I think is not something we've been classically taught as far as the diagnosis of spinal leaks. Another thing I'm really interested in your opinion on is, you talked a lot about how to optimize and what can make you successful at diagnosis. I'm curious what you think one of the easiest mistakes to make or, you know, that we should hopefully avoid when treating patients with this disease. Dr Madhavan:  Yeah. And I think, you know, one other thing that's been discussed a lot in this topic… you know, we've talked about the patients with a normal brain MRI. Another barrier or challenge particularly with CSF-venous fistulas is, sometimes they can be very subtle on imaging. So, it's not always you see it very definitive CSF-venous fistula where you can say, like, there's no question, that's a fistula. There are many times where we do a good-quality myelogram and we see something that looks, like, possible for a CSF venous fistula, or probable. If I had to put a number on it, maybe there's a 50 to 70% chance of real. So, in those cases, we end up wondering, like, should we treat this suspected leak? And I think one common mistake  or one thing that needs to be looked at further is, how do we handle these patients where we don't know whether the fistula is real or not? That's usually something where I will have a discussion with the patient, and I'm usually just very upfront with him about my interpretation of the imaging. I'll just tell them, we did a good-quality myelogram. You did a great job. We got good images. I don't see anything definitive, but I see this thing that I think has maybe a 60% chance of being real. And then I'll confer with one of my neurology colleagues and we'll decide whether it's worth treating that or not. And we'll just be very upfront with a patient about whether- about the likelihood of its success and what their long-term prognosis is. And oftentimes we let them make the decision. But I think that remains to be one of the big challenges is, how do we treat these patients who have suspected leaks that are not definitive on imaging. Dr Grouse:  That sounds absolutely like an important area where there can be problems, so I appreciate that insight. I'm interested what you think in your article would come as the biggest surprise to our listeners who may not have kept up as much with all of the changes that have happened in recent years? Dr Madhavan:  One of the things that was certainly, at least, a surprise to me as I was going through my training and learning about this topic is how diverse myelography has really become. You know, when I was a radiology resident, I learned about myelography as this thing that we've been doing for 30 to 40 years. And historically we've used myelograms just to look for degenerative changes: disc bulges, you know, disc herniations and things like that. Now that MRI is more prevalent, we don't use it as much, but it has turned out that it has a very big role in patients with spinal fluid leaks. Furthermore, something that I've learned is just how diverse these different types of myelograms have become. It used to kind of be just that a myelogram is a myelogram is a myelogram, but now we have different types of positioning, different types of equipment that we use. We vary the timing between contrast injection and imaging to optimize success for finding spinal fluid leaks. So, I think many times I talk to people who may not be as familiar with this field and they're surprised at just how diverse that has become and how sophisticated some of the various myelographic techniques have become and how much that really makes a difference in being able to accurately diagnose these patients. Dr Grouse:  Well, I can say it was a surprise to me. Even as someone who does treat quite a few patients with this condition, I was surprised to see the breadth of different options that have become available. And then kind of a follow-up to that, what do you think the current area of controversy is in this area of diagnosis and treatment? Dr Madhavan:  The biggest ones are ones you've sort of already alluded to. So, one big one is, how far do we go in patients who have a normal brain MRI who still have a clinical suspicion of the disease? And sometimes it's really hard, because sometimes you will find patients who clinically have a very strong case for having spontaneous intracranial hypotension. You look at them, they have very acute-onset orthostatic headaches. There's no better explanation for their symptoms that we know of. And it's hard to know what to do with those patients, because some of them want to continue to undergo diagnostic workup, but you can only do so many myelograms and you can only do so much with this diagnostic workup that requires some radiation dose before it becomes very challenging. That's a major point of just, I guess, ongoing research as to what can we do better for that subset of patients. Fortunately, it's not all of them, it's a subset of them, but I think we could help those patients better in the future as we learn more about the disease. So that's one. And the other one is treating these equivocal findings, like I discussed.  And where should our threshold be to treat a patient, and what type of treatment should we do in patients where we don't know whether a leak is real? Should we just do a very noninvasive- relatively noninvasive blood patch? Do we do an embolization where we're leaving a foreign body there? Is it worth sending those patients to surgery? Those are all unanswered questions and things that continue to spark ongoing debate. Dr Grouse:  Do you think that there's going to be any new big breakthroughs, or even, do you know of any big developments on the horizon that we should be keeping our eyes out for? Dr Madhavan:  You know, I think for me the biggest thing is, imaging is dramatically improving. We talked a little bit about photon counting detector CT in our article, and that's one of the newest and best techniques for imaging these patients because it has very, very high resolution, it has a lower radiation dose, it has allowed us to find leaks that we were not able to find before. And there are other high-resolution modalities that are emerging and becoming more accessible to things like cone beam CT which we do in addition to digital subtraction myelography. And on top of that, we've started to use AI-based tools to make images look a lot better. So, there are various AI algorithms that have come out that allow us to remove artifacts from imaging. They help us image patients with a bigger body habitus better without running into a lot of imaging artifacts. They help us reduce noise in imaging. They can just give us better-quality images and aid us in the diagnosis. For me as a radiologist, those are some of the most exciting things. We're finding less invasive ways with less radiation to better diagnose these patients with just better-quality imaging. Dr Grouse:  Well, that is definitely something to be excited about. So, I just want to thank you so much for talking with us today. It's been such an interesting, informative discussion and a real privilege to talk with you about this important topic. Dr Madhavan:  Yeah, thanks so much. I really appreciate the time to talk with you, and I look forward to seeing the article out there and hopefully getting some interesting questions. Dr Grouse:  Again, today I've been interviewing Dr Ajay Madhavan about his article on Radiographic Evaluation of Spontaneous Intracranial Hypotension, which he wrote with Dr Levi Chasen. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. 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.

