Podcasts about Neurology

Dr. Dara Albert talks with Dr. Jon Stone about the latest advancements in FND from the recent International Conference on Functional Neurological Disorder. Dr. Jon Stone shares insights on the field's growth, multidisciplinary care, cultural perspectives, and future directions. Check out the FNDS website for more information about FND.  Disclosures can be found at Neurology.org. 

Dr. Stacey Clardy talks with Dr. John Ney about the link between military sexual trauma and migraine among US veterans.  Read the related article in Neurology® Clinical Practice.  Disclosures can be found at Neurology.org. 

Behind Closed Doors: Male Victims Of Intimate Partner Violence Men make up nearly half of the victims of intimate partner violence, so why do so many survivor programs focus only on women? Our experts shed light on this frequently overlooked crisis, exploring the heavy realities of male victims of intimate partner violence and challenging the gender stereotypes that surround domestic abuse. Guests:  Dr. Denise Hines, Elizabeth Shirley Enochs Endowed Professor of Social Work, George Mason University College of Public Health Aaron Ellis, survivor & advocate Host and producer: Kristen Farrah   A World Of Silence Pt.2: Is Early Intervention Safe For Infant Hearing Loss? The FDA recently lowered the age criteria for children to receive cochlear implants to just seven months old, a shift that promises better developmental outcomes but leaves many parents deeply hesitant. Our experts this week demystifies the procedure – including why the actual surgical recovery might be far easier than families expect. Guests:  Dr. Nancy Young, medical director of Audiology and Cochlear Implant Programs, The Ann & Robert H. Lurie Children's Hospital of Chicago, Lillian S. Wells professor in pediatric otolaryngology, Northwestern University Feinberg School of Medicine Doug and Eva Tweedy, parents Host: Greg Johnson Producer: Kristen Farrah Facebook: ingoodhealthpodX: @ ingoodhealthpodIG: @ingoodhealthpodYouTube: @ingoodhealthpodSpotify Apple Podcast In Good Health PodcastSubscribed to the newsletterFull ArchiveContact UsBecome an Affiliate Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The FDA recently lowered the age criteria for children to receive cochlear implants to just seven months old, a shift that promises better developmental outcomes but leaves many parents deeply hesitant. Our experts this week demystifies the procedure – including why the actual surgical recovery might be far easier than families expect. Facebook: ingoodhealthpodX: @ ingoodhealthpodIG: @ingoodhealthpodYouTube: @ingoodhealthpodSpotify Apple Podcast In Good Health PodcastSubscribed to the newsletterFull ArchiveContact UsBecome an Affiliate Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

What makes you left or right handed? The simple answer is that we're born that way, but a new study suggests that practice might have something to do with it...Ahmet Arac, Assistant Professor in Neurology at UCLA, joins Seán to discuss.

What makes you left or right handed? The simple answer is that we're born that way, but a new study suggests that practice might have something to do with it...Ahmet Arac, Assistant Professor in Neurology at UCLA, joins Seán to discuss.

Dr. Derek Stitt talks with Dr. Jennifer Morganroth about the evolving landscape of genetic testing in ALS, the importance of longitudinal care for at-risk individuals, and the capacity challenges faced by clinics.  Read the related article in Neurology® Genetics.  Disclosures can be found at Neurology.org. 

*Content Warning:  neglect, rejection, friendship betrayal, betrayal, and infidelity.Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources   SWW Sticker Shop!: https://brokencyclemedia.com/sticker-shop SWW S26 Theme Song & Artwork: The S26 cover art is by the Amazing Sara Stewart instagram.com/okaynotgreat/  Follow Something Was Wrong: Website: somethingwaswrong.com  IG: instagram.com/somethingwaswrongpodcast TikTok: tiktok.com/@somethingwaswrongpodcast  Follow Tiffany Reese: Website: tiffanyreese.me  IG: instagram.com/lookieboo Follow Dr. Marisa G. Franco: Website - https://www.drmarisagfranco.com/ Instagram - https://www.instagram.com/drmarisagfranco Platonic, How The Science of Attachment Can Help You Make - and Keep - Friends - https://drmarisagfranco.com/platonic-the-book/ Worth, The New Science of Self-Esteem and Secure Attachment: https://drmarisagfranco.com/worth-the-book/ *Sources:  Almaatouq, Abdullah, et al. "Are You Your Friends' Friend? Poor Perception of Friendship Ties Limits the Ability to Promote Behavioral Change." PLOS ONE, vol. 11, no. 3, 2016, article e0151588, https://doi.org/10.1371/journal.pone.0151588 Center for the Study of Traumatic Stress. When Losses of Loved Ones Are Not Acknowledged: Understanding Disenfranchised Grief. Department of Psychiatry, Uniformed Services University, n.d., https://www.cstsonline.org/assets/media/documents/CSTS_FS_When_Losses_of_Loved_Ones_Are_Not_Acknowledged_Understanding_Disenfranchised_Grief.pdf Dodson, William W., et al. "Rejection sensitivity dysphoria in attention-deficit/hyperactivity disorder: A case series." Neurology 7 (2024): 23-30.  Franco, Marisa G. Platonic: How the Science of Attachment Can Help You Make—and Keep—Friends. Penguin Random House, 6 Sept. 2022 https://www.penguinrandomhouse.com/books/676695/platonic-by-marisa-g-franco-phd/ Franco, Marisa G. Worth: The New Science of Self-Esteem and Secure Attachment. G.P. Putnam's Sons, 15 Sept. 2026, Penguin Random House,https://www.penguinrandomhouse.com/books/784327/worth-by-marisa-g-franco-phd/ Gobin, Robyn L., and Jennifer J. Freyd. "The impact of betrayal trauma on the tendency to trust." Psychological Trauma: Theory, Research, Practice, and Policy 6.5 (2014): 505. https://psycnet.apa.org/record/2013-24397-001 Guy-Evans, Olivia. “Self-Verification Theory.” Simply Psychology, 11 May 2026, https://www.simplypsychology.org/self-verification-theory.html Here & Now Newsroom. “Research Shows We Replace Half Our Friends Every 7 Years. Here's How to Make New Ones.” NPR Illinois, 23 June 2025, https://www.nprillinois.org/2025-06-23/research-shows-we-replace-half-our-friends-every-7-years-heres-how-to-make-new-ones Hillman, James. "Betrayal." Loose Ends: Primary Papers in Archetypal Psychology, Spring Publications, 1975, pp. 63–79. Jarrett, Christian. "The Liking Gap: We Usually Think People Like Us Less Than They Actually Do." Research Digest, British Psychological Society, 13 Sept. 2018, https://www.bps.org.uk/research-digest/liking-gap Kenny, Serafina. "Having Friends Is as Important as Diet and Exercise for Living Longer, a Longevity Expert Says." Business Insider, 22 Sept. 2023, https://www.businessinsider.com/longevity-antiaging-friendship-social-interaction-relationships-2023-9 Nader, Karim. “Reconsolidation and the Dynamic Nature of Memory.” Cold Spring Harbor perspectives in biology vol. 7,10 a021782. 9 Sep. 2015, doi:10.1101/cshperspect.a021782, https://pubmed.ncbi.nlm.nih.gov/26354895/ Nussbaum, Ben. "FRIENDSHIP FLATTENS HILLS: It's time to put connections at the center of wellbeing, says relationship expert Marisa Franco." Spirituality & Health Magazine, vol. 25, no. 5, Sept.-Oct. 2022, pp. 46+. Gale Academic OneFile link.gale.com/apps/doc/A763799199/AONE?u=anon~858b38f4&sid=googleScholar&xid=6b08179d One Another. Directed by Amber Love, produced by Andrea Raby, Joycie Films, 2026. World premiere, SXSW Film & TV Festival, Austin, TX, 12 Mar. 2026. https://schedule.sxsw.com/2026/films/2249924 Romm, Cari. "Half of Your Friends Probably Don't Think of You as a Friend." The Cut, 9 May 2016, https://www.thecut.com/2016/05/half-of-your-friends-probably-dont-think-of-you-as-a-friend.html Thompson, Sophia, Kaitlyn Deaner, and Marisa G. Franco. "How to Help Clients Make Friends." Journal of Health Service Psychology 49.2 (2023): 77-85 https://link.springer.com/article/10.1007/s42843-023-00085-w Wallace, Anna Kodé. "Why Friendship Betrayal Feels Impossible to Get Over." The Cut, 22 Apr. 2026, https://www.thecut.com/article/friendship-betrayal-explained-psychology-summer-house.html

Yaara Zisman-Ilani is an associate professor in the Department of Social and Behavioral Sciences at the Barnett College of Public Health and in the Department of Psychiatry and Behavioral Science at the Lewis Katz School of Medicine, both at Temple University. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. Y. Zisman-Ilani and Others. Pharmacotherapeutic Decisions in Autism. N Engl J Med 2026;395:214-217.

