Caption: Eliza Miller, the newly appointed division chief of women’s neurology and associate professor of neurology at the University of Pittsburgh School of Medicine and recommended candidate for the UPMC Chair in Women’s Brain Health, speaks to colleagues during a Grand Rounds lecture on Feb. 20, 2025.
By Kat Procyk
Photography by Rayni Shiring, University of Pittsburgh
Brains are squishy, wrinkly and drab. Side by side, a man’s and a woman’s brain look nearly identical to the untrained eye due to minimal anatomical differences.
Yet, neurological conditions can affect women differently than they do men. In Alzheimer’s disease, for example, women are more likely to decline cognitively and face more instances of memory loss, language difficulties and trouble with social interactions.
But, why? And how can they be prevented?
To answer those questions, researchers have accelerated work into women’s neurology—an emerging subspecialty that focuses on neurological conditions in women and girls—within the past few years.
However, women’s neurology is still considered a niche specialty, according to Eliza Miller, the newly appointed division chief of women’s neurology and associate professor of neurology at the University of Pittsburgh School of Medicine. But she doesn’t think it should be.
"The brain is a vital component of women’s health," said Miller, a globally recognized leader in women's cerebrovascular health and the recommended candidate for the UPMC Chair in Women’s Brain Health. "Unfortunately, many young neurologists lack specialized training in reproductive physiology—leading to significant knowledge gaps and unnecessary fear in how to navigate neurological problems women are faced with."
Pregnancy and the Brain
Pitt’s Department of Neurology is one of only two neurology departments in the United States with dedicated divisions of women’s neurology. The other is at Brigham and Women’s Hospital (BWH) in Boston, Massachusetts, affiliated with Harvard Medical School. Page Pennell was an active contributor to the development of the women’s neurology program at BWH before she joined Pitt as neurology chair and Henry B. Higman Professor.
Pennell recognized the importance of considering sex as a biological variable and the expression of neurological diseases early in her research career. Researchers at the center of women’s neurology, including Pennell and Miller, are exploring whether certain neurological disorders in women may be influenced, signaled or exacerbated by the many physiological changes that occur during pregnancy, other reproductive phases and other sex-specific factors in women. They’re still not entirely sure how it’s all linked.
Pitt’s division was established by Autumn Klein, a former assistant professor of neurology in the School of Medicine, pioneer in women’s neurology and the founder of BWH’s division, before her early death in 2013. Klein envisioned the division as an interdisciplinary unit that integrates neurology with subspecialties such as obstetrics and gynecology. It was then led by Janet Waters, former clinical associate professor of neurology at the School of Medicine, until her retirement in 2024.
"Having a division already established in the School of Medicine is a unique strength for both the care of women with neurologic disorders, as well as an important part of our training and teaching for our students, residents and fellows,” Pennell said.
Pennell was determined to continue the flagship program under the leadership of someone with a demonstrated history of making discoveries about women’s brain health and how it can be improved. She recruited Miller, who had already established ties to Pitt and previously collaborated with University researchers in neurology, obstetrics and gynecology, psychiatry and epidemiology through her multicenter cohort studies.
Miller cites Klein, Waters and Pennell as the blueprints for her clinical and educational mission of the division. She cites her patients for the inspirations behind her research, which focuses on cerebrovascular complications of preeclampsia, a pregnancy condition related to high blood pressure and protein in the urine that can increase the risk of stroke, and other adverse pregnancy outcomes using both physiological and epidemiological approaches. As of March 2025, Miller has published more than 45 research publications and more than 35 book chapter reviews and editorials on the subject. She founded the Mothers Center Neurovascular Clinic at Columbia University, which provided coordinated treatment of individuals with cerebrovascular complications during pregnancy and postpartum.
Miller plans to continue and build upon the work of both Klein and Waters by working with Pennell. Over the next few years, Miller will expand the division into a multispecialty care unit by mentoring junior clinicians and University researchers at all levels, growing the fellowship program from one to two fellows per year, improving education in women’s health in neurological residencies, recruiting and retaining top faculty, and strengthening interdepartmental collaborations in women’s health research through Pitt’s existing infrastructure. She will contribute to the development of curriculum and treatment guidelines for women’s neurology, which are now emerging.
Her end goal is to position Pitt at the forefront of this growing specialty and develop more holistic, integrated treatments to improve women’s brain health.
“I really think we are set up to lead this field,” Miller said. “A lot of this work is already happening in different divisions and places across the University, but centralizing and formalizing this work would benefit our patients in the long term.”
From Dancer to Brain Expert
Miller’s path to becoming a physician was anything but conventional. She became a mom to twins first.
Her career as a professional dancer took her to New York City, but when she learned she was pregnant, she left the “struggling artist” life behind.
“Being a dancer is a tough life,” Miller said. “I’d always been interested in the body, and I thought there was one thing that might be easier than being a dancer: going to medical school.”
She returned to school at the City College of New York and then went to medical school at Columbia University—having another baby along the way. She also earned a degree in patient-oriented research at Columbia University’s Mailman School of Public Health. Throughout her residency, fellowship and career, her work became inspired by the patients with pregnancy complications she cared for.
"These women left a lasting impression on me," Miller said. "The complications of these conditions can profoundly impact a person’s life—economically, psychologically, and beyond. But we're discovering predictors, which means there’s potential for intervention."