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In part one of this three-part series, Dr. Justin Abbatemarco and Drs. John Chen and Smathorn Thakolwiboon discuss the outcomes following plasma exchange in MOGAD and explore how the findings from this study can inform patient care.
Dr. Justin Abbatemarco talks with Drs. John Chen and Smathorn Thakolwiboon about the outcomes following plasma exchange in MOGAD and explore how the findings from this study can inform patient care. Disclosures can be found at Neurology.org.
Dr. Dan Ackerman and Drs. Luuk Dekker and Jasper D. Daems discuss the analysis of various aLVO stroke detection scales to determine which one is the most useful for prehospital triage. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213570
The July 2025 recall features four episodes on systems and innovation in delivering neurologic care. The episode begins with Dr. Scott Friedenberg discussing challenges faced by neurologists in balancing financial productivity with optimal patient care. The episode leads into a conversation with Dr. Marisa Patryce McGinley discussing the utilization of telemedicine in neurology, particularly focusing on disparities in access among different demographic groups. The conversation transitions to Dr. Lidia Moura talking about the implications of large language models for neurologic care. The episode concludes with Dr. Ashish D. Patel discussing headache referrals and the implementation of a design thinking approach to improve access to headache care. Podcast links: Empowering Health Care Providers Disparities in Utilization of Outpatient Telemedicine for Neurologic Care Large Language Models for Quality and Efficiency of Neurologic Care Using Design Thinking to Understand the Reason for Headache Referrals Article links: Empowering Health Care Providers: A Collaborative Approach to Enhance Financial Performance and Productivity in Clinical Practice Disparities in Utilization of Outpatient Telemedicine for Neurologic Care Implications of Large Language Models for Quality and Efficiency of Neurologic Care: Emerging Issues in Neurology Using Design Thinking to Understand the Reason for Headache Referrals and Reduce Referral Rates Disclosures can be found at Neurology.org.
In this episode of the Neurology Minute, Dr. Alison Christy delves into another women's history minute to discuss Mary Lasker.
This is Sara, and I remember the time 20 years ago when I got schooled by a psychoanalyst. It must have been the fall, because I was supremely agitated that I was having to write, design, and send holiday cards out to a huge list of people all by myself, without the help of my fiancé. If you know me, you know that cards were a staple of my winter growing up, with cards from my parents' friends stapled onto long felt ribbons hanging down each doorway, surrounding us with love and smiling faces for weeks on end. The therapist asked if I could just not do them, if it was annoying me so much, and my instant fury was revealed: Are you kidding? I have to send these cards out, it's the nice thing to do!! Cut to the point, and it's this - nice according to who? Nice for whom? Certainly not nice for me if I were going to be resentful and pissy about it. I came to terms with the fact that I actually just really enjoyed writing and sending cards out to people who warmed my heart that year, and that my partner wasn't a nice person for not agreeing to send these cards out with me. But it leads us to ask this. What do we mean by niceness - and what, more importantly, is its not-as-related-as-it-seems and so much more important character trait of kindness? How can understanding this difference and leaning into kindness help us be better people? What to listen for: How a medically trained doctor got into a “touchy-feely” thing like kindness The shockingly tremendous impact that kindness has on our individual health and our societal wellbeing What's the difference between niceness vs kindness? Ways to begin practicing more kindness About our guest: Kelli Harding, MD, MPH, is dedicated to creating a kinder and healthier world for all. An expert in mental health, medicine, and public health, she teaches at Columbia University's Vagelos College of Physicians and Surgeons (VP&S) in New York City and is a diplomate of the American Board of Psychiatry and Neurology, also boarded in the sub-specialty of consultation-liaison psychiatry or psychosomatic (mind-body) medicine. Known for making complex scientific research understandable to general audiences, she's the author of the critically acclaimed book The Rabbit Effect: Live Longer, Happier, and Healthier with the Groundbreaking Science of Kindness. Dr. Harding has appeared on Today, Good Morning America, BBC, The New York Times, The Washington Post, Prevention, LA Times, Oprah Magazine, Parents, Medscape, Sesame Street Workshop, and The World Economic Forum. Additionally, she has spoken at global events at the United Nations and World Happiness Summits and served on the Boards of Organizations such as the Association of American Medical Colleges (AAMC) and social media platform Nextdoor. Dr. Harding lives in New York City with her husband and three sons—an eleventh-grader, a ninth-grader, and a sixth-grader, and beloved rescue pup, Athena. Her next book, Different, co-authored with Sara Blanchard, will be out in Fall 2026. Website kellihardingmd.com LinkedIn Kelli Harding MD MPH Instagram @kellihardingmd
In the final episode of this three-part series, Dr. Andy Southerland and Dr. Seemant Chaturvedi discuss the PINGS-2 Trial, which was presented at the 2025 European Stroke Organization Conference. Show reference: https://eso-stroke.org/wp-content/uploads/Curtain-Raiser-2-1.pdf
The Cognitive Crucible is a forum that presents different perspectives and emerging thought leadership related to the information environment. The opinions expressed by guests are their own, and do not necessarily reflect the views of or endorsement by the Information Professionals Association. During this episode, Dr. James Giordano discusses a broad range of topics related to national security from biopsychology to complexity to neurotechnology to enactivism. Recording Date: 25 Jun 2025 Research Question: James Giordano suggests an interested student or researcher examine: “How might the convergence of neurotech, big data, and AI lead to improved human and multinational relations, and in these ways, contribute to avoiding conflict and warfare?” Resources: Cognitive Crucible Podcast Episodes Mentioned #72 Noah Komnick on Cybernetics and the Age of Complexity James Giordano NDU Website Enactivism Architectonics Heilmeier Catechism N3: Next-Generation Nonsurgical Neurotechnology Bioethics and Brains, published by MIT Press, which I co-authored with my longtime colleague Dr John Shook Neuroscience, Neuroculture and Neuroethics, published by Springer, which I co-authored with John Shook and Dr Roland Benedikter Link to full show notes and resources Guest Bio: Dr. James Giordano is the Director of the Center for Disruptive Technologies and Future Warfare of the Institute for National Strategic Studies at the National Defense University. He is Professor Emeritus in the Departments of Neurology and Biochemistry, and Senior Scholar Emeritus of the Pellegrino Center for Clinical Bioethics of Georgetown University Medical Center, Washington, DC. Dr. Giordano has served as Senior Scientific Advisory Fellow of the Strategic Multilayer Assessment Branch of the Joint Staff, Pentagon; Senior Bioethicist of the Defense Medical Ethics Center; Distinguished Fellow in Science, Technology and Ethics of the Stockdale Center for Ethics at the United States Naval Academy; and as an appointed member of the Neuroethics, Legal and Social Advisory Panel of the Defense Advanced Research Project Agency (DARPA), and an appointed member of the Department of Health and Human Services' Secretary's Advisory Committee for Human Research Protections. Dr Giordano is internationally recognized for his research on the use – and ethical guidance and governance - of neurocognitive sciences and technology in military, intelligence and global security operations A widely published author of over 350 peer-reviewed papers in the international scientific literature, 25 governmental reports, 37 book chapters, and 10 books - which most recently include Bioethics and Brains; Neuroscience, Neuroculture and Neuroethics; and Neurotechnology in National Security and Defense: Technical Considerations, Neuroethical Concerns. Dr. Giordano is a former Fulbright Fellow; an elected Fellow of the Hastings Center for Ethics; the European Academy of Science and Arts; and the Royal Society of Medicine (UK); and frequently lectures in German and Italian. A former United States Naval officer, he was winged as a Naval Aerospace Physiologist, co-designated as a Research Physiologist and Psychologist, and served with US Navy and US Marine Corps. About: The Information Professionals Association (IPA) is a non-profit organization dedicated to exploring the role of information activities, such as influence and cognitive security, within the national security sector and helping to bridge the divide between operations and research. Its goal is to increase interdisciplinary collaboration between scholars and practitioners and policymakers with an interest in this domain. For more information, please contact us at communications@information-professionals.org. Or, connect directly with The Cognitive Crucible podcast host, John Bicknell, on LinkedIn. Disclosure: As an Amazon Associate, 1) IPA earns from qualifying purchases, 2) IPA gets commissions for purchases made through links in this post.