Intracerebral hemorrhage carries high morbidity and mortality, but growing evidence highlights meaningful opportunities for prevention, risk reduction, and long-term recovery. This episode covers key strategies, including blood pressure management, interpretation of neuroimaging markers, and individualized decisions around antithrombotic therapy. It also emphasizes the prolonged recovery timeline and the importance of a holistic, patient-centered approach to improving outcomes. In this episode, Casey S. Albin, MD, FAAN, speaks with Wendy C. Ziai, MD, and Vishank A. Shah, MD, coauthors of the article "Intracerebral Hemorrhage" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Ziai is a professor of neurology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Shah is an assistant professor of neurology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Intracerebral Hemorrhage Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Guest: @VishankShah3 Full episode transcript available here Dr Albin: A patient has suffered an intracerebral hemorrhage. They're taken to the neuro ICU, and they fortunately survive. But the journey does not end there. In fact, in some ways, the journey has just begun. Join us today as we unpack holistic care for ICH patients.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Albin: Hello to our audience. This is Dr. Casey Albin. Today, I'm interviewing Dr. Wendy Ziai and Dr. Vishank Shah about their article on intracerebral hemorrhage. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast. I am so delighted that both of you are joining. To begin, let's just do a brief introduction of who you are and, and a little bit of how you got interested in the topic.  Dr Ziai: Hi, I'm Wendy Ziai. Thank you for having me on this podcast. I am a professor of neurology at Johns Hopkins. I am a neurointensivist, and I think I got primarily interested in this topic through clinical trials that I have been a part of since my fellowship days.  Dr Shah: Hi, everyone. I'm, uh, Vishank Shah. I am also, uh, very thankful for being invited to be a part of this podcast. I'm also a neurointensivist at Hopkins and the fellowship program director here for neurocritical care, and I'm interested in recovery after ICH, and that's why I'm a part of this work.  Dr Albin: Welcome to you both. It is such a treat for me to get to interview fellow neurointensivist, particularly those who have such a wealth of experience. So, I am delighted to dive into this. All right. So, to set the stage for our audience, intracerebral hemorrhage has long been approached with pessimism. But your article really highlights that there are meaningful advantages in prevention and risk stratification and long-term recovery for these patients. Though you both are neurointensivist, this article really emphasizes primary prevention and the holistic long-term care for the survivors. And so, to begin, Dr. Shah, can you just lay out a little bit for our listeners the scope of intracerebral hemorrhage and its community impact?  Dr Shah: Yeah. So, you know, ICH is the second most common type of stroke. There are more than three million new cases of ICH globally each year, and it accounts for thirty percent of all stroke types, but it is the one that has the highest mortality, with more than forty to fifty percent of the patients dying in the first thirty days, and then continued long-term impact on both functional as well as outcomes, as well as survivorship after the early period. And it also disproportionately impacts lower socioeconomic, and then minority races like Blacks, Asians, as well as Hispanic ethnicity. And so, there's a lot of work that needs to be done to reduce the burden of this disease.  Dr Albin: Absolutely. I mean, these can really be devastating for families, and I really am appreciative of your highlighting that there's a lot of disparities, and there's a lot of work to be done to really increase equity to these patients. I think a lot of this goes into really the AAN's focus on brain health and trying to improve some of what we're doing to maintain brain health. And I really wanted to kind of drill down on this because for ICH, there's a lot that can be done upfront as we think about how do we counsel patients who may walk into the office about strategies to prevent ever becoming an intracerebral hemorrhage patient. So, Dr. Shah, can you walk us through a little bit about what neurologists in the community need to be doing to make sure that no one ends up with us in the neurointensive care unit?  Dr Shah: Yeah, sure. So, I think, you know, one of the most important risk factors is, of course, hypertension and long-standing uncontrolled hypertension. And so really recognizing the need for early onset screening with regular blood pressure monitoring at a very early age, particularly in the races that I discussed earlier. And then I think another big part, obesity, metabolic syndrome, and type two diabetes. And I think there's a lot of interesting new work that with the GLP-1 agonist, you know, in a large multicenter cohort studies showing that patients receiving these had a significantly lower reduction risk of ICH. And so, this might be a really important part that, you know, clinicians need to start increasingly recognizing and using in their practice. And then, of course, other risk factors that are common include smoking, diet high in sodium, exposure to air pollution, both indoor as well as outdoor. And so, mitigating all of these risk factors can also reduce the burden of ICH.  Dr Albin: Absolutely. And I really want to highlight that hypertension plays such an important role and that we as neurointensivist, as community neurologists, really need to be creative about ways that we can help people meet those blood pressure target and meeting people in the community where they are, making sure that they're not suffering from side effects from their medication that would prevent them from sticking with it long term. Dr. Ziai, anything else to add about what we can do in the community?  Dr Ziai: So, we really want to emphasize, even in the acute phase, that patients moving forward need to have targeted interventions to reduce blood pressure, smoking, enhance their physical activity, have a diet that is high in fruits and vegetables and low in alcohol and salt, and then promoting weight loss, of course.  Dr Albin: And Dr. Ziai, I'm gonna ask you a little bit about one of the things that maybe not all of our listeners have heard about is this APOE2, APOE4 genetic risk for intracerebral hemorrhage. What's going on there and, and should clinicians be testing for that? Dr Ziai: That's a great question, and it is not one that we currently test people for at least acute ICH presentation. APOE2 and A4- E4 alleles, these give patients a two to three times higher risk of ICH by increasing cerebral amyloid deposition. And if you happen to have APOE2 carrier ship status, then along with other risk factors like white matter disease and vascular risk factors, these predict the onset of new microbleeds even during very short follow-up periods of about two years. And as we know, having cerebral microbleeds are associated with an increased risk of all strokes, ischemic and ICH, but they are one of many MRI markers of small vessel disease, which along with cortical superficial siderosis, does significantly increase future ICH risk. And so even in people who've never had an ICH, if they happen to have an MRI, it may be reasonable to look at the MRI and incorporate this burden of small vessel disease, and especially these hemorrhagic markers into, uh, decision-making about interventions.  Dr Albin: That's a really excellent point. And so, I think that your article did a really beautiful job of thinking holistically about the patient, incorporating clinical markers of their risk for having ICH, but also those radiographic markers. I'm just gonna ask you to summarize those again one more time because not everyone will be familiar with these. So, when you're looking at an MRI, what are the things that you're particularly clued in on that would increase the patient's risk of future ICH?  Dr Ziai: In the past, what we're looking for really is markers of cerebral amyloid angiopathy, which significantly increase a person's risk for lobar hemorrhage in particular. And so, we have a set of criteria called the Boston Criteria, and there's a new version of these, version 2.0. And these, um, incorporate a number of imaging markers that provide a very high sensitivity and specificity to diagnose CAA after an ICH. But even if someone's never had an ICH, and they evaluate that risk-benefit ratio for different cardiovascular prevention strategies. And so, the markers that we're specifically interested in are, of course, microbleeds. But not just having microbleeds, but are they lobar or are they deep? Lobar having a higher risk for lobar ICH. How many microbleeds are there? Is it greater than five, or is it just one or two? Also, cortical superficial siderosis is a marker, a hemorrhagic marker, that does portend a significant increased risk of recurrent ICH, along with having a lobar ICH. And now we have these new markers, which are the white matter hyperintensity multi spot pattern, which requires these hyperintensities on flare imaging in the subcortical area, having greater than at least ten of these multi spots, and also having enlarged perivascular spaces in the centrum semiovale, and having at least twenty of those. And finally, white matter hyperintensities, which can be measured with the physica score or just by visualizing them. We can look at white matter hyperintensities as well as being a measure of small vessel disease.  Dr Albin: Got it. And so just to summarize, we're looking for small vessel disease markers because that puts our patients at higher risk of ongoing future bleeds. And then we're also looking for markers of particularly small vessel disease that's caused by cerebral amyloid angiopathy, which again, because it's having that protein deposition, that puts the patient at risk of those leptomeningeal very small vessels, putting the patient at risk of lobar ICH. Just confirming I've summarized this all correctly.  Dr Ziai: Yes. That was perfect.  Dr Albin: Amazing. Dr. Shah, I'm gonna go back to you. Let's say we have a patient. Let's say this is a sixty-five-year-old man who comes in and they want follow-up and they're... And you're trying to think about they've had an ICH in the past, and they are also at risk for ischemic disease. Let's say they, they have hypertension, they've had a smoking history. They have some risk for ischemic events. And you're trying to think about how do you balance those. Let's say the patient needs to be on aspirin but does have some of those high-risk features on their MRI. Is there any guidance on how we think through preventing them from having a recurrent bleed if they're a high-risk patient, also preventing them from having an ischemic event, which they might be at high risk for as well?  Dr Shah: Yes. So, I think, you know, the first step is of course trying to understand what was the type of bleed. I think that has a very important role, like you mentioned. If it's a lobar hemorrhage versus a deep hemorrhage, the risk of recurrent ICH and ischemic events is very variable. So lobar hemorrhages, there's obviously a higher risk of recurrent hemorrhage events, whereas deep hemorrhage is actually at or behaves sort of like small vessel ischemic strokes and have a higher risk of recurrent arterial ischemic events. So that distinction in itself can help you gauge which patients would be safe and would benefit from these therapies. To begin, and of course, looking for some of these markers on MRI that were mentioned by Dr. Ziai for recurrence of hemorrhage risk. In terms of antiplatelet, the, there is a lot more data now to guide treatment, and we have the RESTART as well as the ESTART trial that showed that starting an, a single antiplatelet after intracerebral hemorrhage did not increase the risk of hemorrhage recurrence. They were very variable in the timing when aspirin was started, and so that remains still a question about what is the safest time point to start aspirin. For example, in the ESTART trial, they started them very early, within the first three days, whereas in  the RESTART it was all the way up to two months after the hemorrhage. And so... But in general, the risk of recurrent ICH was very low with a single antiplatelet agent. And so, if it's needed for ischemic prevention, it's relatively safe broadly across all types of hemorrhages.  Dr Ziai: Yeah. I would just mention that there was also a subgroup analysis of the RESTART trial using MRI. And so, this more than likely included patients with CAA, since 40% of the hemorrhages were lobar in that study, and therefore seeing that there was no increased risk of recurrent ICH in RESTART, it is thought that putting patients back on their antiplatelet therapy is safe.  Dr Albin: That's a really huge takeaway pearl for our listeners, that regardless of whether it's a lobar bleed or a deep bleed, if there is a strong indication, you know, this is not just, oh, because someone gave them aspirin 81, but truly that there is a reason that they need to be on a single antiplatelet agent, it probably benefits them to be on that agent, and there's good data that there's not a huge increase in risk. Summarizing all of that?  Dr Ziai: Great.  Dr Albin: Now, things are gonna get a little bit tricky here, because what if the patient, what if they need to be on dual antiplatelet therapy? Or what if they need to be on anticoagulation? Dr. Ziai, I'll, I'll throw that to you. How do you tackle that patient population?  Dr Ziai: Yeah, the safety of dual antiplatelet therapy hasn't really been studied in patients who've had a prior ICH. Although, in people who've had previous strokes, putting them on dual antiplatelets doesn't seem to increase the risk of ICH, but it does increase extracranial hemorrhage. And so there may be other reasons not to put patients on dual antiplatelet agents. Patients who have cancer and also cardiovascular or cerebrovascular disease, putting them on dual antiplatelet therapy does seem to increase the risk for intracranial hemorrhage. So, I think there is enough of a bias against DAPT therapy in patients who have had an ICH that we would not recommend DAPT for patients with a prior ICH.  Dr Albin: Absolutely. And, and then what about, let's say they have atrial fibrillation, and you know that they have a high CHA2DS2-VASc score, and they are at very high risk of ischemic events, but they've also had a prior intracerebral hemorrhage. Walk us through a little bit, how should we approach that patient? Dr. Ziai, I'm gonna start with you again.  Dr Ziai: Sure. So again, looking at the MRI, which all patients with ICH should have nowadays. If patients do have these hemorrhagic findings, a lobar ICH, evidence of CSS, cortical superficial siderosis, especially if it's disseminated, and also lobar microbleeds, especially if there are greater than five, if they're multiple, then anticoagulation should really be avoided in those patients.  Dr Albin: Absolutely. So, I'm really hearing that when we have a patient with ICH, it is just critically important that we understand is this a hypertensive bleed or is this a lobar bleed that is probably related to cerebral amyloid angiopathy? And getting to that distinction is going to play a major role in our deciding whether or not the patient can be on DAPT or can be on anticoagulation. And then what are some of the strategies for patients that you're referring them to if they really cannot tolerate being on anticoagulation, but they have atrial fibrillation, and they do need some sort of ischemic stroke prevention?  Dr Shah: There's still a lot of controversy, even in non-lobar hemorrhages, about resuming anticoagulation and when that would be safe. HAF trial, there was a reduction in ischemic stroke recurrence, uh, but a significantly higher increase in hemorrhage recurrences. I think that trial included both deep and lobar hemorrhages. So, we still need more data, and I think the ASPIRE trial and maybe a meta-analysis would answer that eventually. But in the meantime, if a, specifically for lobar hemorrhages, which are, uh, thought to be CAA related, if they, uh, and the patient has AFib, you know, where anticoagulation would be contraindicated, a watchman device or, you know, AFib ablation may be some of the other strategies that can be looked into for those patients specifically.  Dr Albin: Right. I think that's a really important point to emphasize, that we don't just don't give up and say, "Oh, you're not a candidate for anticoagulation," but we really reach out to our cardiovascular friends and say, "Hey, what other procedures can you offer that will minimize the risk of recurrence?" You know, we don't want them to have an ischemic event, but we also know long-term that there would be a real risk of anticoagulation. Just reminder to our listeners that there are new procedures, and our cardiology colleagues are always doing new trials and new devices, and so we should really leverage their expertise here. I am in the final minutes gonna just switch gears a little bit from talking about sort of the nitty-gritty of secondary ischemic prevention and secondary hemorrhagic stroke prevention and thinking about there has been this degree of pessimism around ICH patients, and that, you know, they have a much more severe outcome than our patients with ischemic strokes. I think that that is probably a myth that we need to do some debunking around, and I think maybe we need to reframe in terms of thinking about just the trajectory. So, Dr. Shah, walk us through a little bit about what we can expect about the recovery trajectory in ICH compared to those patients who have an ischemic stroke. Dr Shah: Yes. From some newer data and studies, it is becoming clear that recovery after ICH is much slower than we expect. In general, for ischemic stroke, recovery is measured within the first few weeks to up to 90 days. But in ICH, we now know that patients can keep recovering all the way up to six months and even beyond. In general, from just a, a study of heart recovery that occurs after ischemic stroke, there's a steep recovery in the first seven days, and then sort of after that, patients still continue to recover, but it, it starts plateauing where up to 90 days. Whereas with ICH, there is not much recovery in the first 7 to 30 days, but after that, there is a recovery that occurs significantly between day 30 and day 180, and then some patients continue to recover all the way up to one year. The more severe the hemorrhage, the slower the recovery, but there's still some evidence to suggest that even severe hemorrhage patients can recover all the way up to one year out and beyond. This is, of course, in terms of functional recovery.  Dr Albin: I think that's a really important point for our audience. Many of the listeners are residents, they're fellows, they're seeing these patients in the hospital, and they may not see a whole lot of improvement over even 30 days. But to keep in mind that just because the patient has not had a dramatic recovery within that first month that they may be in the ICU and then on the floor does not mean that that patient will never have recovery, and that we reset our expectations that recovery is possible, it's just gonna be slower. And I think that that's not only important for the healthcare team to take in mind, but also for patients and their families to know there is hope here. It's just gonna be slower. Dr. Ziai, looking ahead, what developments in this are you most excited about that you think will move the needle for care for the long-term outcomes and the prevention for these patients? What's ahead in, in ICH?  Dr Ziai: Yeah, I think the research that's going on is very exciting at the moment. We just saw the presentation at the World Stroke Organization conference in the fall of the TRIDENT trial, Triple therapy prevention of Recurrent intracerebral Disease events, meaning strokes. And these investigators found that a single pill, a fixed dose of three blood pressure-lowering agents actually was successful in significantly reducing the risk of recurrent stroke in patients who have had a history of ICH and have just normal or low-grade hypertension. So rather than having patients on multiple antihypertensive agents, it may be possible to have them on a single pill, and may dramatically reduce their stroke risk. So that's exciting. There is also a trial ongoing, ASPIRING, testing whether antiplatelet monotherapy after 24 hours only can reduce the risk of all serious vascular events in ICH survivors. So very early antiplatelets. The SATURN trial, we didn't talk about statins yet, but it is comparing continuation versus discontinuation of statin therapy in ICH patients. And then we have ongoing epidemiological studies that are really needed to understand this interaction between the cardiovascular prevention strategies, the antithrombotic use, the blood pressure targets, and these high-risk neuroimaging markers for ICH. And I think that's gonna be key, personalizing the interventions for these patients.  Dr Albin: So, I love that. And what I'm hearing is that it's really important to think about the personalized approach as well as how do we simplify things. We know that blood pressure control is critically important to the primary and secondary prevention of ICH, but we have to make it easy for patients to do so. Dr. Shah, I want to end with kind of understanding, you know, this was an unusual topic for neurointensivists to talk about. This was really about prevention. It was about long-term survivorship. It was about not what's happening in the neuro ICU. How did you guys get interested in sort of that aspect of care?  Dr Shah: Yeah, so that's a great question. Dr. Ziai has been my mentor since I was in fellowship, so now about eight years that I've been working with her, and this was a project that I started in fellowship with under her mentorship, looking at long-term recovery in ICH patients, and specifically severe patients. Happy that work has received a lot of recognition. It was published in JAMA Neurology. We looked at patients with severe intracerebral and intraventricular hemorrhage, those that survived with an mRS of four and five at day 30, and what happened to them over the course of the year. There was really not much data on recovery after ICH. And we were very surprised to see that up to 40% of patients that were an mRS of four and five, so really, really severely disabled at day 30, recovered to an mRS of zero to three by one year. About one-third of that group that recovered actually achieved functional independence with an mRS of zero to two, which was very surprising, really breaking the myths around the pessimism with ICH. We found that a lot of the baseline comorbidities like diabetes, white matter disease, as well as what happens to them during the acute hospitalization, were adding all of that information to the severity of the hemorrhage significantly improved our ability to predict long-term recovery after ICH. And so that's kind of how we got interested in this work, looking at how factors in the care that we provide in the ICU, as well as what the patients come in with, how all of that could be modified to promote recovery in these patients that are often been forgotten.  Dr Albin: I think that there's one takeaway to our listeners is that this is really a place where there's a lot of hope for recovery, and that the nihilism that has really surrounded ICH is a thing of the past, and we have to move forward with thinking about how do we proactively impact the recovery and counsel the patients and give them hope. Because just as your research shows, there really is the ability that they can attain that functional independence, which is absolutely astounding. It's really amazing. Again, today I've been interviewing Dr. Wendy Ziai and Dr. Vishank Shah about their article on intracerebral hemorrhage. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Please be sure to check out Continuum Audio episodes from this and other issues. Please go and check out. They have a wonderful article with lots of tables and figures, so much data. And again, thank you to our listeners for joining us today. Thank you, Dr. Ziai and Dr. Shah.  Dr Ziai: Thanks very much.  Dr Shah: 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.

