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In this episode, we review the high-yield topic Anti-Epileptic Drugs from the Neurology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode of The Psychedelic Podcast, Paul F. Austin is joined by renowned neuroscientist Dr. Robin Carhart-Harris and microdosing policy advocate John Downs for a replay of a live event originally held on June 10th, Microdosing vs. SSRIs: What's Happening in the Brain and Why It Matters. Find full show notes and links here: https://thethirdwave.co/podcast/episode-312b/?ref=278 Together, they explore the scientific distinctions between SSRIs and psychedelics, focusing on neuroimaging, brain entropy, emotional processing, and the REBUS model. Dr. Carhart-Harris shares key insights from landmark studies on psilocybin therapy and discusses the evidence (and limitations) around microdosing. John Downs closes the conversation with an update on the Microdosing Collective's efforts to shift policy and expand access. Robin Carhart-Harris, PhD is a neuropharmacologist, psychologist, and Ralph Metzner Distinguished Professor in Neurology and Psychiatry at the University of California, San Francisco. He leads the Psychedelics Division at UCSF's Neuroscape and formerly founded and led the Centre for Psychedelic Research at Imperial College London. John Downs is Executive Director of the Microdosing Collective, advocating for responsible policy reform and legal access to microdosing. With 25 years' experience in sales, business development, and emerging markets, John helps individuals optimize mindset, performance, and purpose. Episode Highlights: Why SSRIs blunt, while psychedelics reset emotional processing How psilocybin compares to antidepressants in clinical trials Brain entropy, plasticity, and the REBUS model explained The role of the default mode network in mental health Why microdosing research is still so limited Ketamine vs. psilocybin: differences in brain mechanisms Is serotonin syndrome a real microdosing risk? Can psychedelics reverse long-term SSRI effects? The Microdosing Collective's mission for policy reform What Robin Carhart-Harris' upcoming book will explore Episode Links: Robin's lab & upcoming book Microdosing Collective Join Dr. Robin Carhart-Harris at our Practitioner Intensive (November 5–10, Costa Rica) Episode Sponsors: Golden Rule Mushrooms - Get a lifetime discount of 10% with code THIRDWAVE at checkout Psychedelic Coacing Isntitute's Intensive for Psychedelic Professionals in Costa Rica - a transformative retreat for personal and professional growth.
Dr. Trey Bateman talks with Dr. Gregg Day about the study design, findings, and clinical implications of using plasma biomarkers in real-world patient care. Read the related article in Alzheimer's & Dementia. Disclosures can be found at Neurology.org.
What if the biggest obstacle standing between you and your best health isn't lack of time, but the way you approach it? Today's guests, Ryan Williamson and JP Newman, are here to break down why so many entrepreneurs are sabotaging their health without even realizing it—and it's not because of lack of effort or willpower. The problem is deeper than that. Ryan, a neurologist with a background in the U.S. Navy, shares why entrepreneurs tend to ignore sleep, stress, and the mental side of health, even though optimizing these areas can skyrocket both performance and longevity. As the founder of Transcend Health Group, Ryan helps people take control of their mental and physical well-being using evidence-based practices. JP Newman, a seasoned entrepreneur with a background in real estate and a passion for performance, understands the demands of business and how health often takes a backseat. He's here to share his personal experience with optimizing health for busy professionals, and why making it a priority can be a game-changer. We also explore the rise of biohacking, where everyone is an expert, but few actually have the credentials or real science behind them. Tune in to learn how to optimize your health in a way that enhances every area of your life, and discover why purpose, sleep, and smart habits are the true keys to success. — This episode is part of the 8FE (8-figure entrepreneur) series, where we talk to entrepreneurs who have already passed the million-dollar mark. — Key Takeaways: 00:00:00 Intro 00:01:59 Who to listen to relative to health? 00:09:22 Entrepreneurs and biohacking 00:12:19 Longevity, lifespan, and healthspan 00:19:41 Genetic testing and longevity 00:25:57 Interpreting health data and resolving health problems 00:32:23 How to sleep better as an entrepreneur? 00:45:15 Sleep aids and supplements 00:53:49 Practical approaches to sleep and health 01:03:47 Neuroplasticity and stress management 01:10:13 High-impact health activities 01:13:41 Sauna or cold plunge? 01:16:13 Resources and outro — Additional Resources:
In part one of this two-part series, Dr. Justin Abbatemarco and Dr. Eric L. Voorn discuss how exercise remains essential for people with neuromuscular disorders, even amid limited pharmaceutical options and safety concerns. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213781 https://www.sciencedirect.com/science/article/pii/S0960896625000458?via%3Dihub
This panel was recorded June 26, 2025. We hope you'll join us live in the future to ask your own questions and participate in the attendee chat! See similar events on demand and read other free MedTech resources at RQMplus.com.SummaryHear leading neurology innovators discuss how to navigate complex regulatory pathways, accelerate approvals, and reduce risk in bringing groundbreaking neurological devices to market.LinkedIn panelist and moderator profiles
In this two-part episode of the Brain & Life Podcast, co-host Dr. Katy Peters is joined by Elizabeth Ansell, founder and director of #NotJustFatigue. #NotJustFatigue is a nonprofit organization shining a light on myalgic encephalomyelitis/chronic fatigue syndrome, also known as ME/CFS, and educates patients, clinicians, and health organizations about the condition. Elizabeth shares how raising awareness, and furthering research really improves the everyday lives of people living with ME/CFS. Dr. Peters is then joined by Dr. W. Ian Lipkin, who is known internationally for his research and is the John Snow Professor of Epidemiology, Professor of Neurology, and Professor of Pathology and Cell Biology at Columbia University Irving Medical Center, Mailman School of Public Health. Dr. Lipkin discusses what's next in ME/CFS research and what the future could hold. Additional Resources #NotJustFatigue How to Fight Fatigue Understanding the Impact of Invisible Illnesses on Daily Life How Families Are Leading the Charge in Rare Disease Advocacy Other Brain & Life Podcast Episodes on Similar Topics Rare Thoughts on a Rarer Neurologic Condition Shedding Light and Love on a Rare Genetic Condition with Deborah Vauclare Neurofibromatosis Advocacy and Community Building with the Gilbert Family Foundation 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: Elizabeth Ansell @notjustfatigue; Dr. W. Ian Lipkin @columbiapublichealth Guests: Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD
In this episode, editor-in-chief Joseph E. Safdieh, MD, FAAN, highlights articles about upadacitinib, a new treatment for giant-cell arteritis; growing evidence linking oral health to a higher risk of neurologic conditions; and why a trial of a new meningitis B vaccine drew a mixed response.