In this episode, we'll be talking about Cassie Ventura and trauma. Cassie is someone the world first met beside one of the most powerful names in music and business. From the outside, everything looked glamorous, even like something to aspire to. But what unfolded behind closed doors was something much darker. As Cassie bravely took the stand years later, now a mother and no longer silent, she revisited the pain she suffered and the years it took to reclaim her voice. We're going to go through her lawsuit from 2023, her testimony in May of 2025, what abuse really does to the brain, and why the question shouldn't be “Why didn't she leave?” but “What kept her from feeling like she could?”Connect with Paige:Instagram: instagram.com/reverietruecrime TikTok: tiktok.com/@paige.elmore Facebook: facebook.com/reverietruecrime Twitter/X: twitter.com/reveriecrimepod BlueSky: reverietruecrime.bsky.social Intro and Outro by Jahred Gomes: https://www.instagram.com/jahredgomes_officialSources:https://www.courthousenews.com/wp-content/uploads/2023/11/diddy-cassie.pdfhttps://scholarsarchive.byu.edu/cgi/viewcontent.cgi?article=1251&context=intuitionhttps://www.domesticshelters.org/articles/health/how-trauma-rewires-the-brainhttps://www.sciencedirect.com/science/article/pii/S0091302216300139#s0005https://abcnews.go.com/US/live-updates/sean-diddy-combs-trial-live-updates/?id=121656142https://www.janiceklaw.com/blog/how-sexual-abuse-affects-the-brain/https://www.womenagainstabuse.org/education-resources/learn-about-abuse/types-of-domestic-violencehttps://psychcentral.com/health/effects-of-emotional-abuse#brain-impactshttps://www.psychologytoday.com/us/blog/why-bad-looks-good/202107/why-do-domestic-violence-victims-return-to-abusershttps://psychcentral.com/blog/liberation/2017/10/long-term-narcissistic-abuse-can-cause-brain-damage#4https://dana.org/article/the-abused-brain/https://www.businessinsider.com/sean-diddy-combs-trial-striking-revelations-to-know-2025-5https://www.nbcnews.com/news/us-news/live-blog/sean-diddy-combs-trial-cassie-ventura-lawyers-live-updates-rcna206807https://www.dailymail.co.uk/tvshowbiz/cassie-ventura/index.htmlhttps://www.verywellmind.com/the-cycle-of-sexual-abuse-22460https://people.com/escort-hired-diddy-alleged-freak-offs-speaks-out-message-for-cassie-exclusive-11744158https://www.charliehealth.com/post/the-long-term-effects-of-narcissistic-abusehttps://deadline.com/2025/05/cassie-ventura-sean-diddy-combs-trial-1236395063/https://cptsdfoundation.org/2020/06/22/the-neuroscience-of-narcissism-and-narcissistic-abuse/https://www.npr.org/2025/05/13/nx-s1-5396851/diddy-trial-cassie-sean-combshttps://www.shorelinerecoverycenter.com/how-domestic-abuse-affects-the-brain/https://apnews.com/article/diddy-trial-sex-trafficking-cassie-testimony-69c7a6ad766103e39c4f7f35df841205https://www.verywellmind.com/effects-of-narcissistic-abuse-5208164https://www.newsnationnow.com/crime/sean-diddy-combs-cassie-ventura-trial/https://www.nytimes.com/live/2025/05/13/arts/sean-combs-diddy-trial-cassiehttps://www.theguardian.com/music/2025/may/16/cassie-ventura-sean-diddy-combs-trialhttps://www.bbc.com/news/articles/cj42nvrkgznohttps://www.bbc.com/news/articles/cwy71k1pee5ohttps://pmc.ncbi.nlm.nih.gov/articles/PMC9931748/https://www.harborchc.org/blog/domestic-violence-and-the-impacts-on-your-physical-and-mental-health#:~:text=The%20two%20main%20changes%20to,for%20memory%20and%20regulating%20emotions.https://www.npr.org/2024/03/13/1238225255/domestic-violence-is-now-recognized-as-a-leading-cause-of-traumatic-brain-injuryhttps://biausa.org/public-affairs/media/domestic-violence-as-a-cause-of-tbihttps://www.allianceforhope.org/family-justice-center-alliance/news-archive/commentary-domestic-violence-how-trauma-impacts-the-brain-and-behaviorhttps://pmc.ncbi.nlm.nih.gov/articles/PMC9931748/Become a supporter of this podcast: https://www.spreaker.com/podcast/reverie-true-crime--4442888/support.

In part two of this three-part series, Dr. Justin Abbatemarco and Dr. Sumanth Reddy discuss how patients with amyloid-beta–related angiitis present.  Show reference: https://www.neurology.org/doi/10.1212/NXI.0000000000200397   

Dr. Diego Torres-Russotto, Chair of Neurology and Distinguished Endowed Chair in Neurology at Baptist Health Miami Neuroscience Institute, Baptist Health South Florida, joins the podcast to share his insights on Parkinson's disease—what it is, key symptoms to watch for, and his work in the field. He explores advancements in research and how evolving technologies are helping to improve outcomes and reduce symptoms for patients living with Parkinson's.

