BrainWaves: A Neurology Podcast

Myoclonus is the most etiologically non-specific motor manifestation of neurologic and systemic disease. It’s like slurred speech or altered mental status. But in the appropriate context, it can become a useful clue in your differential diagnosis. Dr. John Caviness of the Mayo Clinic joins Jim Siegler this week for a discussion on this abnormal movement and what it may indicate.

Produced by James E. Siegler and John Caviness. Music courtesy of Kevin McLeod and E’s Jammy Jams. “Endings” and  “What’s the Angle” were produced by Shane Ivers (https://www.silvermansound.com). The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.

REFERENCES

1. Caviness JN. Myoclonus and neurodegenerative disease--what's in a name? Parkinsonism Relat Disord. 2003;9:185-92.
2. Caviness JN. Parkinsonism & related disorders. Myoclonus. Parkinsonism Relat Disord. 2007;13 Suppl 3:S375-84.
3. Caviness JN. Pathophysiology and treatment of myoclonus. Neurol Clin. 2009;27:757-77, vii.
4. Zutt R, van Egmond ME, Elting JW, van Laar PJ, Brouwer OF, Sival DA, Kremer HP, de Koning TJ and Tijssen MA. A novel diagnostic approach to patients with myoclonus. Nature reviews Neurology. 2015;11:687-97.
5. Levy A and Chen R. Myoclonus: Pathophysiology and Treatment Options. Current treatment options in neurology. 2016;18:21.
6. Caviness JN. Myoclonus. Continuum (Minneap Minn). 2019;25:1055-1080.

How much can a picture mean to a patient? How much can it mean to a provider? And what if that picture is an MRI, instead of a photograph? In this episode of our Humanities section, we deliver 2 perspectives on imaging in patient care. On the one hand, MRI and CT scan can tell you a lot about a patient's medical history and active medical disease. On the other, a personal photograph may illuminate the social history in a way words may fail to capture.

The content in this episode was approved and vetted by Salim Chahin. BrainWaves podcasts and online content are intended for medical education purposes only and should not be used for routine clinical decision making.

*Remastered for release on 11 January 2018.

Unfortunately, stroke is all too common. Nearly 1 million new strokes are diagnosed in the US each year. And this means that complications of stroke--even if rare--may also be common. One such complication is hemorrhagic transformation. This week, Dr. Ava Liberman reviews a clinical case of hemorrhage following ischemic stroke.

Produced by James E. Siegler. Music by Ghost, Kevin McLeod, and Scott Holmes. Voiceover by David Manly. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

1. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jimenez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, American Heart Association Council on E, Prevention Statistics C and Stroke Statistics S. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018;137:e67-e492.
2. Frontera JA, Lewin JJ, 3rd, Rabinstein AA, Aisiku IP, Alexandrov AW, Cook AM, del Zoppo GJ, Kumar MA, Peerschke EI, Stiefel MF, Teitelbaum JS, Wartenberg KE and Zerfoss CL. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocritical care. 2016;24:6-46.
3. Prabhakaran S, Gupta R, Ouyang B, John S, Temes RE, Mohammad Y, Lee VH and Bleck TP. Acute brain infarcts after spontaneous intracerebral hemorrhage: a diffusion-weighted imaging study. Stroke; a journal of cerebral circulation. 2010;41:89-94.

REFERENCES

1. McKeith IG. Spectrum of Parkinson's disease, Parkinson's dementia, and Lewy body dementia. Neurol Clin. 2000;18:865-902.
2. Frieling H, Hillemacher T, Ziegenbein M, Neundorfer B and Bleich S. Treating dopamimetic psychosis in Parkinson's disease: structured review and meta-analysis. Eur Neuropsychopharmacol. 2007;17:165-71.
3. Galvin JE, Duda JE, Kaufer DI, Lippa CF, Taylor A and Zarit SH. Lewy body dementia: the caregiver experience of clinical care. Parkinsonism Relat Disord. 2010;16:388-92.
4. Koga S, Aoki N, Uitti RJ, van Gerpen JA, Cheshire WP, Josephs KA, Wszolek ZK, Langston JW and Dickson DW. When DLB, PD, and PSP masquerade as MSA: an autopsy study of 134 patients. Neurology. 2015;85:404-12.
5. Stinton C, McKeith I, Taylor JP, Lafortune L, Mioshi E, Mak E, Cambridge V, Mason J, Thomas A and O'Brien JT. Pharmacological Management of Lewy Body Dementia: A Systematic Review and Meta-Analysis. Am J Psychiatry. 2015;172:731-42.
6. Desmarais P, Massoud F, Filion J, Nguyen QD and Bajsarowicz P. Quetiapine for Psychosis in Parkinson Disease and Neurodegenerative Parkinsonian Disorders: A Systematic Review. J Geriatr Psychiatry Neurol. 2016;29:227-36.
7. McKeith IG, Boeve BF, Dickson DW, Halliday G, Taylor JP, Weintraub D, Aarsland D, Galvin J, Attems J, Ballard CG, Bayston A, Beach TG, Blanc F, Bohnen N, Bonanni L, Bras J, Brundin P, Burn D, Chen-Plotkin A, Duda JE, El-Agnaf O, Feldman H, Ferman TJ, Ffytche D, Fujishiro H, Galasko D, Goldman JG, Gomperts SN, Graff-Radford NR, Honig LS, Iranzo A, Kantarci K, Kaufer D, Kukull W, Lee VMY, Leverenz JB, Lewis S, Lippa C, Lunde A, Masellis M, Masliah E, McLean P, Mollenhauer B, Montine TJ, Moreno E, Mori E, Murray M, O'Brien JT, Orimo S, Postuma RB, Ramaswamy S, Ross OA, Salmon DP, Singleton A, Taylor A, Thomas A, Tiraboschi P, Toledo JB, Trojanowski JQ, Tsuang D, Walker Z, Yamada M and Kosaka K. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017;89:88-100.
8. Armstrong MJ. Lewy Body Dementias. Continuum (Minneap Minn). 2019;25:128-146.
9. Taylor JP, McKeith IG, Burn DJ, Boeve BF, Weintraub D, Bamford C, Allan LM, Thomas AJ and O'Brien JT. New evidence on the management of Lewy body dementia. The Lancet Neurology. 2020;19:157-169.