In this solo episode, Dr. Joy Kong breaks down the 5 biggest mistakes patients make when undergoing stem cell therapy—and how to avoid them to get the most out of your investment. Learn why using your own cells may not be ideal, the dangers of over-expanded lab-grown cells (especially from overseas clinics), and how lifestyle habits like overexertion, alcohol, and poor diet can sabotage your results. If you're considering regenerative therapy, this is essential listening for safer, more effective outcomes.Additional Resources:Visit My Clinic: Chara Health
Dr. Dan Ackerman talks with Drs. Luuk Dekker and Jasper D. Daems about analyzing various anterior-circulation large-vessel occlusion (aLVO) stroke detection scales to determine which one is the most useful for prehospital triage. Read the related article in Neurology®. Disclosures can be found at Neurology.org.
In part two of this three-part series, Dr. Andy Southerland and Dr. Seemant Chaturvedi discuss the OPTIMISTmain Trial, which was presented at the 2025 European Stroke Organization Conference. Show reference: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00549-5/abstract
Episode #115 is all about diving into the midlife woman's brain—your most vital, complex, and vulnerable organ—and why protecting it matters more than ever. Here's a fact that doesn't get enough attention: two out of three people with Alzheimer's are women. And this isn't just about old age. The seeds of cognitive decline can start as early as your 40s—or even sooner.We'll talk about:• Why women are at greater risk for Alzheimer's and dementia• The brain-hormone connection during menopause and midlife• What you can do now to preserve memory, focus, and cognitive resilience• How genes like APOE4 interact with lifestyle—and what that means• How belly fat, or visceral fat. Affect cognition and brain health• And the power of early, personalized preventionMy guest, Dr. Kellyann Niotis, MD, is the first fellowship-trained preventive neurologist in the world, specializing in risk reduction strategies for neurodegenerative disorders such as Alzheimer's Disease, Lewy Body Dementia, and Parkinson's Disease. Dr. Niotis led the preventive neurology program within Dr. Peter Attia's medical practice, Early Medical, and managed the country's first Alzheimer's Prevention Clinic at Weill Cornell Medical College/NewYork-Presbyterian Hospital, where she developed research programs for Parkinson's and Lewy Body Dementia prevention. Her work has been published in several medical journals, including Neurology, Nature Mental Health, Frontiers of Aging Neuroscience, Aging and Disease, Movement Disorders, Journal of Alzheimer's Disease, Alzheimer's & Dementia, and Journal of the Prevention of Alzheimer's Diseas,e and has been presented at national and international conferences.She is passionate about the budding medical space of preventive neurology, in particular pertaining to the advocacy of preventive neurology policy changes and making treatment & education more accessible to the masses. She has received numerous honors and awards, and her opinions have been featured in popular media outlets, including CNN.Whether you're looking for tools to sharpen your brain today or you're thinking long-term about protecting yourself and your loved ones, this conversation is full of insight and hope.Medical Disclaimer:By listening to this podcast, you agree not to use this podcast as medical advice or to make any lifestyle changes to treat any medical condition in yourself or others. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any of my guests on my podcast.Learn more about Dr. Niotis:Website: https://drkellyannniotis.com/IG: @drkellyannniotisFB: @drkellyannniotisResources:Lancet Commission Modifiable Risk Factor list:https://www.thelancet.com/infographics-do/dementia-riskStay connected with JFW:Watch on my YouTube channel: https://www.youtube.com/@jillfooswellness/videosFollow me on Instagram: https://www.instagram.com/jillfooswellness/Follow me on Facebook: https://www.facebook.com/jillfooswellnessGrab discounts on my favorite biohacking products: https://www.jillfooswellness.com/health-productsEnjoy 20% savings and free shipping at Fullscript for your favorite supplements by leading brands:https://us.fullscript.com/welcome/jillfooswellnessSubscribe to the JFW newsletter at www.jillfooswellness.com and receive your FREE Guide on How To Increase Your Protein in 5 Easy Steps and your free Protein Powder Recipe Ebook. Schedule your complimentary 30-minute Zoom consultation here:https://calendly.com/jillfooswellness/30-minute-zoom-consultations
In part one of this three-part series, Dr. Andy Southerland and Dr. Seemant Chaturvedi discuss the BRIDGE-TNK Trial, which was presented at the 2025 European Stroke Organization Conference. Show reference: https://www.nejm.org/doi/full/10.1056/NEJMoa2503867
Pria Anand speaks to managing editor Emily Everett about her story “The Elephant's Child,” which appears in The Common's spring issue. The piece is a vivid retelling of a Hindu myth, the origin story of the elephant-headed god Ganesh. Pria talks about the process of writing and revising many versions of this ancient myth, why she felt inspired by it, and how her literary writing intersects with her career as a neurologist. Pria also discusses her debut book, The Mind Electric: A Neurologist on the Strangeness and Wonder of Our Brains, out this month from Simon & Schuster. The book explores how story and storytelling can illuminate the rich, complex gray areas within the science of the brain, weaving case study, history, fable, and memoir. Pria Anand is a neurologist and the author of The Mind Electric, out from Simon & Schuster in the U.S. and Little, Brown in the U.K. Her stories and essays have appeared in the Los Angeles Review of Books, Time Magazine, The Boston Globe, The Washington Post, The New York Times, Ploughshares, and elsewhere. She is a graduate of Yale University and Stanford Medical School, and she trained in neurology, neuro-infectious diseases, and neuroimmunology at the Johns Hopkins Hospital and the Massachusetts General Hospital. She is now an Assistant Professor of Neurology at the Boston University School of Medicine, and she cares for patients at the Boston Medical Center. Read Prias's story “The Elephant's Child” in The Common at thecommononline.org/the-elephants-child. Order The Mind Electric in all formats via Simon & Schuster at simonandschuster.com/books/The-Mind-Electric/. Learn more about Pria at www.priaanand.com. The Common is a print and online literary magazine publishing stories, essays, and poems that deepen our collective sense of place. On our podcast and in our pages, The Common features established and emerging writers from around the world. Read more and subscribe to the magazine at thecommononline.org, and follow us on Instagram, Bluesky, and Facebook. Emily Everett is managing editor of the magazine and host of the podcast. Her new debut novel All That Life Can Afford is the Reese's Book Club pick for April 2025. Her work has appeared in The New York Times Modern Love column, the Kenyon Review, Electric Literature, Tin House, and Mississippi Review. She was a 2022 Massachusetts Cultural Council Fellow in Fiction. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network
Pria Anand speaks to managing editor Emily Everett about her story “The Elephant's Child,” which appears in The Common's spring issue. The piece is a vivid retelling of a Hindu myth, the origin story of the elephant-headed god Ganesh. Pria talks about the process of writing and revising many versions of this ancient myth, why she felt inspired by it, and how her literary writing intersects with her career as a neurologist. Pria also discusses her debut book, The Mind Electric: A Neurologist on the Strangeness and Wonder of Our Brains, out this month from Simon & Schuster. The book explores how story and storytelling can illuminate the rich, complex gray areas within the science of the brain, weaving case study, history, fable, and memoir. Pria Anand is a neurologist and the author of The Mind Electric, out from Simon & Schuster in the U.S. and Little, Brown in the U.K. Her stories and essays have appeared in the Los Angeles Review of Books, Time Magazine, The Boston Globe, The Washington Post, The New York Times, Ploughshares, and elsewhere. She is a graduate of Yale University and Stanford Medical School, and she trained in neurology, neuro-infectious diseases, and neuroimmunology at the Johns Hopkins Hospital and the Massachusetts General Hospital. She is now an Assistant Professor of Neurology at the Boston University School of Medicine, and she cares for patients at the Boston Medical Center. Read Prias's story “The Elephant's Child” in The Common at thecommononline.org/the-elephants-child. Order The Mind Electric in all formats via Simon & Schuster at simonandschuster.com/books/The-Mind-Electric/. Learn more about Pria at www.priaanand.com. The Common is a print and online literary magazine publishing stories, essays, and poems that deepen our collective sense of place. On our podcast and in our pages, The Common features established and emerging writers from around the world. Read more and subscribe to the magazine at thecommononline.org, and follow us on Instagram, Bluesky, and Facebook. Emily Everett is managing editor of the magazine and host of the podcast. Her new debut novel All That Life Can Afford is the Reese's Book Club pick for April 2025. Her work has appeared in The New York Times Modern Love column, the Kenyon Review, Electric Literature, Tin House, and Mississippi Review. She was a 2022 Massachusetts Cultural Council Fellow in Fiction. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/literary-studies