Does weather have an impact on migraine headaches? Guest: Danielle Wilhour, Assistant Professor of Neurology, University of Colorado Medical Campus Learn more about your ad choices. Visit megaphone.fm/adchoices
More Crackdowns coming to combat Money Laundering Guest: Ron Usher, a former general counsel for the society of notaries public of BC Plastic Surgeon speaks out against medical tourism Guest: Dr. Paul Oxely, plastic surgeon who has corrected many medical tourism mishaps Does weather have an impact on migraine headaches? Guest: Danielle Wilhour, Assistant Professor of Neurology, University of Colorado Medical Campus BC Lagging on reform and better protections for kids in government care Guest: Jennifer Charlesworth, BC Children and Youth Representative What is Economic Anxiety? Guest: Omar H. Fares, Assistant Professor, Faculty of Business, University of New Brunswick Laneway housing could solve a lot of problems! Guest: Brad Ingram, Senior design manager, Synthesis designs Learn more about your ad choices. Visit megaphone.fm/adchoices
In part four of this ten-part series, Dr. Paul Crane and Dr. Prashanth Ramachandran discuss enterovirus D68 and the findings presented in this article. Show reference: https://pubmed.ncbi.nlm.nih.gov/39564148/
Exploring Innovative Approaches to Pain Management with Dr. Fawad Mian, a neurologist and regenerative medicine specialist. He delves into the various forms of pain and the limitations of traditional treatments such as drugs and surgery. Dr. Mian shares his personal journey with chronic pain and his transition into regenerative medicine. The discussion covers alternative treatments like prolotherapy, platelet-rich plasma (PRP), and stem cell therapies, emphasizing their potential benefits and the importance of image guidance in their administration. They also touch upon lifestyle modifications and nutritional supplements for managing conditions like diabetic neuropathy and CIDP. Dr. Mian highlights the importance of a multifocal approach to pain management and offers insights from his book, “Getting to Pain Free: How to Make Your Body Stop Hurting So That You Can Start Living Again Without Drugs Or Surgery.”
Dr. Hoffman continues his conversation with Dr. Fawad Mian, a neurologist and regenerative medicine specialist, and author of “Getting to Pain Free: How to Make Your Body Stop Hurting So That You Can Start Living Again Without Drugs Or Surgery.”
Curious about the manifestation secrets that can turn your dreams into reality? In this episode of the Manifested podcast, Kathleen Cameron is joined once again by Dr. Steven Resnick, who dives deep into the powerful connection between personal manifestation stories and the subconscious mind. Dr. Resnick shares his fascinating journey of manifesting multiple dream boats, illustrating how the subconscious mind plays a pivotal role in turning desires into tangible outcomes. The episode delves into the neuroscience behind manifestation, highlighting how imagination and sensory experiences influence intentions in the subconscious. Dr. Resnick explains how the subconscious constantly scans your environment, aligning actions with your goals to create what might feel like serendipitous moments. This episode is for you if you're ready to understand how the subconscious mind shapes your reality and how to use that knowledge to manifest your dreams. Tips in this episode: The subconscious mind is constantly active, processing and valuing experiences in ways that can manifest external realities, even outside conscious awareness. Providing clear and vivid intentions allows the subconscious mind to prioritize and manifest those desires over default or negative patterns. Understanding brain networks, such as the salience and default mode networks, can shed light on how manifestation works from a neurological perspective. Evaluating and altering limiting beliefs can transform personal and professional life experiences by fostering a growth mindset and improving health outcomes. About The Guest: Dr. Steven Resnick is the Medical Director of the Mount Sinai Comprehensive Stroke Center. Board-certified in Neurology and Vascular Neurology, Dr. Resnick is an attending Neurologist with direct supervision of internal medicine and medical students at Mount Sinai Hospital. Dr. Resnick has co-authored a textbook entitled Practical Neuroimaging in Stroke and has published articles in the Journal of the Peripheral Nervous System, the Journal of Neurology, and the Journal of Neurology, Neurosurgery, and Psychiatry. He has lectured extensively on stroke prevention, acute ischemic stroke, practical Neuroimaging in cerebrovascular disease, and other related topics. Clinical research includes studies of drug therapies to treat Neuromuscular diseases. Connect with Dr. Resnick Website: https://drstevenresnick.com/ Instagram: https://www.instagram.com/dr.stevenresnick Facebook: https://www.facebook.com/DrStevenResnick/ Podcast: https://drstevenresnick.com/the-healthy-mind-podcast/ Subscribe To The Manifested Podcast With Kathleen Cameron: Apple Podcast | YouTube | Spotify Connect With The Kathleen Cameron: Facebook | Instagram | LinkedIn | Youtube | TikTok | Kathleencameronofficial.com Unlock Your Dreams with House of ManifestationA community where you take control of your destiny, manifest your desires, and create a life filled with abundance and purpose? Look no further than the House of Manifestation, where your transformation begins: https://houseofmanifestation.com/ About Kathleen Cameron: Kathleen Cameron, Chief Wealth Creator, 8-figure entrepreneur, and record-breaking author. In just 2 years, she built a 10 Million dollar business and continues to share her knowledge and expertise with all of whom she connects with. With her determination, unwavering faith, and powers of manifestation, she has helped over 100,000 people attract more love, money, and success into their lives. Her innovative approaches to Manifestation and utilizing the Laws of Attraction have led to the creation of one of the top global success networks, Diamond Academy Coaching, thousands of students have been able to experience quantum growth. The force behind her magnetic field has catapulted many students into a life beyond their wildest dreams and she is just getting started. Kathleen helps others step into their true potential and become the best version of themselves with their goals met. Kathleen graduated with two undergraduate degrees from the University of Windsor and the University of Toronto with a master's degree in nursing leadership. Her book, “Becoming The One", published by Hasmark Publishing, launched in August 2021 became an International Best Seller in five countries on the first day. This Podcast Is Produced, Engineered & Edited By: Simplified Impact
Normal pressure hydrocephalus (NPH) is a pathologic condition whereby excess CSF is retained in and around the brain despite normal intracranial pressure. MRI-safe programmable shunt valves allow for fluid drainage adjustment based on patients' symptoms and radiographic images. Approximately 75% of patients with NPH improve after shunt surgery regardless of shunt type or location. In this episode, Aaron Berkowitz, MD, PhD, FAAN, speaks with Kaisorn L. Chaichana, MD, author of the article “Management of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology at the University of California San Francisco in the Department of Neurology in San Francisco, California. Dr. Chaichana is a professor of neurology in the department of neurological surgery at the Mayo Clinic in Jacksonville, Florida. Additional Resources Read the article: Management of Normal Pressure Hydrocephalus 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: @LyellJ Guest: @kchaichanamd 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 Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Kaisorn Chaichana about his article on management of normal pressure hydrocephalus, which he wrote with Dr Jeremy Cutsforth-Gregory. The 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 Chaichana: Yeah, thank you for having me. I'm Kaisorn Chaichana. I'm a neurosurgeon at Mayo Clinic in Jacksonville, Florida. Part of my practice is doing hydrocephalus care, which includes shunts for patients with normal pressure hydrocephalus. Dr Berkowitz: Fantastic. Well, before we get into shunt considerations and NPH specifically, which I know is the focus of your article, I thought it would be a great opportunity for a neurologist to pick a neurosurgeon's brain a bit about shunts. So, to start, can you lay out for us the different types of shunts and shunt procedures, the advantages, disadvantages of each type of shunt, how you think about which shunt procedure should be used for which patient, that type of thing? Dr Chaichana: Yeah. So, there are different types of shunts, and the most common one that is used is called a ventricular peritoneal shunt. So, it has a ventricular catheter, it has a catheter that tunnels underneath the skin and it goes into the peritoneum where the fluid