Dr. Theodore Henderson is an MD. PhD, Founder, CEO and Medical Director of Neuro-Luminance, who brings decades of clinical experience in psychopharmacology, neurobiology, infrared light therapy, and neuroimaging to the successful treatment of brain disorders.   Dr. Henderson and his team specialize in treating patients with depression, concussion, brain injury, PTSD, Chronic Fatigue Syndrome, Parkinson's Alzheimer's, and ADHD. He is also the author of the recently published book titled “Brighter Days Ahead: Leaving Depression Behind Through Innovative New Treatments” which is an excellent and easily readable introduction for people of every walk of life to understand the concepts as well as the benefits and healing power of infrared light therapy.  In this informative, positive, hopeful, and also entertaining episode, Dr, Henderson skillfully explains exactly how the brain changes as a result of depression, traumatic brain injury, Long COVID, chronic fatigue syndrome, and other brain disorders. He describes the revolutionary new treatments that activate the brain's own ability to repair itself. He has a knack for describing complex brain conditions and neurological function in great detail and in terms that are easy to understand, and he does it with a sense of humor as well.   Download this fascinating episode to hear Dr. Henderson's story and discover how these groundbreaking new treatments can give hope and healing to people suffering from brain disorders and neurological dysfunction, and please share this positive message of hope and healing with your friends, family, and anyone you know who can benefit from this remarkable technology.   Connect with Dr. Henderson: https://neuro-luminance.com/ https://www.facebook.com/LuminanceBrainHealth https://x.com/neuroluminance?lang=en&mx=2 https://www.youtube.com/@NeuroLuminance?app=desktop https://www.linkedin.com/in/theodore-henderson-md-phd-98201318/ https://www.youtube.com/watch?v=zdFstQSR_A4

In this episode of Research Renaissance, host Deborah Westphal welcomes Dr. Yvette Wong, Assistant Professor of Neurology at Northwestern University and 2024 Toffler Scholar, for a deep dive into the dynamic inner world of cells—and how her lab is uncovering new clues about neurodegenerative diseases by studying the microscopic interactions between organelles.Dr. Wong discusses how organelles like mitochondria and lysosomes don't just function in isolation—they actually “talk” to each other at contact points within cells. These cellular conversations may hold the key to unlocking better understanding and treatments for conditions like ALS, Parkinson's, and Huntington's disease.Through vivid analogies (like buses exchanging cargo), Dr. Wong helps translate complex science into clear visuals, while also highlighting how advances in super-resolution live-cell microscopy and data analysis are transforming what's possible in neuroscience.

Dr. Katie Krulisky talks with Dr. Leah Blank about the impact of outpatient follow-up on readmission rates for older adults with epilepsy or seizures. Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

In the concluding segment of this series, Dr. Halley Alexander and Dr. Coral M. Stredny delve into the essential components of seizure action plans and identify the individuals who should have one. Show reference:  https://www.neurology.org/doi/10.1212/CPJ.0000000000200449  

Alexander Pantelyat, MD, FAAN is an associate professor of Neurology at the Johns Hopkins University School of Medicine. He is the founder and director of the Johns Hopkins Atypical Parkinsonism Center, and the co-Founder and Director of the Johns Hopkins Center for Music and Medicine. Dr. Pantelyat's research is focused on the diagnosis and treatment of atypical parkinsonian disorders, such as dementia with Lewy bodies, progressive supranuclear palsy, corticobasal syndrome/degeneration and multiple system atrophy; cognitive aspects of movement disorders; and music-based rehabilitation of neurodegenerative diseaseshttps://www.seniorcareauthorit...

In this episode of ‘The Aging Well Podcast', Dr. Dr. Armstrong's guest is Dr. Pria Anand, author of ‘The Mind Electric.' They discuss the intricate relationship between storytelling, aging, and the brain. Dr. Anand emphasizes that aging is not merely a decline but a complex transformation that involves both challenges and improvements in cognitive functions. The discussion explores neurodegenerative diseases, the impact of infections and autoimmune disorders on brain health, and the critical role of patient narratives in diagnosis and treatment. Dr. Anand advocates for better communication in healthcare and highlights the importance of patient advocacy in navigating the medical system and the challenges faced by women and underrepresented genders in navigating the healthcare system, emphasizing the importance of self-advocacy. She shares her journey of balancing a medical career with creative writing, highlighting how motherhood has shaped her priorities. The discussion considers the lessons learned from neurology that can be applied to everyday life, particularly the significance of storytelling in understanding our experiences and its impact on aging. The conversation concludes with a look at the future of neurology and the importance of continued research in sleep science for… aging well.Learn more about Dr. Anand and the book at:https://www.priaanand.com/https://www.simonandschuster.com/books/The-Mind-Electric/Pria-Anand/9781668064016Please, support The Aging Well Podcast by hitting the ‘like' button, subscribing/following the podcast, sharing with a friend, and….BUY ‘The Mind Electric' on Amazon and support ‘The Aging Well Podcast': https://amzn.to/4m8tUAnBUY the products you need to… age well from our trusted affiliates and support the mission of ‘The Aging Well Podcast'*.Thrive25—Your personal longevity advisor | https://www.thrive25.com/early-access?via=william-jeffreyMemory Lane TV | the first therapeutic streaming platform for people living with dementia — designed to replace overstimulating television with multisensory, evidence-based media that soothes, orients, and restores | for 30% off the annual subscription visit https://www.memory-lane.tv/?rfsn=8714090.a500b0Fusionary Formulas | Combining Ayurvedic wisdom with Western science for optimal health support. | 15% off Code: AGINGWELL | https://fusionaryformulas.com/Jigsaw Health | Trusted supplements. “It's fun to feel good.” | Click the following link for 10% off: https://www.jigsawhealth.com/?rfsn=8710089.1dddcf3&utm_source=refersion&utm_medium=affiliate&utm_campaign=8710089.1dddcf3Auro Wellness | Glutaryl—Antioxidant spray that delivers high doses of glutathione (“Master Antioxidant”) | 10% off Code: AGINGWELL at https://aurowellness.com/?ref=1957Dr Lewis Nutrition | Fight neurodegeneration and cognitive decline with Daily Brain Care by Dr Lewis Nutrition—a proven daily formula designed to protect and restore brain function. | 10% off code: AGINGWELL or use the link: https://drlewisnutrition.com/AGING WELLTruDiagnostic—Your source for epigenetic testing | 12% off Code: AGEWELL or use the link: https://shop.trudiagnostic.com/discount/AGEWELL*We receive commission on these purchases. Thank you.