Pria Anand speaks to managing editor Emily Everett about her story “The Elephant's Child,” which appears in The Common's spring issue. The piece is a vivid retelling of a Hindu myth, the origin story of the elephant-headed god Ganesh. Pria talks about the process of writing and revising many versions of this ancient myth, why she felt inspired by it, and how her literary writing intersects with her career as a neurologist. Pria also discusses her debut book, The Mind Electric: A Neurologist on the Strangeness and Wonder of Our Brains, out this month from Simon & Schuster. The book explores how story and storytelling can illuminate the rich, complex gray areas within the science of the brain, weaving case study, history, fable, and memoir. Pria Anand is a neurologist and the author of The Mind Electric, out from Simon & Schuster in the U.S. and Little, Brown in the U.K. Her stories and essays have appeared in the Los Angeles Review of Books, Time Magazine, The Boston Globe, The Washington Post, The New York Times, Ploughshares, and elsewhere. She is a graduate of Yale University and Stanford Medical School, and she trained in neurology, neuro-infectious diseases, and neuroimmunology at the Johns Hopkins Hospital and the Massachusetts General Hospital. She is now an Assistant Professor of Neurology at the Boston University School of Medicine, and she cares for patients at the Boston Medical Center. Read Prias's story “The Elephant's Child” in The Common at thecommononline.org/the-elephants-child. Order The Mind Electric in all formats via Simon & Schuster at simonandschuster.com/books/The-Mind-Electric/. Learn more about Pria at www.priaanand.com. The Common is a print and online literary magazine publishing stories, essays, and poems that deepen our collective sense of place. On our podcast and in our pages, The Common features established and emerging writers from around the world. Read more and subscribe to the magazine at thecommononline.org, and follow us on Instagram, Bluesky, and Facebook. Emily Everett is managing editor of the magazine and host of the podcast. Her new debut novel All That Life Can Afford is the Reese's Book Club pick for April 2025. Her work has appeared in The New York Times Modern Love column, the Kenyon Review, Electric Literature, Tin House, and Mississippi Review. She was a 2022 Massachusetts Cultural Council Fellow in Fiction. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/literature
Pria Anand speaks to managing editor Emily Everett about her story “The Elephant's Child,” which appears in The Common's spring issue. The piece is a vivid retelling of a Hindu myth, the origin story of the elephant-headed god Ganesh. Pria talks about the process of writing and revising many versions of this ancient myth, why she felt inspired by it, and how her literary writing intersects with her career as a neurologist. Pria also discusses her debut book, The Mind Electric: A Neurologist on the Strangeness and Wonder of Our Brains, out this month from Simon & Schuster. The book explores how story and storytelling can illuminate the rich, complex gray areas within the science of the brain, weaving case study, history, fable, and memoir. Pria Anand is a neurologist and the author of The Mind Electric, out from Simon & Schuster in the U.S. and Little, Brown in the U.K. Her stories and essays have appeared in the Los Angeles Review of Books, Time Magazine, The Boston Globe, The Washington Post, The New York Times, Ploughshares, and elsewhere. She is a graduate of Yale University and Stanford Medical School, and she trained in neurology, neuro-infectious diseases, and neuroimmunology at the Johns Hopkins Hospital and the Massachusetts General Hospital. She is now an Assistant Professor of Neurology at the Boston University School of Medicine, and she cares for patients at the Boston Medical Center. Read Prias's story “The Elephant's Child” in The Common at thecommononline.org/the-elephants-child. Order The Mind Electric in all formats via Simon & Schuster at simonandschuster.com/books/The-Mind-Electric/. Learn more about Pria at www.priaanand.com. The Common is a print and online literary magazine publishing stories, essays, and poems that deepen our collective sense of place. On our podcast and in our pages, The Common features established and emerging writers from around the world. Read more and subscribe to the magazine at thecommononline.org, and follow us on Instagram, Bluesky, and Facebook. Emily Everett is managing editor of the magazine and host of the podcast. Her new debut novel All That Life Can Afford is the Reese's Book Club pick for April 2025. Her work has appeared in The New York Times Modern Love column, the Kenyon Review, Electric Literature, Tin House, and Mississippi Review. She was a 2022 Massachusetts Cultural Council Fellow in Fiction. Learn more about your ad choices. Visit megaphone.fm/adchoices
What if your blood pressure — even just a little too high — is quietly damaging your brain? What if it's increasing your risk of a heart attack or stroke, without you ever feeling a thing? In this episode, Professor Tim Spector reveals why blood pressure is one of the most overlooked – and most dangerous – health issues today. He explains why “normal for your age” might not be safe at all, why medication alone isn't the full answer, and how small, daily changes could dramatically reduce your risk of serious disease. Can your gut microbes raise your blood pressure? Can a banana be as powerful as a pill? Is beetroot juice really three times more effective than cutting salt? You'll also learn why 80% of the salt we eat isn't from the shaker, how stress and sleep secretly push your pressure up, and what most doctors still miss when treating hypertension. If you've ever been told your blood pressure's “fine” — or never measured it at all — this episode might change the way you think about your future health.
Dr. Andy Southerland talks with Dr. Seemant Chaturvedi about several studies presented at the 2025 European Stroke Organization Conference (ESOC). Disclosures can be found at Neurology.org.
Dr. Elizabeth Coon and Dr. Peter Novak discuss how central sensitization plays a role in the autonomic symptoms-sings dichotomy and the importance of addressing both conditions for optimal treatment. Show references: https://www.neurology.org/doi/10.1212/CPJ.0000000000200463
Matias and Greg interview Ying-Hui Fu, PhD, is a Professor of Neurology at UCSF and a world leader in the genetics of sleep. Her lab has discovered the first-known genes behind “natural short sleepers”. Her work bridges human genetics and neuroscience to uncover how to modulate sleep for brain health, aging, and neurodegenerative diseases.In this episode, we discuss:How some people thrive on 4–6 hours of sleep with rare genetic mutationsWhy sleep efficiency is more important than total hours sleptWhat short sleeper genes reveal about preventing Alzheimer's and autismWhy current sleep research tools miss deeper brain activity patternsWhat's next in sleep science with potential therapiesCredits:Created by Greg Kubin and Matias SerebrinskyHost: Matias Serebrinsky & Greg KubinProduced by Caitlin Ner & Nico V. Rey Find us at businesstrip.fm and psymed.venturesFollow us on Instagram and Twitter!Theme music by Dorian LoveAdditional Music: Distant Daze by Zack Frank
New studies show cannabis use is rising among older adults. Clinicians have been able to provide medical marijuana to eligible patients since 2016. But the legalization of cannabis in 2021 means increasing numbers of people are using it for a variety of symptoms and conditions including pain, anxiety, cancer symptoms and seizures. Guest host Racquel Stephen talks with local clinicians and a patient about this trend and about what patients should consider when requesting and using cannabis. Our guests: Leonid Vilensky, M.D., medical director of Upstate Pain Clinic Al Bain, patient who uses cannabis Paul Vermilion, M.D., assistant professor of palliative care in the Departments of Medicine, Pediatrics, and Neurology at the University of Rochester Medical Center Take our audience survey to help us learn more about you, and make a better show for you.