Send us Fan MailOnce we understand that pain is an output of the nervous system, the next question becomes:What do we actually do about it?In Part 2, Matt Bush takes us beyond theory and into practical application, exploring how practitioners can begin integrating neurological principles into rehabilitation and performance. We discuss chronic pain, nociplastic pain, sensory integration, and why the body consistently chooses the movement strategy that feels safest—not necessarily the mechanically ideal one.Matt shares remarkable clinical stories demonstrating how small neurological interventions can create dramatic changes in movement, performance, and pain, while explaining why vision, vestibular function, and proprioception deserve a much larger role in our assessments.We finish with an important discussion about the future of our profession and why embracing applied neurology may represent one of the next major evolutions in rehabilitation and performance.In this episode we discuss:• Nociceptive versus nociplastic pain• Why chronic pain persists after tissues have healed• Pain neuroscience education and athlete confidence• Sensory integration and movement efficiency• How neurological mismatches affect performance• Practical neurological interventions that create immediate change• Why the future of rehabilitation is likely to become increasingly brain-centeredWhether you're a therapist, athletic trainer, strength coach, or movement professional, this episode offers a fresh perspective on helping people move better, recover faster, and perform at a higher level.If you liked this EP, please take the time to rate and comment, share with a friend, and connect with us on social channels IG @Kingopain, TW @BuiltbyScott, LI+FB Scott Livingston. You can find all things LYM at www.LYMLab.com, download your free Life Lab Starter Kit today and get busy living https://lymlab.com/free-lym-lab-starter/Please take the time to visit and connect with our sponsors, they are an essential part of our success:www.ReconditioningHQ.comwww.FreePainGuide.com 

Dr. Justin Abbatemarco talks with Sukhun Kang about seeding trials and other hidden marketing tactics in clinical trials, and their implications for clinical practice and patient care.  Read the related article on The Conversation.  Disclosures can be found at Neurology.org. 

The "Community Meets Clinic" podcast series introduces clinicians and healthcare personnel specializing in rare neuroimmune disorders. In this episode, Krissy Dilger of SRNA spoke with Dr. Ayşe Altıntaş, Professor of Neurology at Koç University School of Medicine in Istanbul, Turkey, which has been designated as a Center of Excellence in Rare Neuroimmune Disorders. Dr. Altıntaş described the unmet needs in rare neuroimmune disorders and noted her role on an international panel developing updated NMOSD diagnostic criteria [00:03:40]. She outlined current research on mechanisms of optic neuritis, pregnancy complications and aquaporin-4 antibodies, and developing accessible biomarkers beyond CSF with a future goal of remote monitoring [00:06:01]. Dr. Altıntaş also explained Koç University's multidisciplinary demyelinating disease center model, emphasizing coordinated consultations, advanced MRI capabilities, shared decision-making, and the value of specialized centers, while expressing hope due to rapid advances in biomarkers and targeted therapies [00:11:43]. You can view the medical profile of Dr. Ayşe Altıntaş here:https://www.kuh.ku.edu.tr/doctors/ayse-altintasAyşe Altıntaş, MD is a professor of neurology at Koç University School of Medicine in Istanbul, Türkiye. She graduated from Ege University Faculty of Medicine in 1986 and completed her neurology residency there in 1992. She received early training in neuroimmunology as a fellow at Mayo Clinic under Prof. Moses Rodriguez and later continued her research at Mayo Clinic with Prof. Claudia Lucchinetti and Prof. Brian Weinshenker, focusing on the animal model, immunopathology, and imaging correlates of multiple sclerosis.Prof. Altıntaş served at Istanbul University Cerrahpaşa School of Medicine for 23 years before joining Koç University in 2018, where she established a neuroimmunology laboratory and continues to lead clinical and translational research. Her work focuses on multiple sclerosis, neuromyelitis optica spectrum disorders (NMOSD) and MOG antibody-associated diseases (MOGAD), with an emphasis on biomarkers and disease mechanisms. She is actively involved in international organizations, including BioMS-eu, The MOG Project, Siegel Rare Neuroimmune Association (SRNA), MEDEN, the MSBase Scientific Leadership Group, and the Guthy-Jackson Charitable Foundation International Scientific Consortium.00:00 Welcome and Guest Intro01:39 Why Neurology03:40 Choosing Rare Disorders06:01 Current Research Projects11:43 Clinic Team and Workflow15:48 Advanced Imaging and Coordination17:20 Self Care and Balance20:20 Advice for New Patients22:17 Hope for the Future24:34 Closing

A World Of Silence: Navigating Infant Hearing Loss & Cochlear Implants The ability to listen is the very first skill we develop in the womb, and it's crucial for cognitive growth. Thankfully, infants born with hearing loss have a few options to keep their development on track. Our experts this week explore the science of pediatric audiology, how to make an early diagnosis, and the cochlear implant journey. Guests:  Dr. Nancy Young, medical director of Audiology and Cochlear Implant Programs, The Ann & Robert H. Lurie Children's Hospital of Chicago, Lillian S. Wells professor in pediatric otolaryngology, Northwestern University Feinberg School of Medicine Eva Tweedy, parent Doug Tweedy, parent   Chronic Disease Is Threatening Your Vision – Here's How To Prevent It Millions of people are currently facing vision loss, and so many more are at risk due to a rise in chronic illnesses. Our experts reveal how common conditions like diabetes threaten our sight, and how proper management can stop this preventable damage in its tracks. Guests:  Jeff Todd, president & CEO, Prevent Blindness Dr. Paul Chan, chair, Department of Ophthalmology & Visual Sciences, University of Illinois Chicago, board member, Prevent Blindness   Facebook: ingoodhealthpodX: @ ingoodhealthpodIG: @ingoodhealthpodYouTube: @ingoodhealthpodSpotify Apple Podcast In Good Health PodcastSubscribed to the newsletterFull ArchiveContact UsBecome an Affiliate Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

A World Of Silence: Navigating Infant Hearing Loss & Cochlear Implants The ability to listen is the very first skill we develop in the womb, and it's crucial for cognitive growth. Thankfully, infants born with hearing loss have a few options to keep their development on track. Our experts this week explore the science of pediatric audiology, how to make an early diagnosis, and the cochlear implant journey. Guests:  Dr. Nancy Young, medical director of Audiology and Cochlear Implant Programs, The Ann & Robert H. Lurie Children's Hospital of Chicago, Lillian S. Wells professor in pediatric otolaryngology, Northwestern University Feinberg School of Medicine Eva Tweedy, parent; Doug Tweedy, parent Host and Producer: Kristen Farrah Facebook: ingoodhealthpodX: @ ingoodhealthpodIG: @ingoodhealthpodYouTube: @ingoodhealthpodSpotify Apple Podcast In Good Health PodcastSubscribed to the newsletterFull ArchiveContact UsBecome an Affiliate Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Links For The Occult Rejectshttps://linktr.ee/theoccultrejectsOccult Research Institutehttps://www.occultresearchinstitute.org/Substackhttps://substack.com/@theoccultrejects?r=7auau0&utm_campaign=profile&utm_medium=profile-pageCash Apphttps://cash.app/$theoccultrejectsVenmo@TheOccultRejectsBuy Me A Coffeebuymeacoffee.com/TheOccultRejectsPatreonhttps://www.patreon.com/TheOccultRejectsAssmann, Jan. Death and Salvation in Ancient Egypt. Translated by David Lorton. Cornell University Press, 2005.Ariès, Philippe. The Hour of Our Death. Translated by Helen Weaver. Knopf, 1981.Beard, Mary, John North, and Simon Price. Religions of Rome. 2 vols. Cambridge University Press, 1998.Blackmore, Susan. Dying to Live: Near-Death Experiences. Prometheus Books, 1993.Boyce, Mary. Zoroastrians: Their Religious Beliefs and Practices. Routledge, 1979.Bremmer, Jan N. The Rise and Fall of the Afterlife: The 1995 Read-Tuckwell Lectures at the University of Bristol. Routledge, 2002.Chalmers, David J. “Facing Up to the Problem of Consciousness.” Journal of Consciousness Studies 2, no. 3 (1995): 200–219.Fenwick, Peter, and Elizabeth Fenwick. The Art of Dying: A Journey to Elsewhere. Continuum, 2008.Graf, Fritz, and Sarah Iles Johnston. Ritual Texts for the Afterlife: Orpheus and the Bacchic Gold Tablets. 2nd ed. Routledge, 2013.Greyson, Bruce. After: A Doctor Explores What Near-Death Experiences Reveal about Life and Beyond. St. Martin's Essentials, 2021.Greyson, Bruce. “The Near-Death Experience Scale: Construction, Reliability, and Validity.” Journal of Nervous and Mental Disease 171, no. 6 (1983): 369–375.Griffiths, Roland R., William A. Richards, Una McCann, and Robert Jesse. “Psilocybin Can Occasion Mystical-Type Experiences Having Substantial and Sustained Personal Meaning and Spiritual Significance.” Psychopharmacology 187, no. 3 (2006): 268–283.Hornung, Erik. The Ancient Egyptian Books of the Afterlife. Translated by David Lorton. Cornell University Press, 1999.Johnston, Sarah Iles. Restless Dead: Encounters between the Living and the Dead in Ancient Greece. University of California Press, 1999.Kerr, Christopher W., et al. “End-of-Life Dreams and Visions: A Longitudinal Study of Hospice Patients' Experiences.” Journal of Palliative Medicine 17, no. 3 (2014): 296–303.Le Goff, Jacques. The Birth of Purgatory. Translated by Arthur Goldhammer. University of Chicago Press, 1984.Moody, Raymond A. Life After Life. Mockingbird Books, 1975.Nahm, Michael, Bruce Greyson, Emily Williams Kelly, and Erlendur Haraldsson. “Terminal Lucidity: A Review and a Case Collection.” Archives of Gerontology and Geriatrics 55, no. 1 (2012): 138–142.Nelson, Kevin R., Michelle Mattingly, Sherman A. Lee, and Frederick A. Schmitt. “Does the Arousal System Contribute to Near Death Experience?” Neurology 66, no. 7 (2006): 1003–1009.Obayashi, Hiroshi, ed. Death and Afterlife: Perspectives of World Religions. Greenwood Press, 1992.Osis, Karlis, and Erlendur Haraldsson. At the Hour of Death. Avon, 1977.Parnia, Sam, et al. “AWAreness during REsuscitation—II: A Multi-Center Study of Consciousness and Awareness in Cardiac Arrest.” Resuscitation 191 (2023).Plato. Phaedo. In Plato: Complete Works. Edited by John M. Cooper. Hackett, 1997.Segal, Alan F. Life After Death: A History of the Afterlife in Western Religion. Doubleday, 2004.Stevenson, Ian. Children Who Remember Previous Lives: A Question of Reincarnation. Rev. ed. McFarland, 2001.Taylor, John H., ed. Journey through the Afterlife: Ancient Egyptian Book of the Dead. Harvard University Press / British Museum Press, 2010.Tucker, Jim B. Life Before Life: A Scientific Investigation of Children's Memories of Previous Lives. St. Martin's Press, 2005.van Gennep, Arnold. The Rites of Passage. Translated by Monika B. Vizedom and Gabrielle L. Caffee. University of Chicago Press, 1960.van Lommel, Pim, Ruud van Wees, Vincent Meyers, and Ingrid Elfferich. “Near-Death Experience in Survivors of Cardiac Arrest: A Prospective Study in the Netherlands.” The Lancet 358, no. 9298 (2001): 2039–2045.Xu, Gang, et al. “Surge of Neurophysiological Coupling and Connectivity of Gamma Oscillations in the Dying Human Brain.” Proceedings of the National Academy of Sciences 120, no. 19 (2023).Also want to remind people about the website, if you're into reading we have tons of information by multiple contributors, and we got t-shirts up on the site if you're interested. Fun fact, the art is all based on the eyeball. 

