BrainWaves: A Neurology Podcast

This week on the program, we bring to you a special episode on the impact of the COVID-19 pandemic on the neurology 2021 match--and potentially MANY subsequent matches. Jim Siegler is joined by the Assistant Program Director of the Cooper Neurology Residency Program, Olga Thon, and the creators of the @NMatch2021 Twitter account (who you should DEFINITELY follow after listening to our episode). If you are an applicant for the 2021 cycle, this show is MANDATORY.

(only kidding, this is just a podcast)

Produced by James E. Siegler, with assistance by Olga Thon, Adriana Romirez, Dylan Del Papa, Justine Ker, and Alvin Singh. Music courtesy of Akash Gandi, Little Glass Men, Kevin MacLeod, Josh Woodward, Julie Maxwell, and Kai Engel. 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.

Halloween is one of the most exciting and festive holidays, but this year I imagine many of us are going to spend it indoors. To help pass the time, enjoy this seasonal special about the neurologic manifestations of zombie-ism. Today's program is a re-run from 2017, featuring Dr. Brian Hanrahan, and has been remastered and updated with some recent additions in light of the coronavirus pandemic.

Produced by James E. Siegler. Music courtesy of Andrew Sacco, Ars Sonor, Yan Terrien, and Unheard Music Concepts. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig, with some original recordings out of Studio 3. 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. Smith TC. Zombie infections: Epidemiology, treatment, and prevention. Bmj. 2015;351:h6423
2. Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R. "Zombie" outbreak caused by the synthetic cannabinoid amb-fubinaca in new york. The New England journal of medicine. 2017;376:235-242
3. Rabinovitz B, Jaywant A, Fridman CB. Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: Implications for the current covid-19 pandemic. Clin Neuropsychol. 2020:1-27
4. Gilmour SJ, Saito E, Yoneoka D. Importance of survival strategies after a zombie pandemic. Bmj. 2016;532:i259
5. Hughes DP, Andersen SB, Hywel-Jones NL, Himaman W, Billen J, Boomsma JJ. Behavioral mechanisms and morphological symptoms of zombie ants dying from fungal infection. BMC Ecol. 2011;11:13

You know the triad for normal pressure hydrocephalus (NPH). Wet, wobbly, and wacky. And you have probably heard of the Evan’s index—the relative proportion of the lateral ventricles in reference to the inner table of the skull. But you might not have heard of high-convexity tight sulci.

Now you have.

Produced by James E. Siegler. Music courtesy of Jason Shaw, Javolenus, and Lee Rosevere, under a Creative Commons License. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. 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. Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N and Imamura T. CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. AJNR American journal of neuroradiology. 1998;19:1277-84.
2. Sasaki M, Honda S, Yuasa T, Iwamura A, Shibata E and Ohba H. Narrow CSF space at high convexity and high midline areas in idiopathic normal pressure hydrocephalus detected by axial and coronal MRI. Neuroradiology. 2008;50:117-22.
3. Allali G, Laidet M, Armand S, Momjian S, Marques B, Saj A and Assal F. A combined cognitive and gait quantification to identify normal pressure hydrocephalus from its mimics: The Geneva's protocol. Clinical neurology and neurosurgery. 2017;160:5-11.
4. Graff-Radford J, Gunter JL, Jones DT, Przybelski SA, Schwarz CG, Huston J, 3rd, Lowe V, Elder BD, Machulda MM, Gunter NB, Petersen RC, Kantarci K, Vemuri P, Mielke MM, Knopman DS, Graff-Radford NR and Jack CR, Jr. Cerebrospinal fluid dynamics disorders: Relationship to Alzheimer biomarkers and cognition. Neurology. 2019;93:e2237-e2246.

The locked-in syndrome is a rare clinical consequence following many types of neurologic injury. In general, the locked-in patient is fully paralyzed, with perhaps minimal function of the fingers, the eyes, or the mouth. What's more, the gross motor dysfunction is enormously disproportional to the cognitive function of the individual. The locked-in patient is conscious and completely aware of their surroundings. They can often hear, see, smell, and feel just as any other person would. But because of their profound physical disability, they have a very limited means of communicating even the simplest thoughts. "I feel hot." "My head hurts." "My cheek itches."