A generation ago, a big clot in the brain meant paralysis or worse. Today, doctors can diagnose clots on AI-enabled brain scans; provide life-saving, targeted medications; or snake a catheter from a patient's groin into the brain to vacuum out the clot. If they intervene in time, they can watch speech and movement return before the sedatives wear off. How did that happen—and what's still missing?In this episode of From Our Neurons to Yours, Stanford neuroscientist and neurocritical care specialist Marion Buckwalter, MD, PhD retraces the 70-year chain of curiosity-driven research—biochemistry, imaging, materials science, AI—behind today's remarkable improvements in stroke care. She also warns what future breakthroughs are at stake if support for basic science stalls.Learn MoreBuckwalter Lab siteHistory of Stroke Care:Tissue Plasminogen Activator for Acute Ischemic Stroke (NINDS) On the development of the first-gen clot-busting drug, tPA Optimizing endovascular therapy for ischemic stroke (NINDS) On the development of mechanical clot clearance using thrombectomy.Mechanical Thrombectomy for Large Ischemic Stroke (Neurology, 2023) A literature meta-analysis shows that thrombectomy improves stroke outcomes by 2.5X, on top of 2X improvements from clot-busting drugsThe uncertain future of federal support for scienceThe Gutting of America's Medical Research: Here Is Every Canceled or Delayed N.I.H. Grant (New York Times, 2025)Trump Has Cut Science Funding to Its Lowest Level in Decades (New York Times, 2025)We want to hear from your neurons! Email us at at neuronspodcast@stanford.edu or... Send us a text!Thanks for listening! If you're enjoying our show, please take a moment to give us a review on your podcast app of choice and share this episode with your friends. That's how we grow as a show and bring the stories of the frontiers of neuroscience to a wider audience. Learn more about the Wu Tsai Neurosciences Institute at Stanford and follow us on Twitter, Facebook, and LinkedIn.
Today on the show, we're joined by Noland Arbaugh — the first publicly known human to receive Neuralink's brain-computer interface implant. After a diving accident left him paralyzed from the shoulders down, Noland volunteered for one of the most experimental technologies of our time. Now, he can control digital devices with his mind. We'll explore the procedure, how the tech works, its ethical implications, and how merging with a machine is reshaping his view of identity, ability, consciousness, and human potential. This is a conversation about risk, resilience, and the future of the mind. Join us as we get rebelliously curious. Watch the YouTube interview - https://www.youtube.com/@RebelliouslyCurious Follow Chrissy Newton: Winner of the Canadian Podcast Awards for Best Science Series. YouTube: https://www.youtube.com/channel/UCM32gjHqMnYl_MOHZetC8Eg Instagram: https://www.instagram.com/beingchrissynewton/ X: https://twitter.com/chrissynewton?lang=en Facebook: https://www.facebook.com/BeingChrissyNewton Chrissy Newton's Website: https://chrissynewton.com Top Canadian Science Podcast: https://podcasts.feedspot.com/canadian_science_podcasts/
This episode of RCM Insights features Bo Bowman, VP of Strategic Accounts at Infinx, in a conversation with a neurology practice leader. Bo shares practical insights on optimizing revenue cycle management with proven strategies in charge capture, coding, system integration, and analytics—delivering better outcomes for neurology practices of any size.
William Sauvé, MD is Chief Medical Officer at Osmind, where he focuses on driving the success of Osmind's nationwide network of 800+ independent psychiatry practices and expanding access to cutting-edge psychiatric care. Dr. Sauvé brings extensive experience in interventional psychiatry, particularly in expanding access to treatments like Transcranial Magnetic Stimulation (TMS) and esketamine. Prior to joining Osmind, he served as Regional Medical Director for Greenbrook TMS NeuroHealth Centers, where he helped grow the organization's network to nearly 200 dedicated interventional psychiatry centers nationwide. His journey in psychiatry began with 11 years of distinguished service as an active-duty Navy psychiatrist. Following his residency, he was deployed to Iraq's Al Anbar Province as the regimental psychiatrist for the 7th Marine Regiment. During his time in the military, he started a procedural psychiatry program that included ECT and patient engagement in post-traumatic stress disorder (PTSD) treatment. After his military service, he served as Military Clinical Director at Poplar Springs Hospital for three years before founding Virginia Interventional Psychiatry, one of the first interventional psychiatry practices in the Mid-Atlantic region. His practice, dedicated to advancing TMS treatment, was the first practice acquired into what is now Greenbrook TMS NeuroHealth Centers, contributing to their nationwide expansion in providing TMS and esketamine treatments. Dr. Sauvé received his medical degree from the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He completed his residency in adult psychiatry through the National Capital Consortium, which includes the Walter Reed National Military Medical Center, Fort Belvoir Community Hospital, and USUHS. He earned his undergraduate degrees in Biology and Biochemistry from Mercyhurst College in Erie, Pennsylvania. He is certified by the American Board of Psychiatry and Neurology and serves as faculty at the Neuroscience Education Institute. He maintains an active membership in the American Psychiatric Association and the Clinical Transcranial Magnetic Stimulation Society. Website: https://www.osmind.org/ Timestamps: 00:00 Trailer 00:37 Introduction 03:39 Osmind as a comprehensive EMR solution 06:49 Brain stimulation boosts neuroplasticity 11:53 Military vs. academic medical experience 15:12 Weight loss for athletic pursuits 17:33 Reaching full speed safely 19:58 "Carnivorish" diet approach 24:08 Historic orchard ranch's new life 25:53 Rare bear sightings, abundant deer 31:15 Empowering independent mental health practitioners 32:25 Evolving psychiatric treatments 36:35 Pioneering comprehensive psychiatry 40:33 Weight loss without nutrition education 42:53 Where to find Will Join Revero now to regain your health: https://revero.com/YT Revero.com is an online medical clinic for treating chronic diseases with this root-cause approach of nutrition therapy. You can get access to medical providers, personalized nutrition therapy, biomarker tracking, lab testing, ongoing clinical care, and daily coaching. You will also learn everything you need with educational videos, hundreds of recipes, and articles to make this easy for you. Join the Revero team (medical providers, etc): https://revero.com/jobs #Revero #ReveroHealth #shawnbaker #Carnivorediet #MeatHeals #AnimalBased #ZeroCarb #DietCoach #FatAdapted #Carnivore #sugarfree Disclaimer: The content on this channel is not medical advice. Please consult your healthcare provider.
In this episode of the Neurology Minute, Dr. Alison Christy delves into another women's history minute to discuss Jean Holowach-Thurston.