To celebrate 75 years of Neurology®, Dr. Chris Boes and Dr. José Merino discuss the journal's history, its evolution, and what lies ahead for the future of Neurology®.   Read more about the first 75 years of Neurology®.   

Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice.In this Mind Moments episode, Daniel Ontaneda, MD, PhD, professor of neurology at the Cleveland Clinic Mellen Center for Multiple Sclerosis, discusses a recently published study in Neurology evaluating the application of the 2024 McDonald Criteria in individuals with nonspecific neurologic symptoms or incidental MRI findings. Using data from the CAHPS-MS study, Ontaneda explains how the revised diagnostic criteria perform in these previously understudied patient populations and what the findings may mean for earlier identification of multiple sclerosis. The conversation explores the rationale behind expanding the 2024 McDonald Criteria, the role of central vein sign and cerebrospinal fluid oligoclonal bands in improving diagnostic confidence, and how clinicians should approach patients who fall into a diagnostic gray zone. Ontaneda also discusses the practical application of the updated criteria, the importance of longitudinal follow-up, and how emerging biomarkers may continue to refine MS diagnosis in the years ahead.  Looking for more Multiple sclerosis & demyelinating disorders discussion? Check out the NeurologyLive® Multiple sclerosis & demyelinating disorders clinical focus page.Episode Breakdown: 1:15 – Why the 2024 McDonald Criteria expanded diagnostic eligibility 4:30 – Applying the criteria in nonspecific symptom presentations 6:20 – Clinical relevance of symptom patterns and MRI findings 8:40 – Using biomarkers to improve diagnostic confidence 11:25 – Neurology News Minute  13:55– Interpreting dissemination in time with updated criteria 15:45 – Future validation of emerging MS diagnostic biomarkers The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: FDA Advisory Committee Schedules Meeting to Review Deramiocel's BLA in Duchenne Muscular Dystrophy FDA Clears PoNS Device for Stroke Rehabilitation, Expanding Neurostimulation Beyond MS Indication FDA Accepts Sarepta's sNDAs for Casimersen and Golodirsen for Duchenne Muscular Dystrophy Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

To celebrate 75 years of Neurology®, Dr. Chris Boes talks with Dr. José Merino about the journal's history, its evolution, and what lies ahead for the future of Neurology®.  Read more about the first 75 years of Neurology®.  Disclosures can be found at Neurology.org. 

Send us Fan MailWhat if pain isn't simply the result of damaged tissue?What if movement quality, performance, and rehabilitation are driven by something far more complex than muscles and joints?In Part 1 of this conversation, I sit down with performance therapist and educator Matt Bush to explore the neurological foundations of pain, threat, and movement. Together, we unpack why the brain constantly interprets information from our visual, vestibular, and proprioceptive systems to determine whether movement is safe—and why that process has profound implications for every therapist, coach, and performance practitioner.Along the way, we discuss why manual therapy is already influencing the nervous system whether we recognize it or not, how previous injuries and life experiences shape pain sensitivity, the role of sensory weighting in chronic tendinopathy, and why understanding the nervous system fundamentally changes the way we assess and treat our athletes.If you've ever wondered why two people with the same injury can have completely different outcomes, this conversation will challenge the way you think about rehabilitation.In this episode, we discuss:• Why the nervous system predicts rather than reacts• The brain's threat detection and salience networks• Why pain is a protective output—not simply a tissue problem• Sensory weighting and its role in persistent knee pain• How previous experiences influence pain sensitivity• Why therapists are already practicing neurology every dayThis is Part 1 of a two-part conversation that explores the future of rehabilitation and performance through the lens of neuroscience.If you liked this EP, please take the time to rate and comment, share with a friend, and connect with us on social channels IG @Kingopain, TW @BuiltbyScott, LI+FB Scott Livingston. You can find all things LYM at www.LYMLab.com, download your free Life Lab Starter Kit today and get busy living https://lymlab.com/free-lym-lab-starter/Please take the time to visit and connect with our sponsors, they are an essential part of our success:www.ReconditioningHQ.comwww.FreePainGuide.com 

Stroke in children and younger adults differs significantly from adult stroke, with varied presentations and a broader range of underlying causes such as congenital heart disease and arteriopathies. This episode highlights key diagnostic considerations and evolving approaches to treatment in these younger populations. In this episode, Aaron L. Berkowitz, MD, PhD, FAAN, speaks with Thalia S. Field, MD, FRCPC, MHSc, coauthor of the article "Stroke in Children and Younger Adults" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology in the Department of Neurology at the University of California, San Francisco, in San Francisco, California. Dr. Field is a professor at the University of British Columbia and the Sauder Family Heart and Stroke Professor of Stroke Research, and a stroke neurologist at the Vancouver Stroke Program, Vancouver Coastal Health in Vancouver, British Columbia, Canada. Additional Resources Read the article: Stroke in Children and Younger Adults Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz Full episode transcript available here Dr Berkowitz: Most neurologists are used to evaluating and treating adults with stroke since it's one of the most common neurologic conditions. But stroke can also occur in children, in infants, and even in utero. Today, I have the privilege of interviewing Dr. Thalia Field to talk about pediatric stroke.  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. Thalia Field about her article on stroke in children and younger adults. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast, Dr. Field, and could you please introduce yourself to our audience?  Dr Field: Well, thanks so much. It's a pleasure to, uh, be speaking to you. I'm a stroke neurologist, and I treat adults generally. My wonderful colleague, Thivya Selvanathan, who's a neonatal neurologist, co-wrote the chapter with me. We do, unfortunately, have to treat some children with stroke collaboratively and I do advise on those cases. My practice is about one-quarter clinical, so I treat patients with acute stroke, look after them on the wards, see patients in stroke prevention clinic, and the rest of my time is mainly research and some administrative work and teaching. I run the clinical trials program for the Vancouver Stroke Program, and I do research of my own, mainly focused on stroke in younger adults. We previously did a trial and registry on cerebral venous thrombosis, and more recently, I've been running a national study looking at brain health in adults and children with congenital heart disease.  Dr Berkowitz: Fantastic. Wow, that is a lot that you do, and we'll look forward to the results of some of those studies. So, when adults suffer a stroke, they typically present with sudden onset focal neurologic deficits, very common scenario we're consulted on.  And one thing you and your colleague talk about in the article is that strokes can present differently in infants and in young children. Can you talk a little bit about the differing clinical presentations of stroke in the youngest young as compared to our usual experience treating the older adults?  Dr Field: Sure. So, you know, speaking about this as someone who doesn't see the children directly but has had the opportunity to discuss these patients with my colleagues and, like we all do, learn about it during our training, I think one of the distinctions, especially with neonates, is that it's generally not a presentation with focal neurologic deficits. Often these babies will have seizures or encephalopathy as their main presentation, and sometimes we're only finding out after the fact if they're presenting with developmental delay or early preference for handedness and hypotonia, things like that. So, in very young children, that's a distinction. And in older children, there can be sudden onset deficits and, and unfortunately, sometimes these are mistaken for other conditions that are more common in children, like seizures. But sometimes you can have a more indolent course, say, with something like a focal cerebral arteriopathy or something like that. So, it depends on the scenario, but the big difference primarily is in neonates, as far as I understand.  Dr Berkowitz: Perfect. That's very helpful. So as an adult neurologist, when I think about causes of stroke or teach sort of the categories of causes of stroke to our residents and students, when we think about the evaluation of stroke, I divide them broadly into causes related to the heart, causes related to the blood vessels, and causes related to the blood with, in the adult world, the most common things, of course, being atrial fibrillation for the heart, atherosclerosis for the blood vessels, and then risk factors for atherosclerosis in the blood, diabetes, hyperlipidemia, very rarely picking up a hypercoagulable disorder in the blood column. And reading your article, it seems that, correct me if I'm wrong, stroke in young adults, stroke in the pediatric population can basically be organized into those same broad categories, heart, blood vessels, and blood, just that there's many more conditions on the differential diagnosis that you would consider in young adults to begin with and then children and then neonates as we get into the younger and younger population. So, I'd like to talk about each of these sort of buckets of etiology in turn and ask you about some of the causes we would consider in young adults and children in each of these, and then as they come up, probably ask you more questions about how frequently we find these sorts of things, how frequently they're the cause of stroke treatment, et cetera. So, let's start with the heart. As I said, in adults, we're mostly looking for rhythm disorders, right, atrial fibrillation. Sometimes we'll pick up a patent foramen ovale or PFO or other structural abnormalities, but mostly we're thinking about atrial fibrillation. But reading your paper, I was struck by the huge variety of conditions that you might be looking for in the heart in children or infants with stroke. So, can you tell us a little more about cardiac etiologies of stroke in the young?  Dr Field: Yeah. So, I'd say unlike in older adults, where it tends more often to be a rhythm disorder, in children and adults who are younger, it's primarily a structural cause, and congenital heart disease being the most common. And it changes a little bit from younger adults shifting downwards in age to younger children in terms of the fact that often if we're seeing an adult with stroke related to congenital heart disease, it can be a paradoxical embolism from a previously undiagnosed PFO. Not in all cases, but fortunately this is improving over time. You know, generally people with diagnoses of more severe congenital heart disease are followed up from childhood and people are aware of the diagnosis, and hopefully they're being managed and watched for things like premature arrhythmias or depressed heart function or other things that can develop and require their own distinct antithrombotic management, for example. In young children, however, more severe causes of congenital heart disease tend to more frequently be associated with stroke. And in many cases, those strokes can be early on in life or associated, say, with perioperative complications or other iatrogenic-related causes in, in that way. Again, congenital heart disease can be associated with stroke at, at any point in the life course. But as adult neurologists, most frequently we're seeing very simple lesions like PFO with large shunts, and in children, it tends to be the more complex causes of congenital heart disease.  Dr Berkowitz: Got it. So, let's move on to the blood vessels. Again, in adults, we're usually thinking about atherosclerotic disease, be that of the cervical arteries or of the intracranial arteries. But in your paper, a lot of discussion about the various vasculopathies, arteriopathies that can be cause of stroke in younger adults and in children. Could you talk a little bit more about some of the vasculopathies and vascular conditions that are causes of stroke in the younger population?  Dr Field: Sure. Before I do that, I will say that especially in older younger adults, particularly over the age of thirty-five, and you know, kind of makes me shudder that that's an older younger adult. But, um, in, in any case, certainly conventional vascular risk factors are more common in this population with stroke, especially in those who don't have PFO-associated stroke. Like conventional atherosclerosis, you know, certainly is a cause of stroke in younger adults. But that being said, certainly other vascular causes and vasculopathy in particular is a much more common cause of stroke in younger adults and, and children than it is in older adults. In particular, dissection is an extremely common cause of stroke in younger adults. Generally cervical artery dissection from non-inflammatory vasculopathy, usually on, sometimes on the FMD fibromuscular dysplasia spectrum and, and sometimes, you know, provoked by minor trauma or something post-infectious that may make the vessels a little bit more susceptible. And in younger children, this inflammatory focal cerebral arteriopathy is a distinct cause that is a common cause of stroke in, in young children. There are other causes that can affect the blood vessels, you know, rarer things like vasculitis and vasculopathies that can develop in the context, say, of sickle cell anemia. But in general, as a bucket, vessels are still very important, but the pathology tends to shift.  Dr Berkowitz: Got it. And you, um, alluded to a point that I wanted to ask you about. You mentioned the sort of, there's stroke in the young, and then where do you draw the line at young? Less than sixty, less than thirty-five, and then we've also talked about strokes as young as before the age of birth. Yeah, I'm remembering, is it the Helsinki study, one of the early large series of stroke in younger individuals? I think that, was it eighteen to forty-nine in that or fifty-nine? I don't remember the exact age, but being struck reading that paper as a resident and thinking about the workup for exotic causes we do, right, and when a young patient has a stroke. And correct me if I'm wrong, the most common etiologies of stroke in that series, and I'm curious the other large series yourself have been involved with, have still been vascular risk factors and arrhythmias and things that we, even common, quote unquote, common things in the young, such as dissection or hypercoagulable states. Uh, the things that we sort of tend to think about first are actually less common. But acknowledging that that paper has folks up to the late forties when the vascular risk factors may be, um, unfortunately kicking in earlier, uh, and earlier due to dietary and lifestyle factors. So is that true, or do you have sort of an age cutoff when it's, we say stroke in the young, people sort of think, "Oh, they'd work someone up differently if they're less than sixty, and they have no vascular risk factors or few vascular risk factors." When do we start getting into the kind of younger population where atherosclerosis and cardiac arrhythmias are not number one and two?  Dr Field: I'd say first of all, you and I must have trained around the same time because I was also in my training, really struck by the results of the Helsinki study going, "Wow, I, I really didn't know how much of a role these conventional vascular risk factors still play." And I think we're seeing that information reiterated, unfortunately, like even with higher prevalences and more attributable risk in some of the newer series. There are newer European series looking at stroke in younger adults, and more recently, there's been one that we mentioned in the article from the Florida Stroke Registry. And it's true that generally the burden is in the older younger adults. But what I would say overall in terms of kind of how things guide the workup, you need to look at the patient and consider things. I mean, obviously you don't want to miss things that can be treated differently and identified by tests easily. You know, things like ruling out syphilis or antiphospholipid antibody disease in, in younger patients. You really want to make sure that that's not something that, that you'd miss because, you know, obviously your treatment is going to change. However, certainly we start with the basics for stroke workup in any patient that's coming in. At my center, CT angiography. Some centers it may be MR angiography and echocardiography. We take a careful history. We look at the blood work. We look at the vascular risk factor burden. We find out if there's kind of any worrisome personal history, family history, look at their general health context. I think that really helps to guide how far we go in a particular workup, and it also helps to direct the other investigations and types of follow-up we need to do. For example, if a patient has a fairly suspicious story for dissection, let's say they're getting over a cold, and they went to the gym, and, you know, there was a sudden movement that they did that really produced headache and neck pain, and there's an obvious cervical artery dissection. I'm not going to go too far down testing them for rare infections and doing advanced cardiac imaging unless something shows up on their initial echo, for example. But I will make an effort to do more detailed vascular imaging of the rest of their body, find out careful family history. If there's additional manifestations of a non-inflammatory vasculopathy elsewhere, say consider sending them to medical genetics, or obviously, if this is, you know, a second event, your flags raise even more. So, it really depends on the patient. If I find out that there's, you know, a family history of premature cardiac disease and things like that, you know, obviously we're gonna be keeping a close eye on their cholesterol, making sure that we're not identifying, for example, familial hypercholesterolemia, which is, you know, something that comes up not infrequently where we'll see an LDL in an untreated patient of more than five. I apologize, you're gonna have to do the conversion to American units on that. But there are things we identify and, you know, again, you don't want to fall solely on heuristics and your preconceived notion of, of the patient. You do have to consider the results of the investigations that you do order. But I think you can certainly be mindful in terms of how you direct your workup and in turn, how you direct your follow-up.  Dr Berkowitz: That's great to hear your approach. Yeah, as you said, our approach always begins with the same, coming back to these three categories, right? Doing some type of structural imaging of the heart, rhythm monitoring for the heart, and then vascular imaging of the head and neck. And then I was going to ask you, and you sort of began to answer this question. Yeah. What's next and how far do you go? I think most people think the expanded stroke workup in the young is at a minimum, a TEE if there's been no signal thus far on the original workup. I just mentioned and you spoke about, and then probably hypercoagulable testing and only sending arterial side if there's no shunt and venous and arterial side if there's a shunt. Is that your second pass approach or did I miss anything, or are there other nuances there that are helpful to discuss?  Dr Field: No, I think that's generally in keeping with what I do. I think with TEE being very important. I mean, the first pass are arterial stuff. Really, it's antiphospholipid antibodies and, and making sure there's no cancer. Like you said, only if there's a shunt do I pursue other venous hypercoagulability testing. Again, you [chuckles] kind of reiterate, go through with the history, make sure there's kind of no red flags. And sometimes, obviously, you do your best reasonable job with the first pass workup, and you will find out when someone presents with a second event that it's something very unexpected. Maybe first manifestation, someone with no obvious history and very initially normal-looking imaging, say with, with CATASL or something like Fabry's disease or something where you would consider it if there was kind of a more classical picture. But it wouldn't be something you would do kind of on your first or even second pass workup in the absence of any sort of clinical suspicion, family history, or something along those lines.  Dr Berkowitz: I'm curious just as far as rough percentage. I feel like many of these patients we see it's a patient who's young and who's had a stroke, and the initial first pass has been unremarkable, and we do our TEE, and we do our hypercoagulable workup. Again, antiphospholipid antibodies only if it's-- there's no shunt. And if there's a shunt, adding on some of the venous hypercoagulability protein C, protein S, factor five, Leiden, et cetera. A lot of the times I feel like we don't find anything. What's your sort of general gestalt? Again, as a general neurologist who does a lot of inpatient neurology, I feel like when these cases come up, it's not that common that you say, "Oh, I actually diagnosed protein S deficiency." Or every once in a while, diagnose an antiphospholipid antibody, or you'll find a PFO on TEE. You didn't find on TT. I've maybe found one fibroelastoma in many years. How often do you find something? How often is it just as an adult a cryptogenic stroke in a young adult or child?  Dr Field: So much of what we see is PFO-related, dissection-related, conventional vascular risk factor-related. We do send referrals to medical genetics. Sometimes we'll do testing for rare things like Fabry's or consider other diagnoses. But I mean, those tend to be the exceptions. About one in four to one in five young adults with stroke end up with this cryptogenic label. I like to keep them on my radar for a few reasons. I think, one, it produces tremendous anxiety for them to not have a cause of stroke identified and just to kind of have a generic approach to secondary prevention. So, I think just to kind of keep an eye on them, manage their anxieties each year, make sure there's kind of no updates in, in terms of general secondary preventionAnd sometimes just things dawn on you later or there are new conditions, say things like, you know, DADA2, this, you know, adenosine deaminase deficiency. You know, there are new diagnoses that, that come on the radar. And sometimes treatments change. You know, for example, when I was starting my early career, the evidence hadn't yet been in place for PFO closure, and then all of a sudden, the paradigm completely changed. And you want to make sure that you can get in touch with those patients to reconsider your approach at the time. So I realize that not everybody has the luxury of extended follow-up with their patients, but I think often you can kind of encourage them or their healthcare team or just, you know, patient themselves to keep in touch periodically just to make sure that there haven't been any changes in treatment paradigms or just with your own awareness of particular, you know, diagnoses or, or just kind of readdressing the situation, uh, a year after and seeing if there's anything that may have occurred to you in the interim.  Dr Berkowitz: Perfect. Really illuminating to hear your approach to these challenging cases. And as you said here and then a couple of times, I think, in this interview is in many of these cases it's your first pass, maybe even your second pass, you haven't found anything. And the key is, unfortunately, as distressing as it may be for the patient as well as for us to not have an answer, to just keep following these patients. And sometimes you really can't sort it out until something else happens, either neurologically or systemically, where you say, "Oh, that's what this was." But there would've been no way to know it from the first presentation. So, we've talked a lot about the diagnosis of causes of stroke in younger adults and children. And in the last minute or two here, I just wanted to talk a little bit about treatment. You mentioned early on that you're involved in thrombectomy cases in children. What's the state of evidence or at least state of practice in terms of offering therapies like thrombolysis and thrombectomy in our patient population? I guess it would be under 18, right, who is not studied in the major trials. Do we have evidence and, or in the absence of evidence, what's sort of the, the expert guidance on treating young adults under 18 and children with some of these acute therapies?  Dr Field: So, trying to keep up with the literature on this. You know, certainly the evidence has been more established in a small trial and pediatric registries for use of tPA, tissue plasminogen activator, in children just because, you know, it's been around much longer. In terms of tenecteplase, which I, I really think signifies a, a practice shift in adult stroke because of its, you know, non-inferior efficacy and ease of use and potentially better rates of recanalization over time. In children, to my knowledge, that evidence base is, is limited to case series and anecdotal shifts in availability of drug and, and different practices. So, the evidence base is not particularly strong for tenecteplase in children who are identified within a reasonable amount of time who are still otherwise candidates for thrombolysis, you know, thrombolysis in children. Children who are a little bit older, I think, can't remember the exact age, but generally very young, like neonates, children who are under the age of two, I believe. I would want to double-check that thrombolysis is less commonly used and just because the safety has not really been that well-established. And for thrombectomy, it's now recommended to use thrombectomy in otherwise eligible children in the newest AHA guidelines. It gets a little bit more controversial in very young children. Under the age of six, there's less of an evidence base and, and often it will depend on people's level of comfort in terms of the size of the arteries. It's my understanding that once you get to about age six, the artery diameter is similar to that in fully grown people. But in younger children, I think just because of the catheters, there can be risk of, of injury. So, it's more of a case-by-case conversation with your interventionalist for younger children. And again, the evidence to intervene is not there for very, very young babies, for example.  Dr Berkowitz: That's very helpful to hear the current state of the evidence and the current state of practice, acknowledging, of course, there's not that much evidence, and these are relatively uncommon occurrences, fortunately, for children, but making it challenging for practitioners and practices may, um, vary based on different institutional protocols. So again, today I've been interviewing Dr. Thalia Field about her article on stroke in children and younger adults. This article appears in the June 2026 Continuum issue on cerebrovascular disease. 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 the third part of this series, Dr. Halley Alexander explores emerging trends and recent advances in epilepsy.  Show citation:  Tolchin B, Goldstein LH, Reuber M, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. doi:10.1212/WNL.0000000000214466  Hingray C, Popkirov S, Kozlowska K, et al. Functional/dissociative seizures: Proposal for a new diagnostic label and definition by the ILAE task force. Epilepsia. 2025;66(11):4162-4182. doi:10.1111/epi.18574 Krauss GL, Elizebath R, Wheless SSJW, et al. Phase III Trial of EpiWatch for Tonic-Clonic Seizure Detection in Children and Adults. Neurology. 2026;2 (2) e000111. doi:10.1212/WN9.0000000000000111 