It may surprise you that the patient's perspective of their condition is wholly different from how the healthcare provider or caregiver imagines it to be. This week on the program, Dr. Lauren Elman (Pennsylvania Medical Center ALS Multi-disiplinary Clinic) reviews this discrepancy. Dr. Elman also shares her experience  managing this inevitable consequence of ALS when all life-sustaining measures are desired.

REFERENCES

1. Patterson JR and Grabois M. Locked-in syndrome: a review of 139 cases. Stroke; a journal of cerebral circulation. 1986;17:758-64.
2. Trail M, Nelson ND, Van JN, Appel SH and Lai EC. A study comparing patients with amyotrophic lateral sclerosis and their caregivers on measures of quality of life, depression, and their attitudes toward treatment options. Journal of the neurological sciences. 2003;209:79-85.
3. Rousseau MC, Baumstarck K, Alessandrini M, Blandin V, Billette de Villemeur T and Auquier P. Quality of life in patients with locked-in syndrome: Evolution over a 6-year period. Orphanet J Rare Dis. 2015;10:88.
4. Kuzma-Kozakiewicz M, Andersen PM, Ciecwierska K, Vazquez C, Helczyk O, Loose M, Uttner I, Ludolph AC and Lule D. An observational study on quality of life and preferences to sustain life in locked-in state. Neurology. 2019;93:e938-e945.
5. Niedermeyer S, Murn M and Choi PJ. Respiratory Failure in Amyotrophic Lateral Sclerosis. Chest. 2019;155:401-408.

On rounds, I sometimes joke that the two most important organs in the body are the right and left hemisphere. Only one of many, terrible, dad jokes my poor residents and students have to endure. But what happens when one organ fails, or you have to remove it?

This week on BrainWaves, we’ll review a unique neurologic condition where such incredible hemispheric dysfunction can only be treated by surgically removing half of the brain. And OMG, a show about pediatrics!

** IF YOU’RE TAKING YOUR NEUROLOGY BOARDS THIS SUMMER, CHECK OUT THE PENN NEUROLOGY BOARD REVIEW COURSE AT https://upenn.cloud-cme.com/default.aspx?P=5&EID=65373. AND FOR A DISCOUNTED RATE ON THE ONLINE OR STREAMING RESOURCES, USE PROMO CODE ‘WAVES2020’. **

Produced by James E. Siegler. Music courtesy of Ars Sonor, Daniel Birch, Jon Watts, and Lish Grooves. 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. Rasmussen T, Olszewski J and Lloydsmith D. Focal seizures due to chronic localized encephalitis. Neurology. 1958;8:435-45.
2. Hart YM, Cortez M, Andermann F, Hwang P, Fish DR, Dulac O, Silver K, Fejerman N, Cross H, Sherwin A and et al. Medical treatment of Rasmussen's syndrome (chronic encephalitis and epilepsy): effect of high-dose steroids or immunoglobulins in 19 patients. Neurology. 1994;44:1030-6.
3. Andrews PI, Dichter MA, Berkovic SF, Newton MR and McNamara JO. Plasmapheresis in Rasmussen's encephalitis. Neurology. 1996;46:242-6.
4. Leach JP, Chadwick DW, Miles JB and Hart IK. Improvement in adult-onset Rasmussen's encephalitis with long-term immunomodulatory therapy. Neurology. 1999;52:738-42.
5. Bien CG, Granata T, Antozzi C, Cross JH, Dulac O, Kurthen M, Lassmann H, Mantegazza R, Villemure JG, Spreafico R and Elger CE. Pathogenesis, diagnosis and treatment of Rasmussen encephalitis: a European consensus statement. Brain. 2005;128:454-71.
6. Varadkar S, Bien CG, Kruse CA, Jensen FE, Bauer J, Pardo CA, Vincent A, Mathern GW and Cross JH. Rasmussen's encephalitis: clinical features, pathobiology, and treatment advances. The Lancet Neurology. 2014;13:195-205.
7. Tan AP, Wong YLJ, Lin BJ, Yong HRC and Mankad K. Clinico-radiological approach to cerebral hemiatrophy. Childs Nerv Syst. 2018;34:2377-2390.

Can you hear that too? You can’t? Well, that doesn’t mean I’m having auditory hallucinations. It could just be tinnitus, which describes the irritating sound of ringing, buzzing, clicking, or hissing that affect 10-20% of the world's population. But is this a ringing in the ears, or a ringing in the brain?