Idiopathic intracranial hypertension (IIH), a condition of increased intracranial pressure (ICP), causes debilitating headaches and, in some, visual loss. The visual defects are often in the periphery and not appreciated by the patient until advanced; therefore, monitoring visual function with serial examinations and visual fields is essential. In this episode, Kait Nevel, MD speaks with John J. Chen, MD, PhD, and Susan P. Mollan, MBChB, PhD, FRCOphth, authors of the article “Treatment and Monitoring of Idiopathic Intracranial Hypertension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Chen is a professor of ophthalmology and neurology at the Mayo Clinic in Rochester, Minnesota. Dr. Mollan is an honorary professor of metabolism and systems science in the department of neuro-ophthalmology at University Hospitals Birmingham in Birmingham, United Kingdom. Additional Resources Read the article: Treatment and Monitoring of Idiopathic Intracranial Hypertension Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guests: @chenmayo, @DrMollan Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kate Nevel. Today, I'm interviewing Drs John Chen and Susan Mollan about their article on treatment and monitoring of idiopathic intracranial hypertension, which appears in the June 2025 Continuum issue on disorders of CSF dynamics. Drs Chen and Mollan, welcome to the podcast. And please, could you introduce yourselves to the audience? Dr Chen: Hello, everyone. I'm John Chen, one of the neuro-ophthalmologists at the Mayo Clinic. Thanks for having us here. Dr Mollan: Yeah, it's great to be with you here. I'm Susan Mollan. I'm a consultant neuro-ophthalmologist in Birmingham, England. Dr Nevel: Wonderful. So great to have you both here today, and our listeners. To start us off, talking about your article, can you share with us what you think is the most important takeaway from your article for the practicing neurologist out there? Dr Chen: Yeah, so our article talked about the treatment and monitoring of IIH. And I think one takeaway point is, IIH is becoming much more prevalent now that there's this worldwide obesity epidemic with obesity having- essentially being the largest risk factor for IIH other than female. It's really important to monitor vision because vision loss is often peripheral vision loss at first, which the patient may be completely unaware of. And so, it's important to pair up with an ophthalmologist so you can monitor the papilledema of the visual fields and make sure they don't get permanent vision loss. And in the article, we also talk about- there's been changes in the treatment of severe IIH, where traditionally, we used VP shunts; but there's been a trend toward using more venous sinus stenting in addition to the traditional surgeries. Dr Nevel: Great, thank you. I think probably most of our listeners or a lot of neurologists out there have a pretty good understanding of kind of the basics of the IIH. But can you kind of just go over a few key characteristics of IIH, and maybe some things that are less commonly known or things that are maybe just been kind of better understood over the past decade, perhaps? Dr Mollan: Yes, certainly. I think, as Dr Chen said, it's because this condition is becoming more prevalent, people recognize it. I think it's- we like to go back to the diagnostic criteria so that we're making a very accurate diagnosis. So, the patients may come in to the emergency room with, say, papilledema that's been identified elsewhere or crashing headaches. And it's important to go through that sort of diagnostic pathway, taking a blood pressure, taking a full blood count to make sure the patient is anemic, and then moving forward with that confirmation of papilledema into urgent neuroimaging, whether it's CT or MRI, but including venography to exclude a venous sinus thrombosis. And then if you have no structural lesion that's causing the raised ICP, it's moving forward with your lumbar puncture and carefully checking those pressures. But the patients may not only have crashing headache, they often have pulsatile tinnitus and neck pain. I think some of the features that we're now recognizing is the systemic metabolic effects that are unique to IIH. And so, there's an increased risk of cardiometabolic disease that's over and above what is conferred by obesity. Also, our patients have a sort of maternal health burden where they get impaired fertility, gestational diabetes and preeclampsia. And there's also an associated mental health burden, amongst other things. So we're really starting to understand the spectrum of the disease a bit more. Dr Nevel: Yeah, thank you for that. And that really struck me in your article, how important it is to be aware of those things so that we're making sure that we're managing our whole patient and connecting them with the appropriate providers for some of those other issues that may be associated. For the practicing neurologist out there without all the neuro-ophthalmology equipment, if you will, what should our bedside exam focus on to help us get maybe an early but accurate picture of the patient's visual function when we suspect IIH to be at play, perhaps before they can get in with the neuro-ophthalmologist? Dr Chen: Yeah, I think at the bedside you can still check visual acuity and confrontational visual fields, you know, with finger counting. Of course, you have to know that those are, kind of, crude kind of ways of screening. With papilledema, oftentimes the visual acuity is intact. And the confrontational visual fields aren't as sensitive as automated perimetry. Another important thing will be to do your direct ophthalmoscope and look at the amount of papilledema. If it's grade one or two papilledema on the more mild side, it's actually not vision threatening. It's the higher degrees of papilledema that can cause rapid vision loss. And so, if you look in and you see grade one papilledema, obviously you need to do the full workup, the MRI, MRV, lumbar puncture. But in terms of rapidly getting to an ophthalmologist to screen for vision loss, it's not going to be as important because you're not going to have vision loss at that low grade. If you look in and you see this rip-roaring papilledema, grade five papilledema, that patient is going to be at very severe risk of vision loss. So, I think that exam, looking at the optic nerve can be very helpful. And of course, talking to the patient about symptoms; is there decreased vision Is there double vision from a sixth nerve palsy? Are there transient visual obscurations which would indicate at least a higher degree of papilledema? That'd be helpful as well. Dr Nevel: Great, thank you. And when the patient does get in with a neuro-ophthalmologist, you talk in your article and, of course, in clinical practice, how OCT testing is important to monitor in this condition. Can you provide for the listeners the definition of OCT and how it plays a role in monitoring patients with IIH? Dr Mollan: Sure. So, OCT is short for optical coherence tomography imaging, and really the eye has been at the forefront of OCT alone. Our sort of cardiology colleagues are catching up on the imaging of blood vessels. But what it allows us to do is give us really good cross-sectional, anatomical-level changes that we can see both in the retina and also at the optic nerve head. And it gives us some really good measurements. It's not so good at sort of saying, is this definitely papilledema or not? That sort of lower end of disc elevation. But it is very good at ruling out what we call the pseudopapilledema. So, things like drusens or these other little masses we find underneath the optic nerve head. But in terms of monitoring, because we can longitudinally take these images and the reproducibility is pretty good at the optic nerve head, it allows us to see whether there's direct changes: either the papilledema getting worse or the papilledema getting better at the optic nerve head. It also gives us some indication of what's going on in the ganglion cell layer complex. And that can be helpful when we're thinking about sort of looking at structure versus function. So, ophthalmologists in general, we love OCT; and we spend much more time nowadays looking at the OCT than we really do the back of the eye. And it's just become critical for patients with papilledema to be able to be very accurate from visit to visit to see what's changing. Dr Nevel: How do you determine how frequently somebody needs to see the neuro-ophthalmologist with IIH and how often they need that OCT evaluation? Dr Chen: Once the diagnosis of IIH is made, how often they need to be seen and how frequent they need to be seen depends on the degree of papilledema. And again, OCT is really nice. You can quantify it and then different providers can actually use the same OCT numbers, which is super helpful. But again, if it's grade three papilledema or higher, or article thickness of 200 or higher, I tend to follow them a little bit more closely, trying to treat them more aggressively. Try to get the papilledema down into a safer zone. If it's grade one or two papilledema, we see them less frequently. So, my first visit might be three months out. They come with grade five papilledema, I'm seeing them within a few days to make sure that's papilledema's come down quickly because we're trying to decide, are they going to need surgery or not? Dr Nevel: Yeah, great. And that's a nice segue into talking a little bit about how we treat patients with IIH after the diagnosis is confirmed. And I'd like to just point out you have a very lovely figure in your article---Figure 5-6,---that I'd like to direct our listeners to read your article and check out that figure, which is kind of an algorithm on how we think about the various treatment options for patients who have IIH, which seems to rely a lot on the degree of presence of papilledema and the presence of vision disturbance. Could you maybe walk us through a little bit about how you think about the different treatment options for patients with IIH and when