In the third part of this series, Dr. Halley Alexander explores emerging trends and recent advances in epilepsy.  Show citation:  Tolchin B, Goldstein LH, Reuber M, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. doi:10.1212/WNL.0000000000214466  Hingray C, Popkirov S, Kozlowska K, et al. Functional/dissociative seizures: Proposal for a new diagnostic label and definition by the ILAE task force. Epilepsia. 2025;66(11):4162-4182. doi:10.1111/epi.18574 Krauss GL, Elizebath R, Wheless SSJW, et al. Phase III Trial of EpiWatch for Tonic-Clonic Seizure Detection in Children and Adults. Neurology. 2026;2 (2) e000111. doi:10.1212/WN9.0000000000000111 

Dr. Dara Albert talks with Dr. Scott Perry about improving the transition from pediatric to adult epilepsy care.  Read the related article in Neurology® Clinical Practice.   Disclosures can be found at Neurology.org. 

Neurology care is in high demand, but long waitlists and specialist shortages continue to delay access for millions of patients. In this episode, Elizabeth Burstein, CEO and Co-founder of Neura Health, shares how her personal experience with delayed neurological care inspired a more accessible, technology-enabled care model. She explains how Neura Health supports patients with chronic neurological conditions while helping neurologists and care teams work more efficiently. Liz discusses how AI, workflow automation, clinical decision support, and neurological data can expand specialist capacity and reduce administrative burden. She also explores how these innovations can improve access to high-quality neurological care. Tune in to learn how technology-enabled neurology care is helping make specialists more accessible without replacing the human side of medicine. Resources: Connect with and follow Elizabeth Burstein on LinkedIn.  Follow Neura Health on LinkedIn and explore their website. Reach out to Liz at Liz@NeuraHealth.co

Dr. GG deFiebre of SRNA spoke with Dr. Michael Levy and Dr. Benjamin Greenberg about CAR-T therapy for aquaporin-4-positive NMOSD. They described why targeting B cells may reduce aquaporin-4 antibodies over time and could enable long-term remission or reduced need for ongoing drugs [01:37]. The physicians outlined an autologous Phase 1 study at Mass General and UT Southwestern [07:02]. They discussed eligibility rationale and how lessons from this NMOSD-focused trial could inform future neuroimmune disorder research [09:10]. You can find more information about the trial here:https://clinicaltrials.gov/study/NCT07573332?cond=NMOSD&intr=CAR-T&viewType=Card&rank=1Benjamin M. Greenberg, MD, MHS is a Professor and the Cain Denius Scholar in Mobility Disorders in the Department of Neurology [https://utswmed.org/why-utsw/departments/neurology/] at UT Southwestern Medical Center in Dallas, Texas. He currently serves as the Vice Chair of Translational Research and Strategic Initiatives for the Department of Neurology. He is also the interim Director of the Multiple Sclerosis Center [https://utswmed.org/locations/aston/multiple-sclerosis-and-neuroimmunology-clinic/] and the Director of the Neurosciences Clinical Research Center. In addition, he serves as Director of the Transverse Myelitis and Neuromyelitis Optica Program and the Pediatric Demyelinating Disease Program [https://www.childrens.com/specialties-services/specialty-centers-and-programs/neurology/demyelinating-disease-program] at Children's Medical Center.Dr. Greenberg earned his medical degree at Baylor College of Medicine before completing an internal medicine internship at Chicago's Rush Presbyterian-St. Luke's Medical Center. He performed his neurology residency at the Johns Hopkins School of Medicine. He also holds an M.H.S. in molecular microbiology and immunology from the Bloomberg School of Public Health, as well as a bachelor's degree in the history of medicine – both from Johns Hopkins. Prior to his recruitment to UT Southwestern in 2009, Dr. Greenberg was on the faculty of the Johns Hopkins Division of Neuroimmunology, serving as the Director of the Encephalitis Center and Co-Director of the nation's first dedicated Transverse Myelitis Center.Dr. Greenberg splits his clinical time between adult and pediatric patients at William P. Clements Jr. and Zale Lipshy University Hospitals, Parkland, and Children's Medical Center. His research focuses on better diagnosing, prognosticating, and treating demyelinating diseases and nervous system infections. He also coordinates clinical trials to evaluate new treatments to prevent neurologic damage and restore function to affected patients. Michael Levy, MD, PhD is a recognized neurologist with over 15 years of clinical and research expertise in rare neuroimmunological disorders. He established the Neuroimmunology Clinic and Research Laboratory at Massachusetts General Hospital and is the Research Director in the Division of Neuroimmunology and Neuroinfectious Disease. Previously, Dr. Levy was on the faculty at Johns Hopkins University and was the founding Director of their Neuromyelitis Optica Clinic. Clinically, Dr. Levy cares for patients with MOG antibody disease (MOGAD), neuromyelitis optica spectrum disorder (NMOSD), and idiopathic transverse myelitis (TM). Dr. Levy is also the principal investigator (PI) on numerous patient studies and drug trials for new and improved treatments for these disorders. In 2022, Dr. Levy became the lead principal investigator for the two worldwide clinical trials in MOG antibody disease. In the lab, Dr. Levy's research focuses on the development of animal models of NMO and MOG with the goal of tolerization as a sustainable long-term treatment. Dr. Levy has more than 200 peer-reviewed research articles, reviews and editorials, and 3 patents covering NMO tolerization therapy, TM diagnostics, and stem cell regeneration approaches.