In part one of this two-part series, Dr. Halley Alexander and Dr. Coral M. Stredny discuss the importance of seizure action plans and how this might translate into our clinical care.  Show reference:  https://www.neurology.org/doi/10.1212/CPJ.0000000000200449   

Michael has a passion for understanding how the human mind works to drive our decisions. Over the past 12 years, Michael has created a fresh and counter-intuitive insight of how people can use targeted language to rapidly create trust and the decision to buy. Michael talks about the neurological principles behind effective messaging, branding, building client trust, and much more!

Dr. Halley Alexander talks with Dr. Coral M. Stredny about the management of pediatric convulsive status epilepticus, focusing on the importance of seizure action plans and adherence to treatment protocols.  Read the related article in Neurology® Clinical Practice.  Disclosures can be found at Neurology.org. 

Dr. Nadia Khalil and Dr. Jean Bouchart discuss the diagnostic approach to intracerebral hemorrhage, the causes of cerebral small vessel disease, and the interpretation of biomolecular tests.  Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000209796 

In this episode of the Brain & Life Podcast, co-host Dr. Daniel Correa is joined by dedicated public servant and former U.S. Representative for Virginia's 10th congressional district Jennifer Wexton. She shares about her journey with progressive supranuclear palsy (PSP) and what she has learned from the PSP community. She also discusses the importance of advocacy and the use of assistive technology, including the AI-generated voice she uses during this episode. Dr. Correa is then joined by Dr. Janis Miyasaki, a movement disorders specialist who practices at the University of Alberta in Canada where she is the head of the department of clinical neuroscience and co-directs the Neuropalliative Care Clinic. Dr. Miyasaki explains PSP and discusses what the care experience may look like for someone living with PSP and their loved ones as they search for comfort and peace. Interested in getting involved with advocacy? Learn more here: https://www.brainandlife.org/get-involved/advocate/     Additional Resources Former Representative Jennifer Wexton Breaks Barriers with AI-Generated Voice Amid PSP Battle The Research Pipeline for Progressive Supranuclear Palsy CurePSP   Other Brain & Life Podcast Episodes on Similar Topics Family Stories: Diagnosing a Neurodegenerative Condition The Future of Caregiving with Kat McGowan Still Standing with Staff Sergeant John Kriesel   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: Jennifer Wexton @repwexton; Dr. Janis Miyasaki @ualberta Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD

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 the final episode of this three-part series, Dr. Jodie Roberts and Dr. Urs Fisch discuss functional/dissociative seizures and driving risk.  Learn more about the Neurology® Practice Current section and fill out the current survey on functional/dissociative seizures and driving. 