goes from the ventricular system into the peritoneum. Typically, the shunts are in the ventricle because that is the largest fluid-filled space in the brain. Other terminal areas include the atrium, which is really the jugular vein, and those are called ventricular atrial shunts. You can also have ventricular pleural shunts, which end in the pleural space and drain flui into the pleural space. Those are pretty much the most common ventricular shunts. There's also a lumboperitoneal shunt that drains from the lumbar spine, similar to a lumbar drain into the peritoneum. For the lumbar shunts, we don't typically have a lumbar pleural or lumbar atrial shunt just because of the pressure dynamics, because the lumbar spine is below the lung and as well as the atrium. And so, the drainage pattern is very different than ventricular peritoneal which is top to bottom. The most common shunt, why we use the ventricular peritoneal shunt the most, is because it has the most control. So, the peritoneum is set at a standard pressure in the intraabdominal pressure, whereas the ventricular atrial shunt depends on your venous return or venous pressure and your ventricular pleural shunt varies with inspiration and expiration. So, the easiest way for us to control the fluid, the ventricular system is through the ventricular peritoneal shunt. And that's why that's our most common shunt that we use. Dr Berkowitz: Fantastic. So, as you mention in the article, neurologists may be reluctant to offer a shunt to patients with NPH because many patients may not improve, or they improve only transiently; and out of fear of shunt complications. So, of course, as neurologists, we often only hear about a patient's shunt when there is a problem. So, we have this sort of biased view of seeing a lot of shunt malfunction and shunt infection. Of course, we might not see the patient if their shunt is working just fine. How common are these complications in practice, and how do you as a neurosurgeon weigh the risks against the often uncertain or transient benefits of a shunt in a patient with NPH who may be older and multiple medical comorbidities? How do you think about that and talk about it with patients? Dr Chaichana: When you hear about shunt complications, most of the shunt complications you hear about are typically in patients with congenital hydrocephalus. Those patients often require several shunt revisions just from either growing or the shunt stays in for a long time or the ventricular caliber is a lot less than some with normal pressure hydrocephalus. So, we don't really see a lot of complications with normal pressure hydrocephalus. So that shunt placement in these patients is typically pretty safe. The procedure's a relatively short procedure, around 30 minutes to 45 minutes to place a shunt, and we can control the pressure within the shunt setting so that we don't overdrain---which means too much fluid drains from the ventricular system---which can cause things like a subdural, which is probably the most common complication associated with normal pressure hydrocephalus. So, to obviate those risks, what we do is typically insert the shunt and then keep the shunt setting at a high setting. The higher the setting, the less it drains, and then we bring it slowly down based on the patient's symptoms to try to minimize the risk of this over drainage in the subdural hematoma while at the same time benefiting the patient. So, there's a concern for shunt in patients with normal pressure hydrocephalus. The concern or the complication risks are very low. The problem with normal pressure hydrocephalus, though, is that over time these patients benefit less and less from drainage or their disease process takes over. So, I do recommend placing this shunt as soon as possible just so that we can maximize their quality of life for that period of time. Dr Berkowitz: So, if I'm understanding you, then the risk of complication is more sort of due to the mechanical factors in patients with congenital hydrocephalus or sort of outgrowing the shunt, their pressure dynamics may be changing over time. And in your experience, an older patient with NPH, although they may have more medical comorbidities, the procedure itself is relatively quick and low-risk. And the actual complications due to mechanical factors, my understanding, are just much less common because the patient is obviously fully grown and they're getting one sort of procedure at one point in time and tend to need less revision, have less complication. Is that right? Dr Chaichana: Yeah, that's correct. The complication risk for normal hydrocephalus is a lot less than other types of hydrocephalus. Dr Berkowitz: That's helpful to know. While we're talking about some of these complications, let's say we're following a patient in neurology with NPH who has a shunt. What are some of the symptoms and signs of shunt malfunction or shunt infection? And what are the best studies to order to evaluate for these if we're concerned about them? Dr Chaichana: Yeah. So basically, for shunt malfunction, it's basically broken down into two categories. It's either overdrainage or underdrainage. So, underdrainage is where the shunt doesn't function enough. And so basically, they return to their state before the shunt was placed. So that could be worsening gait function, memory function, urinary incontinence are the typical symptoms we look for in patients with normal pressure hydrocephalus and underdrainage, or the shunt is not working. For patients that are having overdrainage, which is draining too much, the classic sign is typically headaches when they stand up. And the reason behind that is when there's overdrainage, there's less cerebrospinal fluid in their ventricular system, which means less intracranial pressure. So that when they stand up, the pressure differential between their head and the ground is more than when they're lying down. And because of that pressure differential, they usually have worsening headaches when standing up or sitting up. The other thing are severe headaches, which would be a sign of a subdural hematoma or focality in their neurological symptoms that could point to a subdural hematoma, such as weakness, numbness, speaking problems, depending on the hemisphere. How we work this up is, regardless if you're concerned about overdrainage or underdrainage, we usually start with a CAT scan or an MRI scan. Typically, we prefer a CAT scan because it's quicker, but the CAT scan will show us if the ventricular caliber is the same and/or the placement of the proximal catheter. So, what we look for when we see that CAT scan or that MRI to see the location of the proximal catheter to make sure it hasn't changed from any previous settings. And then we see the caliber of the ventricles. If the caliber of the ventricles is smaller, that could be a sign of overdrainage. If the caliber of the ventricles are larger, it could be a sign of underdrainage. The other thing we look for are subdural fluid collections or hydromas or subdural hematomas, which would be another sign of lower endocranial pressure, which would be a sign of overdrainage. So those are the biggest signs we look for, for underdrainage and overdrainage. Other things we can look for if we're concerned of the shunt is fractured, we do a shunt X-ray and what a shunt x-ray is is x-rays of the skull, the neck and the abdomen to see the catheter to make sure it's not kinked or fractured. If you're really concerned, you can't tell from the x-ray, another scan to order is a CT of the chest and abdomen and pelvis to look at the location of the catheter to make sure there's no brakes in the catheter, there's no fluid collections on the distal portion of the catheter, which would be a sign of shunt malfunction as well. Other tests that you can do to really exclude shunt malfunction is a shunt patency test, and what that is a nuclear medicine test where radionucleotide is injected into the valve and then the radionucleotide is traced over time or imaged through time to make sure that it's draining appropriately from the valve into the distal catheter into the peritoneum or the distal site. If there's a shunt malfunction that's not drainage, that radioisotope would remain stagnant either in the valve or in the catheter. There's overdrainage, we can't really tell, but there will be a quick drainage of the radioisotope. For shunt infection, we start with an imaging just to make sure there's not a shunt malfunction, and that usually requires cerebrospinal fluid to test. The cerebrospinal fluid can come from the valve itself, or it can come from other areas like the lumbar spine. If the lumbar spine is showing signs of shunt infection, then that usually means the shunt is infected. If the valve is aspirated with- at the bedside with a butterfly needle into the valve and that shows signs of shunt infection, that also could be a sign of infection. Dr Berkowitz: That's very helpful. You mentioned CT and shunt series. One question that often comes up when obtaining neuroimaging