Did you know doctors are paid systematically less for procedures on female anatomy? (For example, 45% more to biopsy a penis than a vagina). This shocking reality, highlighted by creator René Jay @bornwithadarktan and Dr. Kemi Doll's book A Terrible Strength, is a baked-in structural issue.In this episode of Our Womanity, host Dr. Rachel Pope sits down with urogynecologist Dr. Jocelyn Fitzgerald—the lead researcher behind the landmark study "Price and Prejudice"—to dismantle the financial architecture failing female patients and their specialists.Dr. Jocelyn Fitzgerald, MD is a board-certified urogynecologist and reconstructive pelvic surgeon at UPMC Magee-Womens Hospital in Pittsburgh, and an assistant professor at the University of Pittsburgh. Her clinical work and research span chronic pelvic pain, female sexual dysfunction, pelvic floor disorders, and genitourinary syndrome of menopause. She is a prominent advocate for equity in women's healthcare, famously publishing research detailing the surgical reimbursement inequities embedded within female anatomy billing.Key Conversation Highlights: The RVU Trap: How the Relative Value Unit (RVU) billing system systematically devalues the female body, gynecologic surgery, and non-surgical menopause visits. "Moms of Medicine" Dilemma: Why society expects OBGYNs to constantly absorb uncompensated emotional labor and primary care duties, diluting their specialized surgical value. The Workforce Crisis: Why post-op "ghost towns" and devalued billing are driving a massive OBGYN shortage, with only six states projected to have adequate care by 2040. Beyond "Lady Stuff": Why menopause is a systemic transition overlapping with cardiology, rheumatology, and neurology, demanding interdisciplinary research. The Allderdice Connection: A fun look back at Rachel and Jocelyn's shared feminist upbringing at Taylor Allderdice High School in Squirrel Hill, Pittsburgh."In medicine, if we don't study it and we don't name it, it's not there. It's just treated as 'lady stuff.'" — Dr. Jocelyn FitzgeraldConnect & Listen:Subscribe to Our Womanity on Apple Podcasts or Spotify, and follow Dr. Rachel Pope on Instagram: @DrRachelPope for daily midlife wellness tips!The Study: Price and Prejudice: Reimbursement of Surgical Care on Male Versus Female Anatomies by Madeline Penn, Donessa Colley, Pratistha Koirala, Dr. Louise King, and Dr. Jocelyn Fitzgerald.

Send us Fan MailMany people living with migraines say they can "feel a storm coming" before an attack. But is there scientific evidence that environmental exposures can influence migraine risk?In this episode of Causes or Cures, Dr. Eeks talks with Professor Gal Ifergane, neurologist and headache specialist, about his research on migraines and the environment. The conversation explores how air pollution, heat, solar radiation, and weather conditions may help lower the threshold for migraine attacks in people who are already susceptible.Professor Ifergane explains why migraine is often considered a threshold disorder, where genetics, biology, and environmental exposures may all interact to influence when an attack occurs.In this episode, you'll learn:• Can air pollution trigger migraines?• Are weather-related migraines real?• Can heat, sunlight, or solar radiation increase migraine risk?• How researchers study environmental migraine triggers• Why some people may be more sensitive to environmental exposures than others• What these findings could mean for migraine preventionIf you've ever wondered whether your surroundings—not just your brain—could influence migraine attacks, this episode explores what the current science says.About Professor Gal Ifergane:Professor Gal Ifergane is a neurologist, headache specialist, and clinical researcher who serves as Head of the Neurology Department and Chair of the Brain Medicine Division at Soroka Medical Center in Be'er Sheva, Israel. He is also a faculty member at Ben-Gurion University of the Negev.His research focuses on migraine, headache disorders, stroke, post-traumatic stress disorder (PTSD), and the effects of environmental exposures on neurological health. His work examines how factors such as air pollution, heat, and weather conditions may influence migraine risk and severity, with the goal of improving prevention and treatment for people living with migraine and other neurological disorders.Work with me? Perhaps we are a good match. Keep Causes or Cures Ad-Free with Listener SupportYou can contact Dr. Eeks at bloomingwellness.com.Follow Eeks on Instagram here.Follow on X. Or Facebook here.On Youtube.Or TikTok.SUBSCRIBE to her Newsletter here! (the bits not posted on socia media)Support the show

In this episode, Alisha returns to the podcast and joins me as we speak with my producer, Tony, to answer questions from the listeners. We discuss: Can trigger point release cause damage Protective tension and muscle guarding What you need to know about muscle tone Inhibiting pain during recovery Movement visualization Acupuncture, vertigo, and inflammation How to add applied neurology to your practice Cross-body pain patterns Diet and learning what works for you Having kids and running a business And more... Thank you to my podcast idea man and coach, Tony Fowler (Instagram: @tone_reverie) for helping me put together this episode! Free Resources: Join our mailing list HERE to stay up to date on the latest updates from Kruse Elite Join our free Cranial Nerve Masterclass here to get a taste of how neurology impacts your movement and pain issues Subscribe to our YouTube HERE for in-depth educational videos and tutorials Whenever you're ready here's how we can help you: Become an expert in problem solving movement and pain issues with our beginner neuro course, Neuro Foundations Master applied neurology so you can feel confident you can help anyone who walks through your door by joining our advanced neuro course, The Neuro Dojo

Dr. Greg Cooper talks with Dr. Elisabeth Kurpershoek about how clinicians communicate uncertainty during Parkinson disease diagnosis and how this impacts patient trust and understanding.  Read the related article in Neurology® Clinical Practice. Disclosures can be found at Neurology.org.  

Dr. Katie Krulisky and Dr. Marcus Pinto discuss the diagnosis and management of hereditary ATTR amyloidosis. Show citation:  Panrudkevich AH, Jones FJS, Shouman K, et al. Sensitivity of Nerve and Skin Biopsy and Fat Aspirate for Amyloid in Symptomatic Hereditary ATTR Amyloidosis With Peripheral Neuropathy. Neurology. 2026;106(11):e218033. doi:10.1212/WNL.0000000000218033 

In this episode, we explore what essential tremor is, how it differs from Parkinson's disease, and why understanding that distinction can provide reassurance to millions of patients and their families. Featuring Dr. Nima Beheshti, DO, a neurologist specializing in movement disorders, we discuss the clinical diagnosis of essential tremor, its symptoms, and when to seek medical care.#EssentialTremor#Neurology#MovementDisorders#BrainHealth#SalinasValleyHealth  Learn more about neurologist Dr. Nima Beheshti 

The July 2026 Recall features four previously posted episodes related to updates in epilepsy. The episode opens with Dr. Rosemary Dray-Spira discussing trends in prenatal exposure to antiseizure medications over the past decade. The episode continues with Dr. Page Pennell discussing antiseizure medication management during pregnancy and postpartum. The episode then transitions into a conversation with Dr. Matthew Ryan Woodward on the complexities of status epilepticus, focusing on its definitions, the transition to refractory and super-refractory states, and the implications for treatment. In the final episode, Dr. Stefano Meletti discusses the incidence and characteristics of postictal central apnea in focal seizures.  Podcast links:  Trends in Prenatal Exposure to Antiseizure Medications  Antiseizure Medication Dosing Strategy During Pregnancy and Early Postpartum in Women With Epilepsy in MONEAD  Super Refractory Status Epilepticus Diagnosis, Management, and Prognostication  Persistent Postictal Central Apnea in Focal Seizures  Article links:  Trends in Prenatal Exposure to Antiseizure Medications Over the Past Decade A Nationwide Study  Antiseizure Medication Dosing Strategy During Pregnancy and Early Postpartum in Women With Epilepsy in MONEAD   Super-Refractory Status Epilepticus Diagnosis, Management, and Prognostication  Persistent Postictal Central Apnea in Focal Seizures  Disclosures can be found at Neurology.org.  

“Accommodation” is a loaded word. On one hand, we want to provide reasonable accommodations in K-12 so kids can access their education.But determining what is “reasonable” accommodation or modification can be messy.Both parents and educators can unintentionally “overaccommodate” in the moment without realizing it, which over time can impede a child's ability to work through daily challenges and solve problems on their own. This can be in the context of adding too many “cookie-cutter” accommodations on a 504 Plan or IEP, or it can be unofficial accommodations in the way we interact with kids. My colleagues who work on college campuses are seeing the impact of this “overhelping” in K-12. And it's not just kids with neurodevelopmental disorders. It's the neurotypical kids too. That's why I invited my colleague, Jill Fahy, back to De Facto Leaders to talk about the state of college readiness, the upstream impacts of what's happening in K-12 on success both during and after college. Jill Fahy, Professor in the Department of Communication Disorders & Sciences, serves as the Director of STEP, a transitional education program for EIU students with autism. STEP programming supports the development of executive functions, social communication, self-appraisal, and self-regulatory skills to facilitate students' management of their academic and university living demands. Ms. Fahy specializes in the assessment of executive dysfunction, particularly as it is associated with concomitant disorders of language, cognition, or social/pragmatics. She is a widely-known lecturer in the area of executive functions, speaking nationally and internationally on aspects of evaluation and treatment of executive dysfunction, and the role of language in executive functions. Ms. Fahy is co-author of The Source for Development of Executive Functions, 2nd edition, and various articles on self-talk and executive functions.  Ms. Fahy teaches graduate courses in Aphasia/Right Hemisphere Dysfunction,  Cognitive-Communication and Executive Function Disorders, and Medical Grand Rounds. She previously taught undergraduate courses in Neurology and Advanced Clinical Practicum and Diagnostics. Prior to teaching at EIU, Ms. Fahy worked for several years as a medical SLP providing services for patients with acquired neurological deficits resulting from stroke and TBI, including those in acute care, inpatient and day rehabilitation, and home health. In this conversation, we discuss:✅ The difference between accommodations and modifications, what “overhelping” looks like, and why it impedes development of important metacognitive skills.✅ The state of college student mental health, and how it relates to the opportunities students have to practice self-regulation and experiencing failure.✅ Skills many college students are lacking, including managing due dates, extended writing assignments, study skills, working through conflict, and managing their daily life.✅ How and when to start fading supports, and how to recognize if you've been “overaccommodating” for a studentYou can connect with Jill at jkfahy@eiu.edu or on LinkedIn here: https://www.linkedin.com/in/jill-fahy-250478b/Learn more about the Students with Autism Transitional Education Program (STEP) Program at Eastern Illinois University here: https://www.eiu.edu/step/Be sure to listen to my first interview with Jill on De Facto Leaders here: Executive Functioning for College Students: Beyond Checklists and Planners (with Jill Fahy)Link here: https://drkarendudekbrannan.com/ep-122-executive-functioning-for-college-students-beyond-checklists-and-planners-with-jill-fahy/You can also listen to my commentary on her first interview in this episode: Balancing Language, Academic Content Areas, and Executive Functioning (featuring Jill Fahy)Link here: https://drkarendudekbrannan.com/ep-232-balancing-language-academic-content-areas-and-executive-functioning-featuring-jill-fahy/In this episode, I mentioned Language Therapy Advance Foundations, my program that gives speech pathologists a scalable framework for building language skills needed to thrive in school, social situations, and daily life. You can learn more about the program here: https://drkarenspeech.com/languagetherapyI also mentioned School of Clinical Leadership, my program that helps related service providers design scalable executive functioning interventions to ensure students get the scaffolding they need across the school day. You can learn more about the program here: https://drkarendudekbrannan.com/clinicalleadership