Spontaneous intracranial hypotension reflects a disruption of the normal continuous production, circulation, and reabsorption of CSF. Diagnosis requires the recognition of common and uncommon presentations, careful selection and scrutiny of brain and spine imaging, and, frequently, referral to specialist centers.  In this episode, Gordon Smith, MD, FAAN speaks with Jill C. Rau, MD, PhD, author of the article “Clinical Features and Diagnosis of Spontaneous Intracranial Hypotension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Rau is an assistant professor of clinical neurology at the University of Arizona, School of Medicine-Phoenix in Phoenix, Arizona. Additional Resources Read the article: continuumjournal.com 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: @gordonsmithMD Full episode transcript available here Interview with Jill Rau, MD 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 Smith: This is Dr Gordon Smith. Today I'm interviewing Dr Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension, which she wrote with Dr Jeremy Cutsworth-Gregory from the Mayo Clinic. This article appears in the 2025 Continuum issue on disorders of CSF dynamics. I'm really excited to welcome you to the Continuum podcast. Maybe you can start by just telling our listeners a little bit about yourself? Dr Rau: Hi, thanks for having me. I'm really honored to be here, and I really enjoyed writing the paper with Dr Cutsforth-Gregory. I hope you guys enjoy it. I am the director of headache medicine at the Baba Bay Neuroscience Institute at Honor Health in Scottsdale, Arizona. I'm also currently the chair of the special interest group in CSF Dynamics at the American Headache Society, and I've had a special interest in this field since I first watched Dr Linda Gray speak at a conference where she talked about spinal CSF leaks and their different presentations. And they were so different than what I had been taught in residency. They're not just the post-LP headache. They have such a wide variety of presentations and how devastating they can be, and how much impact there is on someone's life when you find it and fix it. And I've been super interested in the field and involved in research since that time. And, yeah. Love it. Dr Smith: Well, thanks for sharing your story. And as I reflected on our conversation ahead of time and have been thinking about this issue… this is a cool topic, and every time I read one of these manuscripts and have the opportunity to speak with one of the authors, I learn a ton, because this was something that wasn't even on the radar when I trained back in the 1800's. So, really looking forward to the conversation. I wonder if you could really briefly just summarize or remind for everyone the normal physiology about CSF dynamics, you know, production, absorption, and so forth? Dr Rau: So, the CSF is the fluid that surrounds the brain and the spinal cord, and it's contained by the dura, which is like a canvas or a sac that covers that whole brain and spinal cord. And within the ventricles of the brain, the choroid plexus produce CSF. It's constantly producing and then being reabsorbed by the arachnoid granulations and pushed into the venous space, the cerebral sinuses, venous sinuses. And also some absorption and push into the lymphatics that we've just learned about in the past year. This is kind of new data coming out, so always learning more and more about CSF, but we know that it bathes the brain and the spinal cord, helps keep some buoyancy of the brain as well as pushing nutrients in and pulling out metabolic waste. And it sort of keeps the brain in the state of homeostasis that's happy. And so, when there's a disruption of that flow and the amount of fluid there, that disrupts that, that can cause lots of different symptoms and problems for people. Dr Smith: One of the many new things I learned is that even the name of this---spontaneous intracranial hypotension---is misleading. And I think this is clinically relevant, as we'll probably get to in a moment, but can you talk a little bit about this? Is this really like a pressure disorder or a volume disorder? Dr Rau: Yeah. It's almost certainly a volume disorder. We do see in some people that they have low pressure, and it's still part of the diagnostic criteria. But it's there because if you have a low pressure, if you measure an opening pressure and it's below six, if you're measuring it in the spine in the right place, then you have indication that there's low volume. But there's over 50% of people's opening pressure who have a spinal CSF leak, have all the symptoms and can be fixed. So, they have normal pressure in 50% of the people. So, it is an inaccurate term, hypotension, but it was originally discovered because of the thought that it was a low-pressure situation. Some of the findings would suggest low pressure, but ultimately, we are pretty sure it's a low-volume condition. Dr Smith: Another new thing that I learned that really blew me away is how bad this can be. I did a podcast with Mark Burish about cluster, and I was reminded many cluster patients are pushed to the point of suicidal ideation or committing suicide by the severity of pain. And this sounds like for many patients it's equally severe. Can you maybe paint a picture for our listeners why this is so clinically important? Dr Rau: A large number of people, even people who are known to have leaks because they've had them before or they've releaked, they have a lot of brain fog and cognitive impairment. They often have severe headaches when they're upright. So, orthostatic headache is probably the number one most common symptom, and those headaches are one of the worst headaches out there. When people stand up, their fluid is not supporting the brain and there's an intense amount of pain. And so, they spend a large portion of their lives horizontal. And there's associated symptoms with that, it's not just headache pain and brain fog. There's neck pain. There's often subsequent disorders that accompany this, like partial orthostatic tachycardia syndrome. We don't know if that's because of deconditioning or an actual sequela of the disease, but it's a frequent comorbidity. We have patients that have extreme dizziness with their symptoms, but many patients are limited to hours, if that, upright per day, combined, total. And so they live their lives, often, just in the dark, lots of photophobia, sensitive to the light, really unable to function. It's also very hard to find and so underrecognized that a lot of patients, especially if they don't have that really clinical symptom of orthostatic headache. So, it's often missed. So, they're just debilitated. You know, treatments don't work because it's not a migraine and it's not a typical headache. It's a mechanical issue as well as a metabolic issue and not found, not a lot helps it. Dr Smith: So, you know, I have always thought about this as really primarily an orthostatic symptom. I wonder if you can talk about the complexity of this; in particular, kind of how this evolves over time, because it's not quite that simple. And maybe in doing so, you can give our listeners some pearls on when they should be thinking about this disorder? Dr Rau: A large portion of people do have headache with spinal CSF leak, in particular, spontaneous intracranial hypertension- hypotension, excuse me. And that's something to be thought about, is that there are spontaneous conditions where people have either rupture of the dural sac, or an erosion of the dural sac, or a development of a connection between the dura and the venous system. And that is taking away or allowing CSF to escape. In these instances that patients have spontaneous, there may be a different presentation than if they have, like, a postdural puncture or a chronic traumatic or iatrogenic leak. And we're not sure of that yet, but we're looking into that. Still, the largest presentation is headache, and orthostatic headache is very dominant in the headache realm. But over time, patients' brains can compensate for that lack of CSF and start overproducing---or at least we think that's probably what's happening. And you may see a reduction in the orthostatic symptoms over time, and you may see an improvement in the radiographic findings. So, there are some interesting papers that have been published that look at these changes over time, and we do see that sometimes within that first three to four months; this is the most common time to see that change. Other patients may worsen. You may actually see someone going from looking sort of normal radiographically to developing more of a SIH-type of picture on the brain. And so it's not predictable which patients have gone from orthostatic to improvement or the other way around, both radiographically and clinically. So, it can be quite difficult to tell. So, for me, if I have a patient that comes to me and they're struggling with headache… if it's orthostatic, very clearly orthostatic: I lay down, I get considerably better or my headache completely goes away. And then when I stand up, it comes on relatively quickly, within an hour. And sometimes it's a worsening-throughout-the-day type of thing, it's lowest in the morning and it worsens throughout the day. These are the times that it's most obvious to think about CSF leak. Especially if that headache onset relatively suddenly, if it onset after a small trauma. Like I've had patients that say, you know, I was doing yoga and I did some twists and I felt kind of a pop. And then I've had this headache that is horrible when I'm upright but is better when I lay down ever since, you know, since that time. That's kind of a very classic presentation of spinal CSF leak or spontaneous intracranial hypotension. Maybe a less common presentation would be someone who comes to you, they've had a persistent headache for a couple years, they kind of remember it started in March of a couple years ago, but they don't know. Maybe it's, you know, it's a little better when they lay down. It may be a little worse when they're up moving around, but so is migraine, and it's a migrainous headache. But they've tried every migraine drug you can think of. Nothing is responding, nothing helps. I'm always looking at patients who are new daily, persistent headaches and patients who aren't responding to meds even if it's not new daily, but they have just barely any response. I will always go back and examine their brain imaging and get full spine to make sure I'm not missing. And you can never be 100% sure, but it's always good to consider those patients to the best of your ability, if that- have that in the back of your mind. Dr Smith: So obviously, goes without saying, this is something people need to have on their radar and think about. And then we'll talk more about diagnostic tools here in a second. But how common is this? If you're a headache doc, you see a lot of patients who have intractable headaches. And how often do you see this in your headache practice? Now you're- this is your thing, so probably