** IF YOU’RE TAKING YOUR NEUROLOGY BOARDS THIS SUMMER, CHECK OUT THE PENN NEUROLOGY BOARD REVIEW COURSE AT https://upenn.cloud-cme.com/default.aspx?P=5&EID=65373. AND FOR A DISCOUNTED RATE ON THE ONLINE OR STREAMING RESOURCES, USE PROMO CODE ‘WAVES2020’. **

Produced by James E. Siegler. Music courtesy of Andrew Sacco, Jon Watts, Kai Engel, Lovira, Patches, and Kevin McLeod. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Sound effects by Mike Koenig and Daniel Simion. 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. Arenberg IK, Countryman LF, Bernstein LH and Shambaugh GE, Jr. Van Gogh had Meniere's disease and not epilepsy. JAMA : the journal of the American Medical Association. 1990;264:491-3.
2. Sullivan M, Katon W, Russo J, Dobie R and Sakai C. A randomized trial of nortriptyline for severe chronic tinnitus. Effects on depression, disability, and tinnitus symptoms. Archives of internal medicine. 1993;153:2251-9.
3. Dobie RA. A review of randomized clinical trials in tinnitus. Laryngoscope. 1999;109:1202-11.
4. Lockwood AH, Salvi RJ, Burkard RF, Galantowicz PJ, Coad ML and Wack DS. Neuroanatomy of tinnitus. Scand Audiol Suppl. 1999;51:47-52.
5. Palomar Garcia V, Abdulghani Martinez F, Bodet Agusti E, Andreu Mencia L and Palomar Asenjo V. Drug-induced otoxicity: current status. Acta Otolaryngol. 2001;121:569-72.
6. Crummer RW and Hassan GA. Diagnostic approach to tinnitus. Am Fam Physician. 2004;69:120-6.
7. Lockwood AH. Tinnitus. Neurol Clin. 2005;23:893-900, viii.
8. Mattox DE and Hudgins P. Algorithm for evaluation of pulsatile tinnitus. Acta Otolaryngol. 2008;128:427-31.
9. Han BI, Lee HW, Kim TY, Lim JS and Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol. 2009;5:11-9.
10. Langguth B, Kreuzer PM, Kleinjung T and De Ridder D. Tinnitus: causes and clinical management. The Lancet Neurology. 2013;12:920-930.

It’s 2020, and for the first time in its 72-year history, the American Academy of Neurology has cancelled its annual meeting because of the COVID-19 pandemic. But that does not mean we (BrainWaves producers, not the AAN) can’t provide a few major updates to advances in neurology and neurotherapeutics! This week on the program, Jim Siegler is joined by Dr. Sammita Satyanarayan (Stanford) on a whirlwind tour of some of the latest advances in neurology from this past year. Enjoy!

** IF YOU’RE TAKING YOUR NEUROLOGY BOARDS THIS SUMMER, CHECK OUT THE PENN NEUROLOGY BOARD REVIEW COURSE AT https://upenn.cloud-cme.com/default.aspx?P=5&EID=65373. AND FOR A DISCOUNTED RATE ON THE ONLINE OR STREAMING RESOURCES, USE PROMO CODE ‘WAVES2020’. **