Rapid advances in acute ischemic stroke care have expanded treatment windows and improved patient outcomes through thrombolysis, mechanical thrombectomy, and optimized antithrombotic strategies. This episode highlights evolving approaches to patient selection, the growing role of tenecteplase, and the importance of team-based systems of care in delivering timely, effective treatment. In this episode, Casey S. Albin, MD, FAAN, speaks with Christopher R. Leon Guerrero, MD, author of the article "Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Leon Guerrero is an associate professor of neurology and the adult neurology residency program director at Atrium Health Carolinas Medical Center in Charlotte, North Carolina, where he also serves as outpatient stroke director. Additional Resources Read the article: Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Full episode transcript available here Dr Albin: In stroke care, every minute kills nearly two million neurons. But today, we're going to unpack all the details about the latest treatments that can give those neurons back.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Albin: Hello and welcome. This is Dr. Casey Albin. Today, I'm interviewing Dr. Christopher Leon-Guerrero about his article on Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast. I always like to start by just having you introduce yourself so our listeners know a little bit about you.  Dr Leon-Guerrero: Thanks for the introduction, Dr. Albin. Really glad to be here today. My name is Chris Leon-Guerrero. I'm a vascular neurologist at Atrium Health in Charlotte, North Carolina, at Carolinas Medical Center. I'm an associate professor in the Department of Neurology. I serve as our Neurology Residency Program Director, and I also wear the hat of an outpatient stroke director in our clinics.  Dr Albin: So, you are wearing a lot of hats and balancing a lot of things, and it's a really exciting time to be talking about this. For our listeners, we are recording this right after the launch of the American Heart Association, American Stroke Association just released their new guidelines on acute ischemic care. So, no better time to kind of dive into some of this. And really, when I think about acute ischemic stroke care, it's dramatically transformed in the last two to three decades. I mean, from lengthening time windows for IV thrombolysis to expanded thrombectomy eligibility, this is really, I think, some of the most exciting stuff in neurology. And your article did a fantastic job of distilling those rapid advancements and clarifying some of the evidence behind some of these new evolving treatment selections and imaging modalities, and it's exciting. So, let's just start with thrombolysis. Where are we now with IV thrombolytics and the time windows there?  Dr Leon-Guerrero: So, a lot has changed in the last decade, since that initial trial with NINDS, nearly thirty years ago. We're still giving intravenous thrombolysis in the traditional time window up to 4.5 hours, and really emphasizing we should be selecting patients for treatment early and quickly as possible. In most of those cases, a non-con head CT is sufficient to rule out bleeding and initiate treatment as quickly as possible. Where things have gotten really exciting is using advanced neuroimaging to help select patients beyond that traditional 4.5 hour window, and we're able to treat patients even up to twenty-four hours from symptom onset.  Dr Albin: Which is really exciting. It has really totally shifted the paradigm here. You know, I think most listeners are going to be pretty familiar with three to four and a half hours. Like, that's sort of our standard. What can you tell us about some of the advanced imaging we're using for that later selection period?  Dr Leon-Guerrero: It's around the principle of you want to be able to, uh, rescue significant salvageable tissue without a lot of core. So, this large profusion deficit and small core is really how you're trying to select out these patients. And two types of modalities are used. One is going to be MRI, and a lot of those imaging protocols, you know, are outlined in the WAKE UP trial and basically are looking for patients with DWI hyperintense lesions and FLAIR negative lesions to suggest that patients in an early time window that's treatable for thrombolysis. And then in the other category, we'll be using profusion imaging, whether that's CT profusion or MR profusion, to look for patients with large salvageable tissue.  Dr Albin: Yeah. And I think that this has been one of the things that, to me, has been really impactful is I think when WAKE UP came out, it was exciting. It was fun to sort of think about, "Hey, we're going to be able to use MRI." But MRI can be very challenging to get acutely, especially in community centers where they don't have the capabilities to get someone from the emergency department into an MRI rapidly enough to make thrombolysis decisions. So, to see some of that expand to CT profusion has been really exciting. How are you going about sort of counseling patients or thinking about their risk when you're using some of those, like, advanced imaging techniques?  Dr Leon-Guerrero: Yeah. I think it's similar to the conversations we've had with patients even within the traditional 4.5 hour window. The risk for intravenous thrombolysis is hemorrhage, and counseling patients on the, you know, the risk and benefits of hemorrhage and the potential clinical benefit of receiving thrombolytics is important. And then providing patients with that information to make an informed decision, so that they can make the best decision for their own care.  Dr Albin: Totally. And it's, again, time sensitive, but trying to give families enough information and enough time to sort of process those, especially when it's a little bit beyond the standard that we're so used to consenting for. The other big area that's really changed is that tenecteplase has become the star of the show. It's really gained momentum, so what should clinicians understand about this?  Dr Leon-Guerrero: Yeah. There's been an explosion of data over the last decade on tenecteplase supporting its use for clinical practice. You know, there was recent updates even from the neurology journal with a large meta-analysis with all of the data showing good clinical outcomes and perhaps even lower risk of bleeding. And so, I think you're seeing a lot of centers across the country switching from alteplase to tenecteplase. There's some practical advantages. So tenecteplase is a one-time bolus dose. And then biologically, it seems to have better fibrin specificity, longer half-life, which may ultimately make it a more attractive drug and may make it even more effective. But I think the practical aspects of tenecteplase are not to be understated. I think there's a lot of advantages for speed and efficiency and for centers to make that switch.  Dr Albin: Yeah. I remember when our health system made the pivot from alteplase to tenecteplase. Like any changes, that obviously created some adjustments with the new workflow. But, the fact that this could be given just as a one-time dose and not with the "we got to calculate the bolus, and now we got to get the infusion on board," like really simplified workflow. So, I think that's been pragmatically one of the nicest things we've done in stroke care. Really exciting.  Dr Leon-Guerrero: Yeah. And, you know, it's a doable thing. I think you have to be, very deliberate about it at whatever center you're at to make sure that all stakeholders are aware of that change. I think that's helpful to get everybody involved and have a lot of planning to avoid wrong dosing errors or inadvertently dosing as alteplase versus tenecteplase. But it's certainly doable, and I think in the long term, centers that have switched have been pretty satisfied with tenecteplase.  Dr Albin: And you know, initially when this came out, there really was sort of a debate about, is it gonna be 0.25? Was it gonna be 0.4? Where have we landed with that debate?  Dr Leon-Guerrero: So, I think we found the correct dose is 0.25 milligrams per kilogram is the recommended dose with a max out of 25 milligrams. There's some within the American Heart Association guidelines that were just published. They mentioned even tier dosing based on 10 kilograms, so intervals. So, that may be an easier way for centers to do it. But that cap out dose of 25 milligrams at 0.25 milligrams per kilogram, I think, is the sweet spot.  Dr Albin: Yeah. That's great, and I think that that has helped, you know, say, "This is what we're doing. There's not a debate that's happening anymore." And that really just got codified in the new ASA guidelines, so really exciting there. So, there is a lot of guidance for these patients, but I think one of the things that your article really tackled is the fact that there are some special populations, where we really still don't have a lot of guidance. And so, I think just to kind of distill those for the listeners, thinking about our pregnant patients, thinking about children, how are we approaching thrombolysis decisions in these special populations?  Dr Leon-Guerrero: These are always tough cases. For example, for pregnant women, they've often been excluded in the thrombolytic trials. But there's still evidence. You know, there's some inference based on the evidence we do have, and there's a lot of registry and case reports suggesting potential safe treatment for pregnant women. And I think when you're approaching those cases, again, it's gonna be patient-centered and really should be multidisciplinary. These are the types of cases you really need to lean on your maternal fetal medicine colleagues, your high-risk OBGYNs, your obstetricians to help with that decision-making. And I think, a multidisciplinary approach is the way to go for these cases. It's the same thing with the pediatric population. We had some data. There was one trial, randomized control trial, called TIPS trial that looked at using intravenous alteplase for acute ischemic stroke in patients under the age of 18. It had difficulty with enrollment. But I think most experts would argue that patients with pediatric stroke should be considered for intravenous thrombolysis if appropriate. Again, same thing. You want to make it a multidisciplinary approach, really getting your pediatric neurologists, your pediatricians involved early to make the best decision for the patient.  Dr Albin: Yeah. That's just really an important takeaway, just thinking about this as a multidisciplinary decision, because there are going to be other stakeholders to the patient's care who may have some different information than what we as neurologists are bringing to the approach. And obviously, our perspective really matters. But trying to work in everyone's unique vantage point of the patient really helps to make the most effective decision. When we talk about acute ischemic stroke care, I really don't think that you could do justice to the topic without pivoting to mechanical thrombectomy, which, you know, as we think about how the medical field as a whole, not just neurology, how the medical field has evolved. I mean, there's probably no bigger impact than mechanical thrombectomy has made in terms of reducing not just morbidity, but mortality from stroke. I mean both. So, thrombectomy has been around for a while, but just walk our listeners through what's the core that we for sure know that these are the patients that this works for?  Dr Leon-Guerrero: The types of patients we should be selecting for intervention are patients with large vessel occlusions. And those initial trials that were published in 2015 really demonstrated that this is a quite an effective treatment for patients with large vessel occlusion ischemic strokes in the anterior circulation. When that smattering of publications occurred in 2015, the general consensus, we should be treating all patients up to six hours from symptom onset if they do have a large vessel occlusion. And then, Dr. Albin, as you know, the, the windows continue to expand. So, we were using advanced neuroimaging with MR selection and perfusion selection based on DAWN and DEFUSE 3 trial protocols to select patients all the way out to the 24 window, and it's even expanded beyond that over the last few years.  Dr Albin: I think that when we think about trials that really, totally, changed the game, when we think about DAWN and DEFUSE 3, and we switched from that time-based window to more of that, like we talked about for thrombolysis, that tissue-based clock and, like, looking at what is salvageable and where can we make an impact on salvageable tissue, truly moved the needle in terms of just bringing this therapy for people who, you know, it's hard to get in within six hours. When we moved the needle to 24, it made a huge difference. But people were still coming in with a lot of ischemic damage already done, and they would have traditionally been excluded from being enrolled in thrombectomy trials. But that's changing too. So where are we there?  Dr Leon-Guerrero: Yeah. I think there were lessons learned from DEFUSE and DAWN that we were probably over-selecting. Perhaps too stringent. You know, we had number needed to treat in the range of two to three for good outcome based on those trials. And so, I think those were lessons learned to move forward, and we, and, and people started looking at large core infarctions. And in the last few years, we've seen a multitude of randomized control trials examining large core infarctions. These are patients with ASPECT scores all the way down to zeros. A lot of the trials relied on three to six as their score, but there was at least one large core study that looked at ASPECT scores down to zero to two, and all of these studies showing benefit.  Dr Albin: Yeah. And we've really moved into if there's some tissue to spare there, probably getting clot out really makes a big difference in impact. You know, it was really surprising to me as a neurointensivist looking at these trials, that the trials had such low rates of hemorrhage, and pretty low rates of dramatic cerebral edema after thrombectomy. I don't know that we've seen all of that in sort of real world applications, but again, we are still seeing some of these patients come in, that really would've been devastated having some amount of functional recovery regained, which is incredible. In terms of another patient population that I think gives a lot of people pause or stickiness, is those basilar artery occlusions, right? Another large vessel, but one that we've had a little bit harder of a time enrolling in trials and having well-selected trials. Where are we now on whether or not basilar artery occlusion should go to mechanical thrombectomy?  Dr Leon-Guerrero: So, a lot of excitement in this area, too. There's at least two studies that were published in the last five years that were showing benefit in doing thrombectomy for patients with basilar artery occlusion up to 24 hours, and these were patients with moderate to severe deficits with NIH Stroke Scale scores greater than 10. And then making sure that they don't have large core, so using a newer scoring algorithm on the CAT scan called PC ASPECT, so basically a posterior circulation ASPECT score, to kind of make sure that patients don't have large core infarctions that are being considered for thrombectomy. All of those things collectively in those two recent studies, the ATTENTION trial and the BAOCHI trial, I think is what ended up making those studies positive, is that we were selecting the right types of patients, uh, without large core, early core, and patients with moderate to severe deficits that made the difference from previous trials.  Dr Albin: Yeah. I think that that's so important. Those trials to me, and like how long it took to get those enrolled, really emphasized to me that there really was a selection bias. Like, we believed this worked, which made it hard to then do a trial. But I'm so glad to hear that we have the data now to support moving forward in a more rigorous way.  Dr Leon-Guerrero: You're absolutely right. I think that was some of the challenges with the initial trials. In fact, the authors had commented on that. There's a lot of difficulties with lack of clinical equipoise, or experts wanting to take these patients anyways out of clinical trial and treat them, and so that's always been an issue. And then, you know, we all remember basilar artery occlusion cases. They can be severe, devastating cases in our career, but the reality is they're not that common. So, if you look at large vessel occlusions, they only account for about 10%, and if you look at all stroke patients presenting to most centers, they represent about 1% of cases. So really hard clinical trials to do just because there's thankfully not a lot of patients walking around with basilar artery occlusions, but certainly makes for challenges when you're trying to conduct randomized controlled trials on this subset of patients.  Dr Albin: Absolutely. But we did it, and I think that, like, really if, if the listeners take nothing else, it's that the field of vascular neurology is really moving forward with evidence-based, doing very rigorously controlled clinical trials, which is, I think, is what makes this field so exciting. Finally, closing out, cause we could talk all day, but we don't have all day. You know, it seems to me that more and more we are just using dual antiplatelet therapy all the time. And maybe that is, uh, a little bit of a hyperbole, cause I don't think it's all the time, but let's walk through— when is there good evidence for dual antiplatelet therapy?  Dr Leon-Guerrero: Yeah. So, there's strong evidence for early initiation of dual antiplatelet therapy or DAPT in patients with minor stroke or high-risk TIAs, and it's been studied using both clopidogrel as an add-on to aspirin and ticagrelor. Both seem like they're viable options in patients. I think one of the key things is the duration of therapy. So, in these cases with minor stroke and high-risk TIAs, we really should be confining the treatment of early DAPT for 21 days. The risk profile changes, so the risk of recurrent stroke starts to decline with time, and that risk of hemorrhage complications increases with time. And so that sweet spot of 21 days, or even some centers will do 30 days for just practical purposes, you know, really is what we should be doing in most of those cases. Other instances where DAPT can be considered, is in patients with intracranial atherosclerosis that's symptomatic, extrapolating from the SAMMPRIS trial that in the, in the medical management arm alone, used dual antiplatelet therapy with aspirin and clopidogrel for up to 90 days. So, you'll see that as well in clinical practice. Some people will opt for a 90-day duration for those patients with symptomatic intracranial atherosclerosis and stroke.  Dr Albin: Just so I emphasize, this is not set it and forget it. You can stay on DAPT forever. It is you're going to have a definitive time course, 21 days, 90 days. We have directed instructions where we're doing more benefit than harm because of that risk of hemorrhage.  Dr Leon-Guerrero: That's correct. In most cases, we really should be confining the duration of DAPT either to 21 days or 90 days. This is a challenging clinical practice. Centers really have been making an emphasis on stroke follow-up, so making sure these patients get appropriate and timely stroke follow-up to address these issues and to make sure that DAPT is discontinued if appropriate.  Dr Albin: Yeah. I love that, and I want to pull on that a little bit because you as someone who is helping direct a stroke center– A lot of this really does rely on systems of care. When we think about early lysis decisions or mechanical thrombectomy, it's how do we get the patient to one of those capable centers as quickly as possible? And then on the back end, when you're discharging a patient, how do you make sure that they are getting follow-up, making sure that they're getting their Holter monitor if they need it? You know, all the stuff that goes into kind of figuring out, why did the stroke happen? What are some of the things that you, in your role, are really excited about, that will move the needle over the next five or 10 years?  Dr Leon-Guerrero: Yeah. I think a lot of centers are doing it just like we're doing it. It really has to be a team-based approach, and you really want to reach the patient where they are in terms of the continuum of care. And so making sure if it's the in the field that you've reached out to your EMS and first responders to make sure they understand triage protocols to get patients where they need to be, to get the acute treatments that they need for the type of stroke that they're presenting with, to the actual centers that you work at, making sure your whole team, nurses, emergency physicians, APPs that are involved in care are all aware of the stroke protocols and how we're selecting these patients, making sure that your imaging protocols are up to date, and so that it's seamless when patients come in, that we're not adding on perfusion if we should have gotten that up front– We already know, have made decisions before that patient gets there. And then thinking about the patient after that hospital stay, I think, is critical. We really want to reduce their risk of recurrence, making sure that we're leveraging transitions of care, getting those patients seen in our stroke clinics for follow-up, and then make sure we're passing that baton to the long term. All of their long-term comorbidities that may be increasing their risk of stroke are managed and reduced as best as possible.  Dr Albin: From the Continuum journal to the continuum of stroke care.  Dr Leon-Guerrero: That's right.  Dr Albin: I mean, we have it all. I think that that really is so important. I'll just close with what's one thing that is your favorite part about being a vascular neurologist?  Dr Leon-Guerrero: I think it's what attracted to me to this field. As a medical student at that time, all we had was intravenous thrombolysis, and there was so much promise. There was so much promise that there was going to be widespread advancements in acute stroke, and here we are. There's been a tremendous amount of advancements and improvements for patients. I'm really excited to see what unfolds in the next few years, and I'm really excited that we've been able to increase the number of patients we're able to treat with acute ischemic stroke. I hope that we continue to expand the time window, the inclusion criteria, all of those things that we can treat more stroke patients effectively.  Dr Albin: It is really a very exciting time to be a vascular neurologist. Again, today, I've been interviewing Dr. Christopher Leon-Guerrero about his article on Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues, and thank you again, Dr. Leon Guerrero and our listeners for joining today.  Dr Leon-Guerrero: Thanks for having me.  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 interview, Dr. Roopa Sharma, MD, interviews with Hans D. Katzberg, MD—Professor of Medicine and Head of the Division of Neurology at University Health Network and the University of Toronto—about his recent article and the AANEM guideline published in Muscle & Nerve, titled “Diagnostic and Screening Laboratory Tests in the Assessment of Patients with Small Fiber Neuropathy: An Evidence-Based Review—Report of the AANEM Small Fiber Neuropathy Task Force.