a little more than others, but, you know, how common will someone who sees a lot of headache encounter these patients? Dr Rau: If you see a lot of headache, I mean, currently the thought is it's about 5 in 100,000. That was from a study before we were finding CSF venous fistulas. I think a lot of us think it's more common than that, but it's not super common. We don't have good estimates, but I would guess between 5 and 10 for 100,000 persons, not “persons who come to a tertiary headache clinic with intractable headaches”. So, it's hard to gauge how frequent it is, but I would say it's considerably more frequent than we currently think it is. There's still a group of people with orthostatic headaches that we can't find leaks on; that, once you treat other things that can cause or look for other things that can cause orthostatic headaches. So, there may be even still a pathophysiology out there that is still a leak type. Before 2014, we didn't even know about CSF venous fistulas. And now here we are; like, 50% of them are CSF venous fistulas. So, you know, we're still in a huge learning curve right now. Dr Smith: So, I definitely want to talk about the fistulas in a second. But before moving on, one of the things that I found really interesting is the wide spectrum of clinical phenotype. And we obviously don't have a lot of time to get into all of these different ones, but the one that I was hoping you might talk about---and there's a really great case, and you're on bunch of great case, a great case of this---is brain sagging dementia, not a term I've used before. Can you really briefly just tell our listeners about that, because that's a really interesting story and a great case in your article? Dr Rau: Yeah. So, brain sag dementia is a… almost like an extreme version of a spontaneous intracranial hypotension. Where there is clear brain sag in the imaging---so that's helpful---but the patients present kind of like a frontotemporal dementia. And when this was first started to being determined, you could turn the patient into Trendelenburg, and sometimes they would improve. There are some practitioners that have introduced fluid into the thecal sac and had temporary improvement. Patching has improvement, then they leak again, sometimes  not. But the clinical changes with this have been pretty tremendous to be able to identify that that's a real thing. And in some cases, out of Cedars Sinai, you know, who does a lot of the best research in this, they've had lots of cases where they can't find the leak, but there's clear brain sag that fits with our clinical picture of CSF leaks. So, we're on a learning curve. But yeah, this- they really present. They have disinhibition and cognitive impairment that is very similar to frontotemporal dementia. Dr Smith: Well, so let's talk about what causes this. You mentioned CSF venous fistulas. I mean, that was reported now just over a decade ago, it's pretty amazing. That accounts for about half of cases, if I understand correctly. What are the other causes? And then we'll talk more about therapy in a minute, but what causes this? Dr Rau: So, within the realm of spontaneous, you know, we say it's spontaneous. But the spontaneous cases we account for, they can be tears in the dura, which are usually sort of lateral tears in the dura. They can be little places that rubbed a hole, often on an osteophyte from the spine. They can come from these spinal diverticuli. So, I always describe it to my patients like those balls that have mesh and squishy, and you squeeze them in the- through the mesh, there's the extra little bubbling out. If you think of like the dura bubbling, out in some cases, through the framing of the spine, right where the spinal nerve roots come out, they should poke out like wires from the dura. But in many cases they poke out with this extra dura surrounding them, and we call that spinal diverticuli. And if you imagine like the weakening of where you squeeze that, you know, balloon through your fingers, in those locations, that's a very common place to find a CSF leak, and you can imagine that the integrity of the dura there may be less than it would be if it were not being expanded in that direction. And that's often the most common place we see these CSF venous fistulas. So, you can get minor traumas; like I said, it can be spontaneous, like someone just develops a leak one day. It can be rubbed off, and it can be a development of a connection between the dura and the venous system. There are also iatrogenic causes, but we don't consider them spontaneous. But when you're considering your patients for spontaneous cases, you should consider if they've ever had chronic---even long, long time ago---had any spinal implementation, procedures near the spine, spinal injections, LPs in the past, and especially women who've had epidurals in pregnancy. Dr Smith: All right, so we see a patient, positional severe headache, who meets the clinical criteria. Next step, MRI scan? Dr Rau: Yeah. So, the first thing is always to get the brain MRI with and without contrast. Most places will have a SIH or a spinal CSF leak protocol, but you should get contrast because one of the most pathognomonic findings on brain MRI is that smooth diffuse dural enhancement. And that's a really fantastic thing when you find it, because it's kind of a slam dunk. If you find it, then you will see other findings. It almost never exists alone. But if you see that, it's pretty much a spinal CSF leak. But you're also looking for subdural collections, any indication of brain sag. We do have these new algorithms that have come out in the past couple of years that are helpful. They're not exclusionary---you can have negative findings on the brain and still have spinal CSF leak---but the brain MRI is extremely helpful. If it's positive for the findings, it really does help you nudge you in the direction of further investigations and treatments. Dr Smith: And what about those further investigations and treatments, right? So, you see that there's findings consistent with low pressure, and I guess I should say low intracranial CSF volume. Be that as it may, what's the next step after that? Dr Rau: Depends on where you are and what you can do. I almost always will get a full spine MRI: so, C spine, T spine, and L spine separately. Not, you know, we don't want it all in one picture, because we want to get the full view. And you want to get that with at least T2 highly- heavily T2 weighted with fat saturation in at least the sagittal and axial planes. It's really helpful if you can get it in the coronal planes, but we have to have- often have good talks with your radiologist to get the coronal plane. I spoke about the spinal diverticuli earlier, and I want to clarify a little bit of something. The coronal image will show those really nicely. It's interesting, but 44% of people have those. So just having the spinal diverticuli does not indicate that you have a leak. But if you have a lot of those, there may be more likelihood of having leak than if you don't have any of those. So, I will get all of those and I will look at them myself, but I've been looking at them myself for a long time. But a lot of radiologists in community hospitals, especially not- nonneuroradiologists, but even neuroradiologists, this isn't something that's that everybody's been educated about, and we've been learning so much about it so rapidly in the past ten years. It's not easy to do and it's often missed. And if it's not protocoled properly, the fat saturation's not there, it's very hard to see… you can have a leak and not see it. Even the best people, like- it's not always something that's visible. And these CSF venous fistulas that we talked about are never visible on normal MRI imaging. Nonetheless, I will run those because if I can find a leak---and 90% of the ones that are found on MRI imaging are in the thoracic spine. So that's where I spend the most of my time looking. But if you find it, that's another thing to take to your team to say, hey, look, here it is, let's try and do this, or, let's try and do that, or, I've got more evidence. And there are other findings on the spine; not just the leak, but other findings, sometimes, you can see on spine that maybe help you push you towards, yes, this is probably a leak versus not. Dr Smith: So, your article has a lot of great examples and detail about kind of advanced imaging to, like, find the fistula and what not. I guess I'm thinking most of our listeners are probably practicing in a location where they don't have a team that really focuses on that. So, let's say we do the imaging of the spine and you don't find a clear cause. Is the next step to just do a blood patch? Do you send them to someone like you? What's the practical next step? Dr Rau: Yeah, if your- regardless of whether you find a leak or not, if your clinical acumen is such that you think this patient has a leak or I've treated them for everything else and it's not working and I have at least a high enough suspicion that I think the risk of getting a patch is lower than the benefit that if they got a patch and it worked, I do send my patients for non-directed blood patches, because it currently does take a long time to get them to a center that can do CT myelograms or any kind of advanced imaging to look for sort of a CSF venous fistula or to get treated outside of a nondirected patch. You know, sometimes nondirected patches are beneficial for patients, and there's some good papers out there that sort of explain the low risks of doing these if done properly versus the extreme benefit for patients when it works. And, I mean, I can't tell you how many people come in and tell me how their lives are changed because they finally got a blood patch. And sometimes it works. And it's life-changing for those people. You know, they go back to work. They can interact with their kids again. Before, they didn't know what was wrong, just had this headache that started. So it's worth doing if you have a strong clinical suspicion. Dr Smith: Yeah. I mean, that was great. And, you know, to go back to where we began, this is severe. It's something like 60% of patients with this problem have thought about suicide, right? And you take this patient and cure the problem. I feel really empowered having read the article and talked to you today. And so, I'm ready to go out and look for this. Thank you so much for a really engaging conversation. This has been terrific. Dr Rau: Thank you. I appreciate it. I enjoyed being here. Dr Smith: Again, today I've been interviewing Dr Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension---which I guess I should say hypovolemia after having talked to you---which she wrote with Dr Jeremy Cutsworth-Gregory. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Please be sure to check out Continuum Audio episodes from this really interesting issue and other interesting issues. And thank you, our listeners, again for listening to us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