in patients with a shunt, who have NPH or otherwise, is whether we need to call you when we're doing an MRI to reprogram the shunt before or after. Is there a way we can know as a neurologists at the bedside or as patients carry a card, like with some devices where we know whether we have to call and bother our neurosurgery colleagues to get this MRI? Or if the radiology techs ask us, is this safe? And is the patient's shunt going to get turned off? How do we go about determining this? Dr Chaichana: Yeah, so unfortunately, a lot of patients don't carry a card. We typically offer a card when we do the shunt, but that card, there's two problems with it. One is it tells the model, but the second thing is it has to be updated any time the shunt is changed to a different setting. Oftentimes patients don't know that shunt setting, and often times they don't know that company brand that they use. There are different types of shunts with different types of settings. If there's ever concern as to what type of shunt they have, an x-ray is usually the best bet to see with a shunt series, or a skull x-ray. A lateral skull x-ray usually looks at the valve, and the valve has certain radio-dense markers that indicate what type of shunt it is. And that way you can call neurosurgery and we can always tell you what the shunt setting is before the MRI is done. Problem with an MRI scan if you do it without a shunt x-ray before is that you don't know the setting before unless the patient really knows or it's in the patient chart, and the MRI can need to change the setting. It doesn't usually turn it off, but it would change the setting, which would change the fluid dynamics within their ventricular system, which could lead to overdrainage or underdrainage. So, any time a patient needs MRI imaging, whether it's even the brain MRI, a spine MRI, or even abdominal MRI, really a shunt x-ray should be done just to see the shunt setting so that it could be returned to that setting after the MRI is done. Dr Berkowitz: So, the only way to know sort of what type of shunt it would be short of the patient knowing or the patient getting care at the same hospital where the shunt was placed and looking it up in the operative reports would be a skull film. That would then tell us what type of shunt is there and then the marking of the setting. And then we would be able to call our colleagues in neurosurgery and say, this patient is getting an MRI this is the setting, this is the type of shunt. And do we need to call you afterwards to come by and reprogram it? Is that right? Dr Chaichana: That's correct, yeah. Dr Berkowitz: Is there anything we would be able to see on there, or it's best we just- best we just call you and clarify? Dr Chaichana: The easiest thing to do is, when you get the skull x-ray, you can Google different types of shunts or search for different shunts, and they'll have markers that show the type of shunt it is as well as the setting that it's at. And just match it up with the picture. Dr Berkowitz: And as long as it's not a programmable shunt, there's no concern about doing the MRI. Is that right? Dr Chaichana: Correct. So, if it's a programmable shunt, even if it's MRI-compatible, we still like to get the setting before and make sure the setting after the MRI is the same. Nonprogrammable shunts can't be changed with MRI scans, and those don't need neurosurgery after the MRI scan, but it should be confirmed before the scan is done. Dr Berkowitz: Very helpful. Okay, so let's turn to NPH specifically. As you know, there's a lot of debate in the literature, some arguing, even, NPH might not even exist, some saying it's underdiagnosed. I think. I don't know if it was last year at our American Academy of Neurology conference or certainly in recent years, there was a pro and con debate of “we are underdiagnosing NPH” versus “we are overdiagnosing NPH.” What's your perspective as a neurosurgeon? What's the perspective in neurosurgery? Is this something we're underdiagnosing, and the times you shunt these patients you see miraculous results? Is this something that we're overdiagnosing, you get a lot of patients sent to that you think maybe won't benefit from a shunt? Or is it just really hard to say and some patients have shunt-responsive noncommunicating hydrocephalus of unclear etiology and either concurrent Parkinson's disease, Alzheimer's, cervical lumbar stenosis, neuropathy, vestibular problems, and all these other issues that play into multifactorial gait to sort of display a certain amount of the percentage of problem in a given patient or take overtime? What's your perspective if you're open to sharing it, or what's the perspective of neurosurgery? Is this debated as it is in neurology or this is just a standard thing you see and patients respond to shunt to some degree in some proportion of the time? And what are the sort of predictors you see in your experience? Dr Chaichana: Yeah, so, for me, I'd say it's too complicated for a neurosurgeon to evaluate. We rely on neurology to tell us whether or not they need a shunt. But I think the problem is, obviously, a part of the workout for at least the ones that I like to do, is that I want them to have a high-volume lumbar puncture with pre- and postgait analysis to see if there's really an objective measure of them improving. If they have an objective measure of improvement---and what's even better is that they have a subjective measure of improvement on top of the objective measure of improvement---then they benefit from a shunt. The problem is, some patients do benefit even though they don't have objective performance increases after a high-volume shunt. And those are the ones that make me the most worrisome to do the shunt, just because I don't like to do a procedure where there's no benefit for the patient. I do see, according to the literature as well, that there's around a 30 to 40%, even 50%, increase in gait function, even in patients that don't have large improvements following the high-volume lumbar puncture. And those are the most challenging patients for us as neurosurgeons because we'll put the shunt in, they say we're no better in terms of their gait, no better in terms of their urinary incontinence. We try to lower their shunt down to a certain setting and we're kind of stuck after that point. The good thing about NPH, though, is that, from the neurosurgery side, the shunt, like I said, is a pretty benign, low-risk procedure. So, we're not putting the patient through a very severe procedure to see if there's any benefit. So, in cases where we try to improve their quality of life in patients that don't have a benefit from high-volume lumbar puncture, we give them the odds of whether or not it's improving and say it might not improve. But because the procedure's minimally invasive, I think it's a good way to see if we can benefit their quality of life. Dr Berkowitz: Yeah, it's a very helpful perspective. Yeah, those are the most challenging cases on our side as well, right. If the patient- we think they may have NPH, or their gait and/or urinary and/or cognitive problems are- at least have a component of NPH that could be reversible, we certainly want to do the large volume lumbar puncture and/or consider a lumbar drain trial, all discussed in other articles and interviews for this issue of Continuum, But the really tough ones, as you said, there is this literature on patients who don't respond to the large-volume lumbar puncture for some reason but still may be shunt responsive. And despite all the imaging predictors and all the other ways we try to think about this, it's hard to know who's going to benefit. I think that's really a helpful perspective from your end that, as you say in the very beginning of your article, right, maybe there's a little bit too much fear of shunting on the neurology side because when we hear about shunts, it's often in the setting of complication. And so, we're not sort of getting the full spectrum of all the patients you shunt and you see who are doing just fine. They might not improve---the question is related to NPH---but at least they're not harmed by the shunt, and we're maybe overbiased and/or seeing a overly representative sample of negative shunt outcomes when they're actually not that common in practice. Is that a fair summary of your perspective? Dr Chaichana: Yeah, that's correct. So, I mean, complications can occur---and anytime you do a surgery, there are risks of complications---but I think they're relatively low for the benefit that we can help their quality of life. And the procedure's pretty short. So, the risk, it mostly outweighs the benefits in cases with normal pressure hydrocephalus. Dr Berkowitz: Very helpful perspective. So, well, thanks so much again. Today I've been interviewing Dr Kaisorn Chaichana about his article on management of normal pressure hydrocephalus, which he wrote with Dr Jeremy Cutsforth-Gregory. 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 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.