In 2012, more than 13,000 Americans were inadvertently exposed to contaminated medical equipment, resulting in one of the largest fungal outbreaks in US history. Despite rapid mobilization by the CDC and FDA, 751 patients died from complications of fungal brain infections.

But this is more the exception than the rule when it comes to fungal infections of the central nervous system. This week on the BrainWaves podcast, we review the common (and uncommon) clinical, radiographic, and diagnostic features of fungal brain disease. Enjoy!

Produced by James E. Siegler. Music by Jahzzar, Swelling, The Insider, and Chris Zabriskie. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

REFERENCES

1. Kainer MA, Reagan DR, Nguyen DB, Wiese AD, Wise ME, Ward J, Park BJ, Kanago ML, Baumblatt J, Schaefer MK, Berger BE, Marder EP, Min JY, Dunn JR, Smith RM, Dreyzehner J, Jones TF and Tennessee Fungal Meningitis Investigation T. Fungal infections associated with contaminated methylprednisolone in Tennessee. The New England journal of medicine. 2012;367:2194-203.
2. Smith RM, Schaefer MK, Kainer MA, Wise M, Finks J, Duwve J, Fontaine E, Chu A, Carothers B, Reilly A, Fiedler J, Wiese AD, Feaster C, Gibson L, Griese S, Purfield A, Cleveland AA, Benedict K, Harris JR, Brandt ME, Blau D, Jernigan J, Weber JT, Park BJ and Multistate Fungal Infection Outbreak Response T. Fungal infections associated with contaminated methylprednisolone injections. The New England journal of medicine. 2013;369:1598-609.
3. McCotter OZ, Smith RM, Westercamp M, Kerkering TM, Malani AN, Latham R, Peglow SL, Mody RK, Pappas PG and Chiller TM. Update on Multistate Outbreak of Fungal Infections Associated with Contaminated Methylprednisolone Injections, 2012-2014. MMWR Morbidity and mortality weekly report. 2015;64:1200-1.
4. Schwartz S, Kontoyiannis DP, Harrison T and Ruhnke M. Advances in the diagnosis and treatment of fungal infections of the CNS. The Lancet Neurology. 2018;17:362-372.
5. Benedict K and Park BJ. Invasive fungal infections after natural disasters. Emerg Infect Dis. 2014;20:349-55.
6. Brouwer MC, Tunkel AR, McKhann GM, 2nd and van de Beek D. Brain abscess. The New England journal of medicine. 2014;371:447-56.
7. Wilson MR, O'Donovan BD, Gelfand JM, Sample HA, Chow FC, Betjemann JP, Shah MP, Richie MB, Gorman MP, Hajj-Ali RA, Calabrese LH, Zorn KC, Chow ED, Greenlee JE, Blum JH, Green G, Khan LM, Banerji D, Langelier C, Bryson-Cahn C, Harrington W, Lingappa JR, Shanbhag NM, Green AJ, Brew BJ, Soldatos A, Strnad L, Doernberg SB, Jay CA, Douglas V, Josephson SA and DeRisi JL. Chronic Meningitis Investigated via Metagenomic Next-Generation Sequencing. JAMA Neurol. 2018.
8. Baddley JW, Salzman D and Pappas PG. Fungal brain abscess in transplant recipients: epidemiologic, microbiologic, and clinical features. Clin Transplant. 2002;16:419-24.