more urgent surgical intervention might be indicated? Dr Mollan: Yeah, sure. We always find it quite hard in any medical specialty to write these kind of flow diagrams because it's really an individual we're looking at. But these are kind of what we'd say is “broad brushstrokes” into those patients that we worry about, sort of, red disease in those patients, more amber disease. Now obviously, even those patients that may not have severe papilledema, they may have crashing headaches. So, they may be an urgent referral themselves because of that. And so, it's nice to try and work out which end of the spectrum you're working with. If we think of the papilledema, Dr Chen's already laid out the sort of lower end of the prison's scale---our grades one, our grades two---that we're less anxious about. And those patients, we would definitely be having discussions about medical management, which includes acetazolamide therapy; but also thinking about weight management. And it may well be that we talk a little bit further about weight management, but I think it's helpful to sort of coach those conversations after you've made a definite diagnosis. And then laying out the risk that's caused, potentially, the IIH in an individual. And then having a sort of open conversation with them about what changes they can have in their lifestyle alongside thinking about medical therapy. There's some patients with very low levels of papilledema that we decide not to put on medicines initially. As patients progress up that papilledema grade, we're definitely thinking about medical therapy. And our first line from the IIH treatment trial would be using acetazolamide, but we need to be thinking about using appropriate dosing. So, a lot of the patients that I see can be sent to me with very low doses that may be inappropriate for that person. In the IIHTT they used up to four grams daily in a divided dose. And you do need to counsel your patients when you're putting them on acetazolamide because of the side effects. You've got quite a nice table in this article about the side effects. I think if you get the patient on board, that they understand that they will experience side effects, that is helpful because they will expect it, and then possibly tolerate it a bit better. Moving through to that area where we're more anxious, that visual-threatening papilledema. As Dr Chen said, it's sort of like you look in and it's sort of “blood and thunder” in there. And you need to be getting on and encouraging the ophthalmologist to get a formal assessment of the visual field. It's very difficult to determine exactly the level at which- and we talk about the mean deviation in a lot of our research studies. But in general, it's a combination of things: the patient's journey to get to you, their symptoms, what's going on with the visual field, but what's also happening at the OCT. So, we look in and we see that fluid is seeping towards the fovea. We get very anxious, and those patients may not even have enough time for a rapid escalation of acetazolamide. It may well be at the first presentation, which we would term, like, fulminant; that we'd be thinking about surgical intervention. And I think before I stop, the other thing to say is, the surgical landscape is really changing. So, we're having some good studies coming out in terms of stenting. And so, there is a sort of bracket where it may well be that we are thinking about neuroradiological intervention in an earlier case. They may not quite be at that visual-threatening stage, but they may be resistant to medical treatments. Dr Nevel: Thank you for that. What do you think is a potential pitfall or a mistake to avoid, if you will, in the management of patients with IIH? Dr Chen: I think it's- in terms of pitfalls, I think the potential pitfalls I've seen are essentially patients where we don't necessarily create a good patient physician relationship. Where they don't have buy-ins on the treatment, they don't have buy-ins to come back, and they're lost to follow-up. And these patients can be dangerous, because they could have vision threatening papilledema and if not getting the appropriate treatment---and if they're not monitoring the vision---this can lead to poor outcomes. So, I've definitely seen that happen. As Dr Mollan said, you really have to tell them about the side effects from the medications. If you just take acetazolamide, letting them know the paresthesias and the changes in taste and some of these other side effects, they're going to immediately stop the medication. Again, and these medications do work, proven in the IIH treatment trial. So again, I think that patient-physician relationship is very important to make sure they have appropriate follow up. Dr Nevel: The topic of weight loss in this patient population can be tricky, and I know I talked with Susie in a prior interview about how to approach this topic with our patients in a sensitive and compassionate manner. Once this topic is broached, I find many patients are looking for advice on strategies for weight loss, or potentially medications or other interventions. How do you prioritize or think about the different weight loss strategies or treatments with your patients, and how do you think about the way that you recommend these different treatments or not? Dr Mollan: Yeah. I think that's a really great question because we sort of stray here into a specialty that we have not been trained in. One thing I definitely ask my patients: if they've been on a weight loss journey before, and what's worked for them and what's not worked for them. And within our different healthcare systems, we have access to different tiers of weight management approaches. But for the person sitting in front of me, that possibly there may be a long journey to access more professional care, it's about understanding. iIs there things that are free, such as, we have some apps in the National Health Service which are weight management applications where they can actually just start putting in their calories, their daily calorie intake. And those apps can be quite helpful and guiding in terms of targeting areas, but also informing the patient of what types of foods to avoid in their diet and what types of foods to include in their diet. And with some of the programs that are completely complementary, they also sometimes add on things about exercise. But I think it is a really difficult thing to manage as, say, an ophthalmologist or a neurologist, mainly because it's not our area of expertise. And I think we've all got to find, in our local hospitals and healthcare systems, those pathways where the patients may be able to access nutritional support, and sort of behavioral lifestyle therapy support, all the way through to the new medications for weight loss; and also for some people, bariatric surgery pathways. It's a tricky topic. Dr Nevel: So how should we counsel our patients about what to expect in the future in terms of visual outcomes? Dr Chen: I think a lot of that depends on the degree of papilledema when they present. If a patient comes in with grade five papilledema, that fulminant IIH that Dr Mollan had mentioned, these patients can have very severe vision loss. And even if we treat them very aggressively with high-dose medications and urgent surgical interventions, sometimes they can have permanent vision loss. And so, we counsel them that, you know, there's a strong chance that they're going to have a good amount of vision loss. But some patients, we're very surprised and we get a lot of vision back. So, we kind of set expectations, but we're cautiously optimistic that we can get vision back. If a patient presents with more mild papilledema like grade one or two papilledema, they're most likely not going to have any permanent vision loss as long as we're treating them, we're monitoring their vision, they're coming to their follow-ups. They tend to do very well from a vision perspective. Dr Nevel: That's great, thank you. And you know, ties into what you said earlier about really making sure that, you know, we create good- as with any patient, but good physician-patient relationships so that they, you know, trust us and they come to follow up so we can really monitor their vision appropriately. What do you think is going on in research in this area that's exciting? What do you think one of the next breakthroughs or thing that we need to understand the most about treatment and monitoring of IIH? Dr Chen: I think surgically, venous sinus stenting is going to probably take over the bulk of surgeries. We still need that randomized clinical trial, but we have some amazing outcomes with venous sinus stenting. And there's many efforts on randomized clinical trials for venous sinus stenting. So we'll have those results soon. From a medical standpoint, Dr Mollan can actually say, actually, more about this. Dr Mollan: I completely agree. The GLP-1 receptor agonists, the twofold prong approach: one is the weight loss where these patients, you know, have significant weight loss to put their disease into remission; and the other side of it is whether certain GLP-1s have the ability to reduce intracranial pressure. So, a phase 2 study that we undertook here in Birmingham did show that we were able to reduce intracranial pressure, but we don't think it's a class effect. So, I think the sort of big breakthrough will be looking at novel therapies like xenotide and other drugs that, say, work on the proximal kidney tubule. Are they able to reduce intracranial pressure directly? And I think we are on the cusp of a real breakthrough for this disease. Dr Nevel: Great. Thank you so much for chatting with me today. And I really learned a lot, appreciated the opportunity. I hope our listeners learned something today, too. So again, today I've been interviewing Drs John Chen and Susan Mollan about their article on treatment and monitoring of idiopathic intracranial hypertension, which appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining 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.