In part three of this ten-part series, Dr. Paul Crane and Dr. Prashanth Ramachandran discuss when to suspect Oropouche virus and how to test for it. Show reference: https://onlinelibrary.wiley.com/doi/10.1002/ana.27139
Dr. Courtney Gillenwater is a US Navy veteran, global humanitarian, and pediatric specialist at Chara Health, Dr. Joy Kong's premier regenerative medicine clinic. With a background in traditional pediatrics and trauma medicine, Dr. Gillenwater transitioned into regenerative therapies after experiencing a rapid personal recovery using stem cells and exosomes. Now, she focuses on combining cutting-edge cellular treatments with comprehensive, integrative care to support children with autism, veterans with chronic injuries, and patients with complex inflammatory conditions.In this powerful episode, Dr. Joy Kong interviews Dr. Gillenwater about her unique path into regenerative medicine and the life-changing results she sees daily at Chara Health. From helping nonverbal children gain communication skills to aiding veterans with lung damage and patients on transplant lists, Dr. Gillenwater shares compelling case studies and clinical outcomes. The episode dives into how personalized stem cell protocols, micronutrient testing, and gut-brain optimization are transforming outcomes for children with autism spectrum disorders and adults facing serious health challenges.Visit My Clinic: Chara Health
In this powerful episode of Research Renaissance, host Deborah Westphal sits down with Dr. Rachel Buckley, Associate Professor of Neurology at Massachusetts General Hospital and Harvard Medical School. Together, they explore a growing body of research that challenges long-standing assumptions about sex differences in Alzheimer's disease.Dr. Buckley shares her unexpected journey from skepticism to advocacy in studying how biological sex and hormonal changes—particularly around menopause—can influence Alzheimer's risk, pathology, and progression. From PET scans to postmortem tissue studies, she unpacks what we now know about tau pathology in women, the role of hormone therapy, and how reproductive history may shape brain health.You'll also hear about:Why women are disproportionately impacted by Alzheimer's—and why it's more than just longevityHow timing of hormone therapy may impact tau buildupSurprising research around pregnancy, caregiving, and even the X chromosomeWhere the research gaps still exist—and how AI might help close themWhy training the next generation of sex-based neuroscientists is essentialWhether you're a caregiver, clinician, researcher, or simply curious about how brain health intersects with gender, this episode offers eye-opening insight and hope for the future.Guest Bio: Dr. Rachel Buckley is an internationally recognized neuroscientist focused on the intersection of sex differences and Alzheimer's disease. She leads groundbreaking research at Massachusetts General Hospital and serves as Chair of the Alzheimer's Association's Sex and Gender Professional Interest Area.Resources & Links:
Harness the power of suggestion for well-being, pain management, and mental health. Dr. Amir Raz is a world-renowned expert on the science of suggestion with recent positions as Canada Research Chair, Professor of Psychiatry, Neurology and Neurosurgery, and Psychology at McGill University, and as Founding Director of The Institute for Interdisciplinary Brain and Behavioral Sciences at Chapman University. His most recent book is The Suggestible Brain: The Science and Magic of How We Make Up Our Minds. In this episode we talk about: How Dr. Raz transitioned from a career in magic to neuroscience The science of suggestibility, how it's defined, and its relation to hypnosis Stage hypnosis vs medical hypnosis How the power of suggestion could be therapeutically harnessed to impact our physiology, behavior, and well-being Practical exercises for increasing thought control The "magical ingredient" when it comes to dealing with life's challenges Why placebos may work even when you know you're taking them How we protect ourselves against mis–and–disinformation And much more Join Dan's online community here Follow Dan on social: Instagram, TikTok Subscribe to our YouTube Channel To advertise on the show, contact sales@advertisecast.com or visit https://advertising.libsyn.com/10HappierwithDanHarris.
Dr. Justin Abbatemarco talks with Dr. Eric L. Voorn about the efficacy of combined personalized home-based aerobic exercise and coaching on physical fitness in people with neuromuscular diseases, compared with usual care. Read the related article in Neurology®. Read the additional article that was referenced. Disclosures can be found at Neurology.org.
In the second episode of this two-part series, Dr. Jeff Ratliff and Dr. Claire Henchcliffe discuss how she advises patients and families on the future of stem cell therapy and Parkinson disease. Show reference: https://www.nature.com/articles/s41586-025-08845-y
In this episode, we review the high-yield topic of Parkinson Disease from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Tuberous Sclerosis from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In the first part of this two-part series, Dr. Jeff Ratliff and Dr. Claire Henchcliffe discuss the important lessons learned from these results. Show reference: https://www.nature.com/articles/s41586-025-08845-y
In this episode, we will be talking with Dr Chris Meyer about the neurology of sleep. Dr Meyer is one of the newest GCSS Board Members, but he is also one of the newest Fellows. I think you will find him to be very deep and thorough in his insight into the process of sleep and how we might help our patients to improve it.
Dr. Nicole Elger just opened up her new practice and brings contagious energy to dentistry. She shares how her interest in Neurology helps her as a dentist, challenges facing the industry, and how a good lab makes your day go smooth. Ladies & Gentlemen, you're listening to "Confessions From A Dental Lab" and we're happy you're here. Subscribe today and tell a friend so we can all get 1% better :)Connect with Dr. Elger on instagram at @drnicoleelger and email her at nelger@bloomingtonfamilydentist.comFollow KJ & NuArt on Instagram at @lifeatnuartdental, you can also reach me via email: kj@nuartdental.comLearn more about the lab and request information via our website: https://www.nuartdental.com/new-dentist-contact-form/
In this episode, we review the high-yield topic of Neurotransmitters from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In the latest bonus podcast, the practical use of intravenous immunoglobulin is discussed with perspectives from three continents. Participants: Professor Alasdair Coles is Head of Department for Clinical Neuroscience and also Co-Director of the Cambridge Centre for Myelin Repair, UK. Dr. Lynette Kiers is a Clinical Associate Professor at The University of Melbourne, and Director of Clinical Neurophysiology at the Royal Melbourne Hospital, Australia. Dr. Christopher Hahn is an Associate Clinical Professor of Neurology at the University of Calgary's Cumming School of Medicine, and the Medical Director of the Calgary Electromyography Lab, Canada. Read the paper (https://pn.bmj.com/content/25/3/228) which is part of the June issue of the Practical Neurology journal. Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Letícia Amorim. Thank you for listening.