What if hair loss and sexual dysfunction weren't just signs of aging—but signals your body needs deeper healing?In this episode, Dr. Joy Kong sits down with Dr. Shivani Amin, a specialist at Chara Health, where she leads our work in hair restoration and sexual wellness. Together, they dive into how stem cells, exosomes, and peptides can rejuvenate the body from the inside out—helping patients feel and look their best.Dr. Amin explains how her personalized, root-cause approach at Chara Health delivers real results for both men and women, and why combining regenerative therapies with energy medicine is the future of healing.If you're seeking support for hair loss, low libido, or whole-body vitality, this episode shows what's possible at Chara Health.More on Dr. Shivani Amin:Website: https://www.drshivaniamin.com/Instagram: https://www.instagram.com/drshivaniamin/?hl=en--Additional Resources:Visit My Clinic: Chara Health

In part two of this three-part series, Dr. Jodie Roberts and Dr. Barbara A. Dworetzky discuss how often seizure-like or seizure-resembling episodes lead to a diagnosis of functional neurologic disorder.  Learn more about the Neurology® Practice Current section and fill out the current survey on functional/dissociative seizures and driving. 

Dr. Nadia Khalil talks with Dr. Jean Bouchart about the diagnostic approach to intracerebral hemorrhage, the causes of cerebral small vessel disease, and the interpretation of biomolecular tests.  Read the related article in Neurology® Resident & Fellow Section.  Disclosures can be found at Neurology.org. 

In part one of this three-part series, Dr. Jodie Roberts and Dr. Barbara A. Dworetzky discuss the term "functional seizures" and clarify the terminology.  Learn more about the Neurology® Practice Current section and fill out the current survey on functional/dissociative seizures and driving. 

The June 2025 replay features four previously released stroke episodes. It begins with Dr. Cheryl Bushnell discussing the 2024 primary stroke prevention guidelines, followed by an interview with Dr. Phillip Ferdinand on the connection between smoking and young cryptogenic stroke. Next, Dr. Aaron Shoskes addresses the vascular risk burden in young adults with stroke. The replay concludes with Dr. Seemant Chaturvedi's overview from the International Stroke Conference.  Podcast links: 2024 Guideline for the Primary Prevention of Stroke Association of Smoking and Young Cryptogenic Ischemic Stroke Vascular Risk Factor Burden Among Young Adults with Ischemic Stroke Overview from the 2025 International Stroke Conference  Article links: 2024 Guideline for the Primary Prevention of Stroke Association of Smoking and Young Cryptogenic Ischemic Stroke: A Case-Control Study Temporal Trends in Vascular Risk Factor Burden Among Young Adults With Ischemic Stroke: The Florida Stroke Registry Disclosures can be found at Neurology.org. 