Welcome to the 28th episode of The Brain Podcast - the official podcast of the journals Brain and Brain Communications. This episode features a discussion with three authors of the Brain article entitled: The relationship between kidney health and neurodegenerative diseases Ms Melody Zuo, Dr Le Chang and Professor Sarah A Gagliano Taliun grace the Brain podcast with an insightful discussion into their recent review examining the connection between kidney disease and neurogeneration. They describe the critical microvascular connection as well as the role of uraemia and small molecules like erythropoetin. Additonally, methodological issues around survival bias, the use of mendelian randomisation and the importance of metadata in the growing age of large available datasets. Check out the full article on the Brain website and will be part of the August 2025 issue: https://doi.org/10.1093/brain/awaf113 This episode was co-hosted, edited and produced by Chaitra Sathyaprakash and Andreas Thermistocleous, edited and produced by Chaitra and Xin You Tai, co-produced by Antonia Johnston, original music by Ammar Al-Chalabi.
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In part one of this two-part series, Dr. Jeff Ratliff and Dr. Brin E. Freund discuss the incidence of acute symptomatic seizures during CAR T-cell therapy. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213535
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In this episode of the Brain & Life Podcast, co-host Dr. Katy Peters is joined by actors Micah Fowler, Kelsey Cardona, and Phoebe Rae Taylor. Micah shares how his Cerebral Palsy (CP) diagnosis differs from the character who he played on ABC's Speechless and his sister Kelsey explains the benefits of this representation that she's seen in real-time. Phoebe Rae then explains how she got her role in Disney's Out of my Mind and how acting has inspired her for the future. Dr. Peters is then joined by Dr. Ann Tilton, a Professor of Neurology and Pediatrics at LSU Health New Orleans with more than 30 years of experience in the field. Dr. Tilton explains what CP is, how it can differ from person to person, and what advancements the community can look forward to. Additional Resources What is Cerebral Palsy? Biking Gives Freedom to a Teen with Cerebral Palsy Becky Dilworth Skied and Raised a Family Despite Cerebral Palsy Other Brain & Life Podcast Episodes on Similar Topics Scoring Goals with CP Soccer's Shea Hammond Gavin McHugh is Building an Acting Career and a Community with Cerebral Palsy RJ Mitte on Living Confidently with Cerebral Palsy We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? Record a voicemail at 612-928-6206 Email us at BLpodcast@brainandlife.org Social Media: Guests: Micah Fowler @micahdfowler; Kelsey Cardona @thekelseycardona; Phoebe Rae Taylor @phoeberaetaylorx Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD
Idiopathic intracranial hypertension (IIH) is characterized by symptoms and signs of unexplained elevated intracranial pressure (ICP) in an alert and awake patient. The condition has potentially devastating effects on vision, headache burden, increased cardiovascular disease risk, sleep disturbance, and depression. In this episode, Teshamae Monteith, MD, FAAN speaks with Aileen A. Antonio, MD, FAAN, author of the article “Clinical Features and Diagnosis of Idiopathic Intracranial Hypertension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Antonio is an associate program director of the Hauenstein Neurosciences Residency Program at Trinity Health Grand Rapids and an assistant clinical professor at the Michigan State University College of Osteopathic Medicine in Lansang, Michigan. Additional Resources Read the article: Clinical Features and Diagnosis of Idiopathic Intracranial Hypertension Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @aiee_antonio Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: Hi, this is Dr Teshamae Monteith. Today I'm interviewing Dr Aileen Antonio about her article on clinical features and diagnosis of idiopathic intracranial hypertension, which appears in the June 2025 Continuum issue on disorders of CSF dynamics. Hi, how are you? Dr Antonio: Hi, good afternoon. Dr Monteith: Thank you for being on the podcast. Dr Antonio: Thank you for inviting me, and it's such an honor to write for the Continuum. Dr Monteith: So why don't you start off with introducing yourself? Dr Antonio: So as mentioned, I'm Aileen Antonio. I am a neuro-ophthalmologist, dually trained in both ophthalmology and neurology. I'm practicing in Grand Rapids, Michigan Trinity Health, and I'm also the associate program director for our neurology residency program. Dr Monteith: So, it sounds like the residents get a lot of neuro-ophthalmology by chance in your curriculum. Dr Antonio: For sure. They do get fed that a lot. Dr Monteith: So why don't you tell me what the objective of your article was? Dr Antonio: Yes. So idiopathic intracranial hypertension, or IIH, is a condition where there's increased intracranial pressure, but without an obvious cause. And with this article, we want our readers---and our listeners right now---to recognize that the typical symptoms and learning about the IIH diagnostic criteria are key to avoiding errors, overdiagnosis, or sometimes even misdiagnosis or underdiagnosis. Thus, we help make the most of our healthcare resources. Early diagnosis and management are crucial to prevent disability from intractable headaches or even vision loss, and it's also important to know when to refer the patients to the appropriate specialists early on. Dr Monteith: So, it sounds like your central points are really getting that diagnosis early and managing the patients and knowing how to triage patients to reduce morbidity and complications. Is that correct? Dr Antonio: That is correct and very succinct, yes. Dr Monteith: And so, are there any more recent advances in the diagnosis of IIH? Dr Antonio: Yes. And one of the tools that we've been using is what we call the optical coherence tomography. A lot of people, neurologists, physicians, PCP, ER doctors; how many among those physicians are well-versed in doing an eye exam, looking at the optic disc? And this is a great tool because it is noninvasive, it is high resolution imaging technique that allows us to look at the optic nerve without even dilating the eye. And we can measure that retinal nerve fiber layer, or RNFL; and that helps us quantify the swelling that is visible or inherent in that optic nerve. And we can even follow that and monitor that over time. So, this gives us another way of looking at their vision and getting that insight as to how healthy is their vision still, along with the other formal visual tests that we do, including perimetry or visual field testing. And then all of these help in catching potentially early changes, early worsening, that may happen; and then we can intervene more easily. Dr Monteith: Great. So, it sounds like there's a lot of benefits to this newer technology for our patients. Dr Antonio: That is correct. Dr Monteith: So, I read in the article about the increased incidence of IIH, and I have to say that I completely agree with you because I'm seeing so much of it in my clinic, even as a headache specialist. And I had a talk with a colleague who said that the incidence of SIH and IIH are similar. And I was like, there's no way. Because I see, I can see several people with IIH just in one day. That's not uncommon. So, tell me what your thoughts are on the incidence, the rising incidence of IIH; and we understand that it's the condition associated with obesity, but it sounds like you have some other underlying drivers of this problem. Dr Antonio: Yes, that is correct. So, as you mentioned, IIH tends to affect women of childbearing age with obesity. And it's interesting because as you've seen that trend, we see more of these IIH cases recently, which seem to correlate with that rising rate of obesity. And the other thing, too, is that this trend can readily add to the burden of managing IIH, because not only are we dealing with the headaches or the potential loss of vision, but also it adds to the burden of healthcare costs because of the other potential comorbidities that may come with it, like cardiovascular risk factors, PCOS, and sleep apnea. Dr Monteith: So why don't we just talk about the diagnosis of IIH? Dr Antonio: IIH, idiopathic intracranial hypertension, is also called pseudotumor cerebri. It's essentially a condition where a person experiences increased intracranial pressure, but without any obvious cause. And the tricky part is that the patients, they're usually fully awake and alert. So, there's no obvious tumor, brain tumor or injury that causes the increased ICP. It's really, really important to rule out other conditions that might cause these similar symptoms; again, like brain tumors or even the cerebral venous sinus thrombosis. Many patients will have headaches or visual disturbances like transient visual obscurations---we call them TVOs---or double vision or diplopia. The diplopia is usually related to a sixth nerve palsy or an abducens palsy. Some may also experience some back pain or what we call pulsatile tinnitus, which is that pulse synchronous ringing in their ears. The biggest sign that we see in the clinic would be that papilledema; and papilledema is a term that we only use, specifically use, for those optic nerve edema changes that is only associated with increased intracranial pressure. So, performing of endoscopy and good eye exam is crucial in these patients. We usually use the modified Dandy criteria to diagnose IIH. And again, I cannot emphasize too much that it's really important to rule out other secondary causes to that increased intracranial