Paul Lingor, MD, is Professor for Neurology, Group Leader and Head of the Outpatient Clinics for Motoneuron Disorders and Co-head of the Outpatient Clinics for Movement Disorders and at the Department of Neurology of the TUM Klinikum Rechts der Isar in Munich, Germany.  Here he discusses the recent publication "Safety, tolerability, and efficacy of fasudil in amyotrophic lateral sclerosis (ROCK-ALS): a phase 2, randomised, double-blind, placebo-controlled trial."

Understanding how values and communication styles differ across cultures is key to succeeding internationally. That’s why training in cross-cultural communication has become commonplace in the international business world. In this session, we’ll look at 6 dimensions of cross-cultural communication and their application to medical scenarios.

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Dr. Katie Krulisky talks with Dr. Marcus Pinto about the diagnosis and management of hereditary ATTR amyloidosis.  Read the related article in Neurology®.  Disclosures can be found at Neurology.org.  

 My guest provides advanced, patient-centered care for stroke, brain aneurysms, and a wide range of neurovascular conditions. Dr. Liff is recognized for his expertise in both medical and catheter-based treatments, including procedures such as cerebral angiography, mechanical thrombectomy, aneurysm coiling and stenting, carotid stenting, and embolization for arteriovenous malformations and tumors.Dr. Liff completed his undergraduate studies in Cognitive Science at Johns Hopkins University, earned his medical degree from SUNY Upstate Medical University, and trained in Neurology at Albert Einstein College of Medicine, where he served as Chief Resident. He specialized in fellowships in Vascular Neurology at Mt. Sinai Hospital and Endovascular Neurosurgery at NYU Langone Medical Center.He has presented original research at major conferences and published it in respected journals. Dr. Liff is a senior member of the Society of Neurointerventional Surgery and is dedicated to serving patients throughout the Tri-State Area, performing procedures at leading hospitals such as St. Francis Hospital, NYU Langone Hospital Long Island, and Lenox Hill Hospital. https://jeremyliffmd.com/#homehttp://www.yourlotandparcel.orgSupport the show

Stay informed on current events, visit www.NaturalNews.com  - Gold and Silver Market Analysis (0:10) - Trump's Strategy and Oil Prices (3:23) - Impact on Emerging Markets and US Economy (7:55) - Data Center Boom and Market Bubble (17:11) - Gold and Silver Market Trends (31:30) - Investment Strategy and Risk Aversion (42:38) - Natural Healing and Psychedelic Therapies (1:03:05) - The Power of Iboga and Neuroplasticity (1:15:18) - The Role of Integration in Healing (1:16:49) - Stillness and Healing Paradigm (1:19:52) - The Role of Nature and Indigenous Knowledge (1:24:57) - Science and Functional Medicine Integration (1:29:23) - Personal Experiences and Overcoming Trauma (1:35:48) - The Importance of Community and Integration (1:43:36) - Legal and Cultural Challenges (1:44:51) - The Vision for Sovereign Healing (1:50:46) - Final Thoughts and Encouragement (1:53:49) Watch more independent videos at http://www.brighteon.com/channel/hrreport  ▶️ Support our mission by shopping at the Health Ranger Store - https://www.healthrangerstore.com ▶️ Check out exclusive deals and special offers at https://rangerdeals.com ▶️ Sign up for our newsletter to stay informed: https://www.naturalnews.com/Readerregistration.html Watch more exclusive videos here:

How quickly can you improve your gut health? Can diet help lower your risk of dementia? And what should you know about food labels and healthy weight loss? In this special live Q&A, Prof Tim Spector, Prof Sarah Berry and Dr Federica Amati answer your biggest nutrition questions and share practical, evidence-based advice you can use today. Drawing on decades of research and data from hundreds of thousands of people, they explain how diet can influence the gut microbiome, brain health, hunger, energy levels and long-term health. They discuss dementia risk, healthy snacking, intermittent fasting, ultra-processed foods, plant diversity, breakfast, food labels and the latest science on weight loss. You'll learn how quickly the gut microbiome may respond to dietary change, why some foods keep you fuller for longer, how to build a healthier breakfast, and simple ways to make better food choices. The team also explain why small dietary changes can have lasting benefits. If your daily food choices influence your gut health, brain health and future wellbeing, which change is worth making first?

Dr. Andy Southerland talks with Dr. Seemant Chaturvedi about recent research presented at the 2026 European Stroke Organization Conference.  Read more about TAPIS trial.  Read more about the ODEA-TIA trial.  Disclosures can be found at Neurology.org.   

In part two of this series, Dr. Jeff Ratliff and Dr. Gabriela Figueiredo Pucci discuss the lessons and experiences that happen in neurology-related social media interaction.  Show citation:  Pucci GF, Gheihman G, Albin CSW. Education Research: A Qualitative Analysis of the Role of Social Media in Neurology Trainees' Professional Identity Formation. Neurol Educ. 2026;5(2):e200307. Published 2026 Apr 22. doi:10.1212/NE9.0000000000200307  

Send us Fan MailGarrett Salpeter is an engineer, entrepreneur, author, and founder of NeuFit, best known as the creator of the NEUBIE device and his pioneering work at the intersection of neuroscience, rehabilitation, and human performance.In this episode of Leave Your Mark, Garrett shares the journey that began with a significant hockey injury and evolved into a lifelong pursuit of understanding how the nervous system influences recovery, movement, and performance. A former collegiate hockey player with a background in physics and engineering, Garrett's curiosity led him beyond traditional rehabilitation models and into the world of functional neurology, motor control, and neuroplasticity.Together, we explore the lessons hockey taught him about devotion, discipline, teamwork, and personal growth, as well as the pivotal experiences that shaped his professional path. Garrett discusses his transition from academia to entrepreneurship, the challenges of building a company from the ground up, and the development of direct current technologies designed to help people move, heal, and perform at a higher level.Our conversation dives into the concept of the nervous system as the body's software, the role of compensation in both physical and psychological health, and why addressing root causes often produces more meaningful and lasting outcomes than simply treating symptoms.Whether you're a coach, therapist, clinician, athlete, or simply fascinated by human performance, this episode offers a thoughtful look at innovation, resilience, and the ongoing pursuit of understanding how we adapt and thrive.In this episode, we discuss:• Garrett's hockey journey and the lessons sport taught him about excellence and contribution• How a serious injury led him to functional neurology and neuroscience• The nervous system's role in movement, pain, and performance• Leaving academia to pursue entrepreneurship and innovation• The development of the NEUBIE and direct current technology• Compensation patterns in rehabilitation and human behavior• Root cause thinking in performance and recovery• Building a business while staying aligned with personal values• The future of neuromuscular rehabilitation and human optimizationEnjoy the conversation.If you liked this EP, please take the time to rate and comment, share with a friend, and connect with us on social channels IG @Kingopain, TW @BuiltbyScott, LI+FB Scott Livingston. You can find all things LYM at www.LYMLab.com, download your free Life Lab Starter Kit today and get busy living https://lymlab.com/free-lym-lab-starter/Please take the time to visit and connect with our sponsors, they are an essential part of our success:www.ReconditioningHQ.comwww.FreePainGuide.com 

Dr. Shuvro Roy talks with Dr. Michael Levy about satralizumab for treating relapsing MOGAD, current management challenges, and the encouraging results of this new therapy.  Read more about this abstract.  Disclosures can be found at Neurology.org. 

In part two of this series, Dr. Stacey Clardy and Dr. John Ney discuss the primary limitation of using claims data to estimate wait times for neurology services, particularly in rural areas or for subspecialty neurology care.  Show citation: Laffargue EK, Van Der Goes DN, Wilson AM, Parziale SD, Sico JJ, Ney J. Neurology Wait Times After Primary Care or Emergency Department Visits Among the Commercially Insured Population in the United States: 2019-2023. Neurology. 2026;106(10):e218008. doi:10.1212/WNL.0000000000218008  

In part two of this series, Dr. Stacey Clardy and Dr. John Ney discuss the primary limitation of using claims data to estimate wait times for neurology services, particularly in rural areas or for subspecialty neurology care.  Show citation: Laffargue EK, Van Der Goes DN, Wilson AM, Parziale SD, Sico JJ, Ney J. Neurology Wait Times After Primary Care or Emergency Department Visits Among the Commercially Insured Population in the United States: 2019-2023. Neurology. 2026;106(10):e218008. doi:10.1212/WNL.0000000000218008  

Do you ever hear a song that transports you to a specific place and time? This auditory wormhole has a name: musical daydreams. Music cognition expert Elizabeth Margulis studies why they happen, and what they tell us about our brains. She joins Host Flora Lichtman to discuss this phenomenon. Guest: Dr. Elizabeth Margulis is a professor and director of Princeton's Music Cognition Lab. She's also the author of “Transported: The Everyday Magic of Musical Daydreams.” Other episodes you may enjoy: A Neurologist Investigates His Own Musical Hallucinations Oliver Sacks Searched The Brain For The Origins Of Music Transcripts for each episode are available within 1-3 days at sciencefriday.com. Subscribe to this podcast. Follow our show on Instagram, TikTok, Facebook, and Bluesky @scifri and sign up for our newsletters. Got a science question that's keeping you up at night? Call us: 877-472-4374 Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.