DISCLAIMER: BrainWaves: A Neurology Podcast is not a product of the American Academy of Neurology (AAN) or its affiliates. Any content discussed on the program does not reflect the opinions of the AAN or its leadership nor does it contain any copyrighted material by the AAN or its affiliates. This program is neither published in collaboration with the AAN nor is it intended to plagiarize any content or programming of the AAN or its affiliates. The opinions discussed in this program are those of the producers and are not reflective of their employers or affiliates. This episode was produced by Sammita Satyanarayan and James E. Siegler. Music courtesy of E’s Jammy Jams, Lee Roosevere, Rui, and Steve Combs. 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. Dodick D, Lipton RB, Martin V, Papademetriou V, Rosamond W, MaassenVanDenBrink A, et al. Consensus statement: Cardiovascular safety profile of triptans (5-ht agonists) in the acute treatment of migraine. Headache. 2004;44:414-425
2. Hall GC, Brown MM, Mo J, MacRae KD. Triptans in migraine: The risks of stroke, cardiovascular disease, and death in practice. Neurology. 2004;62:563-568
3. Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. The New England journal of medicine. 2018;378:1573-1582
4. Kuca B, Silberstein SD, Wietecha L, Berg PH, Dozier G, Lipton RB, et al. Lasmiditan is an effective acute treatment for migraine: A phase 3 randomized study. Neurology. 2018;91:e2222-e2232
5. Cortese I, Muranski P, Enose-Akahata Y, Ha SK, Smith B, Monaco M, et al. Pembrolizumab treatment for progressive multifocal leukoencephalopathy. The New England journal of medicine. 2019;380:1597-1605
6. Goadsby PJ, Wietecha LA, Dennehy EB, Kuca B, Case MG, Aurora SK, et al. Phase 3 randomized, placebo-controlled, double-blind study of lasmiditan for acute treatment of migraine. Brain. 2019;142:1894-1904
7. Tabrizi SJ, Leavitt BR, Landwehrmeyer GB, Wild EJ, Saft C, Barker RA, et al. Targeting huntingtin expression in patients with huntington's disease. The New England journal of medicine. 2019;380:2307-2316
8. Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, et al. Effect of intravenous tenecteplase dose on cerebral reperfusion before thrombectomy in patients with large vessel occlusion ischemic stroke: The extend-ia tnk part 2 randomized clinical trial. JAMA : the journal of the American Medical Association. 2020. Epub ahead of print.

As my wife and I are raising our 9-month old daughter, and she is eating more solid food, I can’t help but think about how important it is she keep an open mind to new food groups. But being open minded is not just a lesson for toddlers. I emphasize it every day on rounds when seeing patients for a “stroke consult”, or a consult for “ICU delirium”. If you reduce yourself to the same anchoring biases that you've grown accustomed to, you’ll never entertain the possibility of other important, and treatable conditions. Or tasty foods.

This week on the BrainWaves Podcast, Dr. Brian Jankowitz (Cooper University Hospital Vascular Neurosurgeon) joins Jim in a discussion about a rare, but treatable cause of myelopathy. A condition you won’t want to miss.

** IF YOU’RE TAKING YOUR NEUROLOGY BOARDS THIS SUMMER, CHECK OUT THE PENN NEUROLOGY BOARD REVIEW COURSE AT https://upenn.cloud-cme.com/default.aspx?P=5&EID=65373. AND FOR A DISCOUNTED RATE ON THE ONLINE OR STREAMING RESOURCES, USE PROMO CODE ‘WAVES2020’. **

Produced by Brian Jankowitz and James E. Siegler. Music courtesy of Kevin McLeod, Lee Rosevere, and Loyalty Freak Music. 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. Jellema K, Tijssen CC, van Rooij WJ, Sluzewski M, Koudstaal PJ, Algra A and van Gijn J. Spinal dural arteriovenous fistulas: long-term follow-up of 44 treated patients. Neurology. 2004;62:1839-41.
2. Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT and Thron A. Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2007;28:1249-58.
3. Krings T and Geibprasert S. Spinal dural arteriovenous fistulas. AJNR American journal of neuroradiology. 2009;30:639-48.
4. Alexander MD, Oliff MC, Olorunsola OG, Brus-Ramer M, Nickoloff EL and Meyers PM. Patient radiation exposure during diagnostic and therapeutic interventional neuroradiology procedures. J Neurointerv Surg. 2010;2:6-10.
5. Cifarelli CP, Kaptain G, Yen CP, Schlesinger D and Sheehan JP. Gamma knife radiosurgery for dural arteriovenous fistulas. Neurosurgery. 2010;67:1230-5; discussion 1235.
6. Kim DJ, Willinsky R, Geibprasert S, Krings T, Wallace C, Gentili F and Terbrugge K. Angiographic characteristics and treatment of cervical spinal dural arteriovenous shunts. AJNR American journal of neuroradiology. 2010;31:1512-5.
7. Chen J and Gailloud P. Safety of spinal angiography: complication rate analysis in 302 diagnostic angiograms. Neurology. 2011;77:1235-40.
8. Manninen AL, Isokangas JM, Karttunen A, Siniluoto T and Nieminen MT. A comparison of radiation exposure between diagnostic CTA and DSA examinations of cerebral and cervicocerebral vessels. AJNR American journal of neuroradiology. 2012;33:2038-42.