Dr. Jeff Ratliff talks with Dr. Claire Henchcliffe about the study's key findings while emphasizing the importance of educating patients about stem cell therapies and the ongoing advancements in this field. Read the related article in Nature. Disclosures can be found at Neurology.org.
In this powerful episode of The Red Light Report, I'm joined by the brilliant Dr. Joy Kong — stem cell specialist, anti-aging physician, and founder of Chara Health and the American Academy of Integrative Cell Therapy. We dive deep into: The science and clinical use of stem cell therapy Why umbilical cord-derived stem cells are safer and more potent than adult sources The truth about exosomes, cytokine storms, and foreign DNA fears How stem cells can transfer mitochondria, reverse tissue damage, and modulate immunity The importance of prepping your terrain with nutraceuticals, detox, and nitric oxide The role of red, green, and yellow light in stem cell activation and targeting Synergy between red light therapy and BioLight's enhanced methylene blue (BioBlue) Whether you're exploring stem cells for longevity, healing, or neuroregeneration, this episode will reshape your understanding of what's truly possible.
Dr. Jason Crowell and Dr. Brian E. Emmert discuss the concept behind the survey and the surprising findings from the survey results. Show reference: https://www.neurology.org/doi/10.1212/NE9.0000000000200221
In this episode, we review the high-yield topic of Cerebrospinal Fluid (CSF) from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this two-part episode of the Brain & Life Podcast, co-host Dr. Katy Peters is joined by Elizabeth Ansell, founder and director of #NotJustFatigue. #NotJustFatigue is a nonprofit organization shining a light on myalgic encephalomyelitis/chronic fatigue syndrome, also known as ME/CFS, and educates patients, clinicians, and health organizations about the condition. Elizabeth shares her diagnosis journey and explains why education around ME/CFS is so vital. Dr. Peters is then joined by Dr. W. Ian Lipkin, who is known internationally for his research and is the John Snow Professor of Epidemiology, Professor of Neurology, and Professor of Pathology and Cell Biology at Columbia University Irving Medical Center, Mailman School of Public Health. Dr. Lipkin explains what ME/CFS is and how it differs from other conditions with similar symptoms, like long COVID. Make sure to tune in next week for part two to hear about what's next in ME/CFS research and the importance of care partners. Additional Resources #NotJustFatigue How to Fight Fatigue Understanding the Impact of Invisible Illnesses on Daily Life How Families Are Leading the Charge in Rare Disease Advocacy Other Brain & Life Podcast Episodes on Similar Topics Rare Thoughts on a Rarer Neurologic Condition Shedding Light and Love on a Rare Genetic Condition with Deborah Vauclare Neurofibromatosis Advocacy and Community Building with the Gilbert Family Foundation 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: Elizabeth Ansell @notjustfatigue; Dr. W. Ian Lipkin @columbiapublichealth Guests: Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD
In part two of this ten-part series, Dr. Paul Crane and Dr. Prashanth Ramachandran discuss the effect of temperature and precipitation on the incidence of West Nile Neuroinvasive Disease. Show reference: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(24)00318-1/fulltext
In today's episode, we are going to talk with Dr Denny O'Hara. Dr O'Hara is someone that of the guests on this podcast would tell you he is their favorite person to talk to. Dr O'Hara is always observant and always insightful, but he does it in a simple way that is easy to grasp. If you find neurology to be an intimidating subject, I think you will find that Dr O'Hara is the perfect person to listen to as he talks about how the body works.
In this episode, we review the high-yield topic of Neurofibromatosis Type I from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Normal pressure hydrocephalus (NPH) is a clinical syndrome of gait abnormality, cognitive impairment, and urinary incontinence. Evaluation of CSF dynamics, patterns of fludeoxyglucose (FDG) uptake, and patterns of brain stiffness may aid in the evaluation of challenging cases that lack typical clinical and structural radiographic features. In this episode, Katie Grouse, MD, FAAN, speaks with Aaron Switzer, MD, MSc, author of the article “Radiographic Evaluation of Normal Pressure Hydrocephalus” 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. Switzer is a clinical assistant professor of neurology in the department of clinical neurosciences at the University of Calgary in Calgary, Alberta, Canada. Additional Resources Read the article: Radiographic Evaluation of Normal Pressure Hydrocephalus 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 Aaron Switzer about his article on radiographic evaluation of normal pressure hydrocephalus, which he wrote with Dr Patrice Cogswell. 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. Switzer: Thanks so much for having me, Katie. I'm a neurologist that's working up in Calgary, Alberta, Canada, and I have a special interest in normal pressure hydrocephalus. So, I'm very happy to be here today to talk about the radiographic evaluation of NPH. Dr Grouse: I'm so excited to have you here today. It was really wonderful to read your article. I learned a lot on a topic that is not something that I frequently evaluate in my clinic. So, it's really just a pleasure to have you here to talk about this topic. So, I'd love to start by asking, what is the key message that you hope for neurologists who read your article to take away from it? Dr. Switzer: The diagnosis of NPH can be very difficult, just given the clinical heterogeneity in terms of how people present and what their images look like. And so, I'd like readers to know that detailed review of the patient's imaging can be very helpful to identify those that will clinically improve with shunt surgery. Dr Grouse: There's another really great article in this edition of Continuum that does a really great job delving into the clinical history and exam findings of NPH. So, I don't want to get into that topic necessarily today. However, I'd love to hear how you approach a case of a hypothetical patient, say, where you're suspicious of NPH based on the history and exam. I'd love to talk over how you approach the imaging findings when you obtain an MRI of the brain, as well as any follow-up imaging or testing that you generally recommend. Dr. Switzer: So, I break my approach down into three parts. First, I want to try to identify ventriculomegaly and any signs that would support that, and specifically those that are found in NPH. Secondly, I want to look for any alternative pathology or evidence of alternative pathology to explain the patient's symptoms. And then also evaluate any contraindications for shunt surgery. For the first one, usually I start with measuring Evans index to make sure that it's elevated, but then I want to measure one of the other four measurements that are described in the article, such as posterior colossal angle zed-Evans index---or z-Evans index for the American listeners---to see if there's any other features that can support normal pressure hydrocephalus. It's very important to identify whether there are features of disproportionately enlarged subarachnoid space hydrocephalus, or DESH, which can help identify patients who may respond to shunt surgery. And then if it's really a cloudy clinical picture, it's complicated, it's difficult to know, I would usually go through the full evaluation of the iNPH radscale to calculate a score in order to determine the likelihood that this patient has NPH. So, the second part of my evaluation is to rule out evidence of any alternative pathology to suggest another cause for the patient's symptoms, such as neurodegeneration or cerebrovascular disease. And then the third part of my evaluation is to look for any potential contraindications for shunt surgery, the main one being cerebral microbleed count, as a very high count has been associated with the hemorrhagic complications following shunt surgery. Dr Grouse: You mentioned about your use of the various scales to calculate for NPH, and your article does a great job laying them out and