pressure. So, after that thorough neurologic and eye evaluation with neuroimaging, we do a lumbar puncture to measure the opening pressure and to analyze the cerebrospinal fluid. Dr Monteith: One thing I learned from your article, really just kind of seeing all of the symptoms that you mentioned, the radicular pain, but also- and I think I've seen some papers on this, the cognitive dysfunction associated with IIH. So, it's a broader symptom complex I think than people realize. Dr Antonio: That is correct. Dr Monteith: So, you mentioned TVOs. Tell me, you know, if I was a patient, how would you try and elicit that from me? Dr Antonio: So, I would usually just ask the patient, while you're sitting down just watching TV---some of my patients are even driving as this happens---they would suddenly have these episodes of blacking out of vision, graying out of vision, vision loss, or blurred vision that would just happen, from seconds to less than a minute, usually. And they can happen in one eye or the other eye or both eyes, and even multiple times a day. I had a patient, it was happening 50 times a day for her. It's important to note that there is no pain associated with it most of the time. The other thing too is that it's different from the aura that patients with migraines would have, because those auras are usually scintillating and would have what we call the positive phenomena: the flashing lights, the iridescence, and even the fortification that they see in their vision. So definitely TVOs are not the migraine auras. Sometimes the TVOs can also be triggered by sudden changes in head positions or even a change in posture, like standing up quickly. The difference, though, between that and, like, the graying out of vision or the tunneling vision associated with orthostatic hypotension, is that the orthostatic hypotension would also have that feeling of lightheadedness and dizziness that would come with it. Dr Monteith: Great. So, if someone feels lightheaded, less likely to be a TVO if they're bending down and they have that grain of vision. Dr Antonio: That is correct. Dr Monteith: Definitely see patients like that in clinic. And if they have fluoride IIH, I'm like, I'll call it a TVO; if they don't, I'm like, it's probably more likely to be dizziness-related. And then we also have patient migraines that have blurriness that's nonspecific, not necessarily associated with aura. But I think in those patients, it's usually not seconds long, it's usually probably longer episodes of blurriness. Would you agree there, or…? Dr Antonio: I would agree there, and usually the visual aura would precede the headache that is very characteristic of their migraine, very stereotypical for their migraines. And then it would dissipate slowly over time as well. With TVOs, they're brisk and would not last, usually, more than a minute. Dr Monteith: So, why don't we talk about routine imaging? Obviously, ordering an MRI, and I read also getting an MRV is important. Dr Antonio: It is very important because, one: I would say IIH is also a diagnosis of exclusion. We need to make sure that the increased ICP is not because of a brain tumor or not because of cerebral venous sinus thrombosis. So, it's important to get the MRI of the brain as well as the MRV of the head. Dr Monteith: Do you do that for all patients' MRV, and how often do you add on an orbital study? Dr Antonio: I usually do not add on an orbital study because it's not really going to change my management at that point. I really get that MRI of the brain. Now the MRV, for most of my patients, I would order it already just because the population that I see, I don't want to lose them. And sometimes it's that follow-up, and that is the difficult part; and it's an easy add on to the study that I'm going to order. Again, it depends with the patient population that you have as well, and of course the other symptoms that may come with it. Dr Monteith: So, why don't we talk a little bit about CSF reading and how these set values, because we get people that have readings of 250 millimeters of water quite frequently and very nonspecific, questionable IIH. And so, talk to me about the set value. Dr Antonio: Right. So, the modified Dandy criteria has shown that, again, we consider intracranial pressure to be elevated for adults if it's above 250 millimeters water; and then for kids if it's above 280 millimeters of water. Knowing that these are taken in the left lateral decubitus position, and assuming also that the patients were awake and not sedated during the measurement of the CSF pressure. The important thing to know about that is, sometimes when we get LPs under fluoroscopy or under sedation, then these can cause false elevation because of the hypercapnia that elevated carbon dioxide, and then the hypoventilation that happens when a patient is under sedation. Dr Monteith: You know, sometimes you see people with opening pressures a little bit higher than 25 and they're asymptomatic. Well, the problem with these opening pressure values is that they can vary somewhat even across the day. People around 25, you can be normal, have no symptoms, and have opening pressure around 25- or 250; and so, I'm just asking about your approach to the CSF values. Dr Antonio: So again, at the end of the day, what's important is putting everything together. It's the gestalt of how we look at the patient. I actually had an attending tell me that there is no patient that read the medical textbook. So, the, the important thing, again, is putting everything together. And what I've also seen is that some patients would tell me, oh, I had an opening pressure of 50. Does that mean I'm in a dire situation? And they're so worried and they just attach to numbers. And for me, what's important would be, what are your symptoms? Is your headache, right, really bad, intractable? Number two: are you losing vision, or are you at that cusp where your optic nerve swelling or papilledema is so severe that it may soon lead to vision loss? So, putting all of these together and then getting the neuroimaging, getting the LP. I tell my residents it's like icing on the cake. We know already what we're dealing with, but then when we get that confirmation of that number… and sometimes it's borderline, but this is the art of neurology. This is the art of medicine and putting everything together and making sure that we care and manage it accordingly. Dr Monteith: Let's talk a little bit about IIH without papilledema. Dr Antonio: So, let's backtrack. So, when a patient will fit most of the modified Dandy criteria for IIH, but they don't have the papilledema or they don't have abducens palsy, the diagnosis then becomes tricky. And in these kinds of cases, Dr Friedman and her colleagues, when they did research on this, suggested that we might consider the diagnosis of IIH. And she calls this idiopathic intracranial hypertension without papilledema, IIHWOP. They say that if they meet the other criteria for modified Dandy but show at least three typical findings on MRI---so that flattening of the posterior globe, the tortuosity of the optic nerves, the empty sella or the partially empty sella, and even the narrowing of the transverse venous sinuses---so if you have three of these, then potentially you can call these cases as idiopathic intracranial hypertension without papilledema. Dr Monteith: Plus, the opening pressure elevation. I think that's key, right? Getting that as well. Dr Antonio: Yes. Sometimes IIHWOP may still be a gray area. It's a debate even among neuro-ophthalmologists, and I bet even among the headache specialists. Dr Monteith: Well, I know that I've had some of these conversations, and it's clear that people think this is very much overdiagnosed. So, that's why I wanted to plug in the LP with that as well. Dr Antonio: Right. And again, we have not seen yet whether is, this a spectrum, right? Of that same disease just manifesting differently, or are they just sharing a same pathway and then diverging? But what I want to emphasize also is that the treatment trials that we've had for IIH do not include IIHWOP patients. Dr Monteith: That is an important one. So why don't you wrap this up and tell our listeners what you want them to know? Now's the time. Dr Antonio: So, the- again, with IIH, with idiopathic intracranial hypertension, what is important is that we diagnose these patients early. And I think that some of the issues that come into play in dealing with these patients with IIH is that, one: we may have anchoring bias. Just because we see a female with obesity, of reproductive age, with intractable headaches, it does not always mean that what we're dealing with is IIH. The other thing, too, is that your tools are already available to you in your clinic in diagnosing IIH, short of the opening pressure when you get the lumbar puncture. And I need to emphasize the importance of doing your own fundoscopy and looking for that papilledema in these patients who present to you with intractable headaches or abducens palsy. What I want people to remember is that idiopathic intracranial hypertension is not optic nerve sheath distension. So, these are the stuff that you see on neuroimaging incidentally, not because you sent them, because they have papilledema, or because they have new headaches and other symptoms like that. And the important thing is doing your exam and looking at your patients. Dr Monteith: Today, I've been interviewing Dr Aileen Antonio about her article on clinical features and diagnosis of idiopathic intracranial hypertension, which appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Thank you again. Dr Antonio: Thank you. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.
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