Perfusion imaging employs concepts that date back to the early 1830s, and it leverages hardware and software that emerged around the same time at multidetector helical CT scans. But it has only become popular in recent years for thrombectomy decision-making.

If I'm being honest, I often never use it for this purpose. So what other purposes might it serve? And how does it work? This week, we review the fundamental concepts of perfusion CT, its utility in stroke care, and how it might prove useful for other neurologic conditions as well.

** IF YOU’RE TAKING YOUR NEUROLOGY BOARDS THIS SUMMER, CHECK OUT THE PENN NEUROLOGY BOARD REVIEW COURSE. FOR A DISCOUNTED RATE ON THE ONLINE OR STREAMING RESOURCES, USE PROMO CODE ‘WAVES2020’. **

Produced by James E. Siegler. Music courtesy of Julie Maxwell, John Bartmann, Kai Engel, and Pachyderm. Our theme song was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Some of the voices you heard throughout the program were those of Dr. Mathias Prokop, Radbound Medical Center, Netherlands; Terri Yeager, Comprehensive Stroke Program Coordinator at Cooper University Hospital; and a recording that was produced by GE Healthcare, which are freely available on YouTube. 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. Campbell BC, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM and Parsons MW. Comparison of computed tomography perfusion and magnetic resonance imaging perfusion-diffusion mismatch in ischemic stroke. Stroke; a journal of cerebral circulation. 2012;43:2648-53.
2. Boned S, Padroni M, Rubiera M, Tomasello A, Coscojuela P, Romero N, Muchada M, Rodriguez-Luna D, Flores A, Rodriguez N, Juega J, Pagola J, Alvarez-Sabin J, Molina CA and Ribo M. Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept. J Neurointerv Surg. 2017;9:66-69.
3. Martins N, Aires A, Mendez B, Boned S, Rubiera M, Tomasello A, Coscojuela P, Hernandez D, Muchada M, Rodriguez-Luna D, Rodriguez N, Juega JM, Pagola J, Molina CA and Ribo M. Ghost Infarct Core and Admission Computed Tomography Perfusion: Redefining the Role of Neuroimaging in Acute Ischemic Stroke. Interv Neurol. 2018;7:513-521.
4. Campbell BCV, Ma H, Ringleb PA, Parsons MW, Churilov L, Bendszus M, Levi CR, Hsu C, Kleinig TJ, Fatar M, Leys D, Molina C, Wijeratne T, Curtze S, Dewey HM, Barber PA, Butcher KS, De Silva DA, Bladin CF, Yassi N, Pfaff JAR, Sharma G, Bivard A, Desmond PM, Schwab S, Schellinger PD, Yan B, Mitchell PJ, Serena J, Toni D, Thijs V, Hacke W, Davis SM, Donnan GA, Extend E and Investigators E. Extending thrombolysis to 4.5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. Lancet. 2019;394:139-147.
5. Siegler JE, Messe SR, Sucharew H, Kasner SE, Mehta T, Arora N, Starosciak AK, De Los Rios La Rosa F, Barnhill NR, Mistry AM, Patel K, Assad S, Tarboosh A, Dakay K, Wagner J, Bennett A, Jagadeesan B, Streib C, Weber SA, Chitale R, Volpi JJ, Mayer SA, Yaghi S, Jayaraman MV, Khatri P and Mistry EA. Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study. J Neuroimaging. 2019. Epub ahead of print.
6. Barber PA, Demchuk AM, Zhang J and Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet. 2000;355:1670-4.
7. Wintermark M, Reichhart M, Thiran JP, Maeder P, Chalaron M, Schnyder P, Bogousslavsky J and Meuli R. Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Annals of neurology. 2002;51:417-32.
8. Parsons MW, Pepper EM, Chan V, Siddique S, Rajaratnam S, Bateman GA and Levi CR. Perfusion computed tomography: prediction of final infarct extent and stroke outcome. Annals of neurology. 2005;58:672-9.
9. Campbell BC, Weir L, Desmond PM, Tu HT, Hand PJ, Yan B, Donnan GA, Parsons MW and Davis SM. CT perfusion improves diagnostic accuracy and confidence in acute ischaemic stroke. Journal of neurology, neurosurgery, and psychiatry. 2013;84:613-8.
10. Mangla R, Ekhom S, Jahromi BS, Almast J, Mangla M and Westesson PL. CT perfusion in acute stroke: know the mimics, potential pitfalls, artifacts, and technical errors. Emerg Radiol. 2014;21:49-65.
11. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, McTaggart RA, Torbey MT, Kim-Tenser M, Leslie-Mazwi T, Sarraj A, Kasner SE, Ansari SA, Yeatts SD, Hamilton S, Mlynash M, Heit JJ, Zaharchuk G, Kim S, Carrozzella J, Palesch YY, Demchuk AM, Bammer R, Lavori PW, Broderick JP, Lansberg MG and Investigators D. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. The New England journal of medicine. 2018;378:708-718.
12. Van Cauwenberge MGA, Dekeyzer S, Nikoubashman O, Dafotakis M and Wiesmann M. Can perfusion CT unmask postictal stroke mimics? A case-control study of 133 patients. Neurology. 2018;91:e1918-e1927.
13. Siegler JE, Olsen A, Pulst-Korenberg J, Cristancho D, Rosenberg J, Raab L, Cucchiara B and Messe SR. Multicenter Volumetric Assessment of Artifactual Hypoperfusion Patterns using Automated CT Perfusion Imaging. J Neuroimaging. 2019;29:573-579.