where they can be helpful. Are there any of these scales that can be reasonably relied on to predict the presence of NPH and responsiveness to shunt placement? Dr. Switzer: I think the first thing to acknowledge is that predicting shunt response is still a big problem that is not fully solved in NPH. So, there is not one single imaging feature, or even combination of imaging features, that can reliably predict shunt response. But in my view and in my practice, it's identifying DESH, I think, is really important---so, the disproportionately enlarged subarachnoid space hydrocephalus---as well as measuring the posterior colossal angle. I find those two features to be the most specific. Dr Grouse: Now you mentioned the concept of the NPH subtypes, and while this may be something that many of our listeners are familiar with, I suspect that, like myself when I was reading this article, there are many who maybe have not been keeping up to date on these various subtypes. Could you briefly tell us more about these NPH subtypes? Dr. Switzer: Sure. The Japanese guidelines for NPH have subdivided NPH into three different main categories. So that would be idiopathic, delayed onset congenital, and secondary normal pressure hydrocephalus. And so, I think the first to talk about would be the secondary NPH. We're probably all more familiar with that. That's any sort of pathology that could lead to disruption in CSF dynamics. These are things like, you know, a slow-growing tumor that is obstructing CSF flow or a widespread meningeal process that's reducing absorption of CSF, for instance. So, identifying these can be important because it may offer an alternative treatment for what you're seeing in the patient. The second important one is delayed onset congenital. And when you see an image of one of these subtypes, it's going to be pretty different than the NPH because the ventricles are going to be much larger, the sulcal enfacement is going to be more diffuse. Clinically, you may see that the patients have a higher head circumference. So, the second subtype to know about would be the delayed onset congenital normal pressure hydrocephalus. And when you see an image of one of these subtypes, it's going to be a little different than the imaging of NPH because the ventricles are going to be much larger, the sulcal enfacement is going to be more diffuse. And there are two specific subtypes that I'd like you to know about. The first would be long-standing overt ventriculomegaly of adulthood, or LOVA. And the second would be panventriculomegaly with a wide foramen of magendie and large discernomagna, which is quite a mouthful, so we just call it PAVUM. The importance of identifying these subtypes is that they may be amenable to different types of treatment. For instance, LOVA can be associated with aqueductal stenosis. So, these patients can get better when you treat them with an endoscopic third ventriculostomy, and then you don't need to move ahead with a shunt surgery. And then finally with idiopathic, that's mainly what we're talking about in this article with all of the imaging features. I think the important part about this is that you can have the features of DESH, or you can not have the features of DESH. The way to really define that would be how the patient would respond to a large-volume tap or a lumbar drain in order to define whether they have this idiopathic NPH. Dr Grouse: That's really helpful. And for those of our listeners who are so inclined, there is a wonderful diagram that lays out all these subtypes that you can take a look at. I encourage you to familiarize yourself with these different subtypes. Now it was really interesting to read in your article about some of the older techniques that we used quite some time ago for diagnosing normal pressure hydrocephalus that thankfully we're no longer using, including isotope encephalography and radionuclide cisternography. It certainly made me grateful for how we've come in our diagnostic tools for NPH. What do you think the biggest breakthrough in diagnostic tools that are now clinically available are? Dr. Switzer: You know, definitely the advent of structural imaging was very important for the evaluation of NPH, and specifically the identification of disproportionately enlarged subarachnoid space hydrocephalus, or DESH, in the late nineties has been very helpful for increasing the specificity of diagnosis in NPH. But some of the newer technologies that have become available would be phase-contrast MRI to measure the CSF flow rate through the aqueduct has been very helpful, as well as high spatial resolution T2 imaging to actually image the ventricular system and look for any evidence of expansion of the ventricles or obstruction of CSF flow. Dr Grouse: Regarding the scales that you had referenced earlier, do you think that we can look forward to more of these scales being automatically calculated and reported by various software techniques and radiographic interpretation techniques that are available or going to be available? Dr. Switzer: Definitely yes. And some of these techniques are already in development and used in research settings, and most of them are directed towards automatically detecting the features of DESH. So, that's the high convexity tight sulci, the focally enlarged sulci, and the enlarged Sylvian fissures. And separating the CSF from the brain tissue can help you determine where CSF flow is abnormal throughout the brain and give you a more accurate picture of CSF dynamics. And this, of course, is all automated. So, I do think that's something to keep an eye out for in the future. Dr Grouse: I wanted to ask a little more about the CSF flow dynamics, which I think may be new to a lot of our listeners, or certainly something that we've only more recently become familiar with. Can you tell us more about these advances and how we can apply this information to our evaluations for NPH? Dr. Switzer: So currently, only the two-dimensional phase contrast MRI technique is available on a clinical basis in most centers. This will measure the actual flow rate through the cerebral aqueduct. And so, in NPH, this can be elevated. So that can be a good supporting marker for NPH. In the future, we can look forward to other techniques that will actually look at three-dimensional or volume changes over time and this could give us a more accurate picture of aberrations and CSF dynamics. Dr Grouse: Well, definitely something to look forward to. And on the topic of other sort of more cutting-edge or, I think, less commonly-used technologies, you also mentioned some other imaging modalities, including diffusion imaging, intrathecal gadolinium imaging, nuclear medicine studies, MR elastography, for example. Are any of these modalities particularly promising for NPH evaluations, in your opinion? Do you think any of these will become more popularly used? Dr. Switzer: Yes, I think that diffusion tract imaging and MR elastography are probably the ones to keep your eye out for. They're a little more widely applicable because you just need an MR scanner to acquire the images. It's not invasive like the other techniques mentioned. So, I think it's going to be a lot easier to implement into clinical practice on a wide scale. So, those would be the ones that I would look out for in the future. Dr Grouse: Well, that's really exciting to hear about some of these techniques that are coming that may help us even more with our evaluation. Now on that note, I want to talk a little bit more about how we approach the evaluation and, in your opinion, some of the biggest pitfalls in the evaluation of NPH that you've found in your career. Dr. Switzer: I think there are three of note that I'd like to mention. The first would be overinterpreting the Evans index. So, just because an image shows that there's an elevated Evans index does not necessarily mean that NPH is present. So that's where looking for other corroborating evidence and looking for the clinical features is really important in the evaluation. Second would be misidentifying the focally enlarged sulci as atrophy because when you're looking at a brain with these blebs of CSF space in different parts of the brain, you may want to associate that to neurodegeneration, but that's not necessarily the case. And there are ways to distinguish between the