Neuroscientist Gül Dölen explores how psychedelics paired with mindful integration can reopen the brain's sensitive learning windows to rewire habits, heal trauma, and expand consciousness.Join the 2025 MAPS conference this June in Denver, Colorado and be a part of the movement that will shape the next era of mental health, medicine, and consciousness. MAPS, The Multidisciplinary Association for Psychedelic Studies, is a nonprofit organization that provides public resources and leadership as we work together to create legal, responsible, evidence-based pathways to psychedelics. Learn more about the conference and use the coupon code LSRF15 for a special promotion at https://www.psychedelicscience.orgIn this episode of Mindrolling, Gül and Raghu chat about: Gül's research on psychedelics and how we can translate animal studies into human neuroscience Looking to Octopuses for sociological answers using MDMACritical periods—windows when the brain is most open to learning and environmental influence.Psychedelics as the master key to reopening critical periods, especially when paired with therapyInducing metaplasticity with psychedelics, reshaping harmful patterns, and promoting transformation.Non-substance methods to reopen critical periods, like sensory and social deprivationHow mystical practices such as meditation and silent retreats can trigger a “beginner's mind” state for deep insightsHow psychedelics propose a learning model rather than a biochemical imbalance model towards approaching depression, addiction, or PTSDFocusing on post-trip integration to harness long-term benefits from the psychedelic experience Maximize the integration period to cement insights gained during psychedelic journeysThe social and psychological changes we go through as we age and adapt to new environments/situations The importance of “set and setting” and how it can influence psychedelic experiences and the formation of helpful or harmful habitsMindrolling is brought to you by Reunion. Reunion is offering $250 off any stay to the Love, Serve, Remember community. Simply use the code “BeHere250” when booking. Disconnect from the world so you can reconnect with yourself at Reunion. Hotel | www.reunionhotelandwellness.com Retreats | www.reunionexperience.orgAbout Gül Dölen:Dr. Gül Dölen is a Professor and the Bob & Renee Parsons Endowed Chair in the Department of Neuroscience, and Department of Psychology, the Berkeley Center for the Science of Psychedelics and the Helen Wills Neuroscience Institute at the University of California, Berkeley. Dr Dölen also maintains an Adjunct Professorship in Neuroscience and Neurology at the Johns Hopkins University, School of Medicine. Dr. Dölen researches the role psychedelics may have in unlocking critical periods in Dölen Lab. She is the recipient of several prestigious awards. “It turns out that our results really suggest that psychedelics are those master keys that we have been looking for all this time.” – Gül DölenSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In part one of this three-part series, Dr. Justin Abbatemarco and Dr. Sumanth Reddy discuss small vessel primary CNS vasculitis. Show reference: https://www.neurology.org/doi/10.1212/NXI.0000000000200397 

When someone we know or love starts to develop psychological issues, we don't often associate it with a form of dementia. However, this trait is one of the most common signs of frontotemporal dementia (FTD) — the most common neurodegenerative disease in people under the age of 65. In his new book, Mysteries of the Social Brain: Understanding Human Behavior Through Science, Dr. Bruce Miller highlights his experiences observing people with FTD and what they have taught him about what he calls the "social brain."Dr. Bruce Miller has been observing people with FTD for decades in the Memory and Aging Center at the University of San Francisco, where he is also Professor of Neurology and the Founding Director of the Global Brain Health Institute. He shares key insights on how to keep our "social brain" healthy and how it can even unlock our creative potential.

Dr. Justin Abbatemarco talks with Drs. Sumanth Reddy and Jeffrey Gelfand about the complexities of small vessel predominant primary CNS vasculitis, clinical features, and the impact of early intensive immunosuppressive therapy on remission.  Read the related article in Neurology® Neuroimmunology & Neuroinflammation.  Disclosures can be found at Neurology.org. 

Distraction is making you anxious and sleepless. Here's how to fix it.   Adam Gazzaley, M.D., Ph.D. is the David Dolby Distinguished Professor of Neurology, Physiology and Psychiatry, and Founder & Executive Director of Neuroscape at UCSF. He co-authored the 2016 book “The Distracted Mind: Ancient Brains in a High-Tech World”.    In this episode we talk about: The impact of multitasking on our attention, relationships, emotions, anxiety, and memory The difference between top-down and bottom-up attention What it means to have cognitive control—and some practical tools for restoring your own cognitive control.  Controversial technologies that could eventually help us have a stronger brain The impact of music and rhythm on the mind And how to use technology for your brain's benefit   Join Dan's online community here Follow Dan on social: Instagram, TikTok Subscribe to our YouTube Channel  

In this episode of Huberman Lab Essentials, my guest is Dr. Karl Deisseroth, M.D., Ph.D., a clinical psychiatrist and professor of bioengineering and of psychiatry and behavioral sciences at Stanford University. We discuss his experiences as a clinician treating complex psychiatric conditions and his lab's pioneering work in developing transformative therapies for mental illness. He explains the complexities of mental illness and how emerging technologies—such as optogenetics and brain-machine interfaces—could revolutionize care. We also explore promising new therapies, including psychedelics and MDMA, for conditions like depression and PTSD. Read the episode show notes at hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman David: https://davidprotein.com/huberman Eight Sleep: https://eightsleep.com/huberman Timestamps 00:00:00 Karl Deisseroth; Neurology vs Psychiatry 00:01:36 Speech; Blood Test?; Seeking Help 00:04:20 Feelings, Jargon; Psychiatric Treatment 00:09:40 Sponsor: David 00:10:55 Future Treatment; Vagus Nerve Stimulation, Depression, Optogenetics 00:19:40 Brain-Machine Interfaces 00:20:53 Sponsor: Eight Sleep 00:23:00 ADHD Symptoms, Lifestyle, Technology 00:29:34 Psychedelics, Depression Treatment, Risks 00:35:43 Sponsor: AG1 00:37:30 MDMA (Ecstasy), Trauma & Post-Traumatic Stress Disorder (PTSD) Treatment 00:40:33 Projections: A Story of Human Emotions Book, Optimism Disclaimer & Disclosures