Imagine what it would have been like, to have lived in 1918. Spanish influenza killed approximately 3% of the world’s population. Other than the world war, international travel was fairly limited. There was no social media. No flu vaccine. No mechanical ventilators. No World Health Organization.

A century later, we’re facing the next great pandemic. And what have we learned? What do we know?

From the neurologic complications of SARS-CoV-2, to non-infectious consequences, the environmental impact of a pandemic, and lessons learned polio, we hope to leave you with a few important take-home messages, a silver lining—and some food for thought—about the ongoing COVID pandemic.

** IF YOU’RE TAKING YOUR NEUROLOGY BOARDS THIS SUMMER, CHECK OUT THE PENN NEUROLOGY BOARD REVIEW COURSE AT https://upenn.cloud-cme.com/default.aspx?P=5&EID=65373. AND FOR A DISCOUNTED RATE ON THE ONLINE OR STREAMING RESOURCES, USE PROMO CODE ‘WAVES2020’. **

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1. Murata K, Inoue O, Akutsu M and Iwata T. Neuromotor effects of short-term and long-term exposures to trichloroethylene in workers. Am J Ind Med. 2010;53:915-21.
2. Umapathi T, Kor AC, Venketasubramanian N, Lim CC, Pang BC, Yeo TT, Lee CC, Lim PL, Ponnudurai K, Chuah KL, Tan PH, Tai DY and Ang SP. Large artery ischaemic stroke in severe acute respiratory syndrome (SARS). Journal of neurology. 2004;251:1227-31.
3. Li Y, Wang M, Zhou Y, Chang J, Xian Y, Mao L, Hong C, Chen S, Wang Y, Wang H, Li M, Jin H and Hu B. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Lancet. 2020;Epub ahead of print.
4. Mao L, Wang M, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Hu Y, Li Y, Jin H and Hu B. Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: A Retrospective Case Series Study. Lancet. 2020;Epub ahead of print.
5. Perbellini L, Olivato D, Zedde A and Miglioranzi R. Acute trichloroethylene poisoning by ingestion: clinical and pharmacokinetic aspects. Intensive care medicine. 1991;17:234-5.
6. Guehl D, Bezard E, Dovero S, Boraud T, Bioulac B and Gross C. Trichloroethylene and parkinsonism: a human and experimental observation. European journal of neurology : the official journal of the European Federation of Neurological Societies. 1999;6:609-11.
7. Gash DM, Rutland K, Hudson NL, Sullivan PG, Bing G, Cass WA, Pandya JD, Liu M, Choi DY, Hunter RL, Gerhardt GA, Smith CD, Slevin JT and Prince TS. Trichloroethylene: Parkinsonism and complex 1 mitochondrial neurotoxicity. Annals of neurology. 2008;63:184-92.
8. Wang G, Zhang Z, Ayala C, Dunet DO, Fang J and George MG. Costs of hospitalization for stroke patients aged 18-64 years in the United States. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2014;23:861-8.
9. West JB. The physiological challenges of the 1952 Copenhagen poliomyelitis epidemic and a renaissance in clinical respiratory physiology. J Appl Physiol (1985). 2005;99:424-32.