two, and I think that's another common pitfall. And then third would be in regards to the CSF flow rate through the aqueduct. And so, an elevated CSF flow is suggestive of NPH, but the absence of that does not necessarily rule NPH out. So that's another one to be mindful of. Dr Grouse: That's really helpful. And then on the flip side, any tips or tricks or clinical pearls you can share with us that you found to be really helpful for the evaluation of NPH? Dr. Switzer: One thing that I found really helpful is to look for previous imaging, to look if there were features of NPH at that time, and if so, have they evolved over time; because we know that in idiopathic normal pressure hydrocephalus, especially in the dash phenotype, the ventricles can become larger and the effacement of the sulci at the convexity can become more striking over time. And this could be a helpful tool to identify how long that's been there and if it fits with the clinical history. So that's something that I find very helpful. Dr Grouse: Absolutely. When I read that point in your article, I thought that was really helpful and, in fact, I'm guessing something that a lot of us probably aren't doing. And yet many of our patients for one reason or other, probably have had imaging five, ten years prior to their time of evaluation that could be really helpful to look back at to see that evolution. Dr. Switzer: Yes, absolutely. Dr Grouse: It's been such a pleasure to read your article and talk with you about this today. Certainly a very important and helpful topic for, I'm sure, many of our listeners. Dr. Switzer: Thank you so much for having me. Dr Grouse: Again, today I've been interviewing Dr Aaron Switzer about his article on radiographic evaluation of normal pressure hydrocephalus, which he wrote with Dr Patrice Cogswell. 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 part one of this ten-part series, Dr. Paul Crane and Dr. Prashanth Ramachandran discuss the new global cryptococcal meningitis guidelines. Show reference: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00731-4/abstract
In this episode, we review the high-yield topic of Hypothalamus from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this week's episode, Ané dives into a fascinating survey-based study that compares how veterinary neurologists and rehabilitation therapists approach the diagnosis and treatment of degenerative myelopathy in dogs. Ané explores key insights into diagnostic procedures, referral practices, assistive walking devices, rehabilitation goals and protocols, and how professionals support clients managing this progressive condition. Find out more about the Vet Rehab Summit: https://vetrehabsummit.com/ Learn more about Paw Prosper's special offer: https://pawprosper.com/OPH Learn more about Paw Prosper: https://pawprosper.com/ To learn about Onlinepethealth, watch a free webinar, or join any of our Facebook groups, click here: https://onlinepethealth.com/podcast
In this episode of The Dr. Joy Kong Podcast, Dr. Joy speaks with Dr. Mike Jamshidi, a naturopathic doctor at Chara Health, about natural, hands-on approaches to pain relief beyond pills and surgery. Dr. Mike shares his journey from healing his own chronic health issues to helping patients address root causes of pain through bodywork, acupuncture, nutrition, and lifestyle changes.They also discuss advanced regenerative treatments like stem cells and exosomes, and Dr. Mike shares powerful stories of patients finding relief from severe conditions. This conversation highlights the power of working with the body's innate healing abilities for deeper, long-lasting recovery.--Additional Resources:Visit My Clinic: Chara Health
Dr. Jason Crowell talks with Dr. Brian E. Emmert about the results from the 2022 AAN Resident Survey and explores areas for future improvement. Read the related article in Neurology® Education. Disclosures can be found at Neurology.org.
In the July episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost discuss the role science plays in what the AAN does. Show reference: https://www.aan.com/about-the-aan/presidents-spotlight
In today's episode, we will begin a week of neurology review by listening to Dr David Geary. Dr Geary is a Gonstead Diplomate and he is on the GCSS Board of Directors; he is also the co-chairman of the Meeting of the Minds committee along with myself. He has a deep love and interest in both the science of chiropractic and the field of Neurology. I think you will find he has some excellent insights for you as you think about the neurology of the subluxation.
In this episode, we review the high-yield topic of Circle of Willis from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Join us for this special edition of the Rx Bricks Podcast, featuring a complete Rx Question Lab session designed to help medical students master high-yield neurological concepts for USMLE Step 1. In this interactive session, we work through four challenging board-style questions that cover essential neurology topics, including speech disorders, genetic syndromes affecting the nervous system, stroke recognition, and neurological pain conditions. Learn systematic approaches to neuroanatomy questions and develop the clinical reasoning skills needed to tackle even the most complex neurology scenarios on Step 1. Dr. Titus, a hematology/oncology fellow at the University of South Alabama, provides expert explanations that connect basic neuroanatomical concepts with clinical presentations, helping you understand not just the correct answers but the underlying pathophysiology. Whether you’re struggling with neuroanatomy or looking to refine your knowledge of neurological disorders, this Question Lab offers practical strategies and insights that will boost your confidence on exam day. Perfect for medical students and IMGs preparing for USMLE Step 1. For more USMLE-Rx resources, visit www.usmle-rx.com and use the code RXPOD for 30% off any new subscription. This special edition was recorded live during our regular Rx Question Lab series. Learn more at https://go.usmle-rx.com/question-lab
In part one of this three-part series, Dr. Justin Abbatemarco and Drs. John Chen and Smathorn Thakolwiboon discuss the outcomes following plasma exchange in MOGAD and explore how the findings from this study can inform patient care.
Dr. Justin Abbatemarco talks with Drs. John Chen and Smathorn Thakolwiboon about the outcomes following plasma exchange in MOGAD and explore how the findings from this study can inform patient care. Disclosures can be found at Neurology.org.
Dr. Dan Ackerman and Drs. Luuk Dekker and Jasper D. Daems discuss the analysis of various aLVO stroke detection scales to determine which one is the most useful for prehospital triage. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213570
The July 2025 recall features four episodes on systems and innovation in delivering neurologic care. The episode begins with Dr. Scott Friedenberg discussing challenges faced by neurologists in balancing financial productivity with optimal patient care. The episode leads into a conversation with Dr. Marisa Patryce McGinley discussing the utilization of telemedicine in neurology, particularly focusing on disparities in access among different demographic groups. The conversation transitions to Dr. Lidia Moura talking about the implications of large language models for neurologic care. The episode concludes with Dr. Ashish D. Patel discussing headache referrals and the implementation of a design thinking approach to improve access to headache care. Podcast links: Empowering Health Care Providers Disparities in Utilization of Outpatient Telemedicine for Neurologic Care Large Language Models for Quality and Efficiency of Neurologic Care Using Design Thinking to Understand the Reason for Headache Referrals Article links: Empowering Health Care Providers: A Collaborative Approach to Enhance Financial Performance and Productivity in Clinical Practice Disparities in Utilization of Outpatient Telemedicine for Neurologic Care Implications of Large Language Models for Quality and Efficiency of Neurologic Care: Emerging Issues in Neurology Using Design Thinking to Understand the Reason for Headache Referrals and Reduce Referral Rates Disclosures can be found at Neurology.org.
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