Practical Neurology Podcast

Another set of intriguing cases from the latest issue of the journal, pored over by the Case Reports team.  In the first case, a 24-yo man presents acutely with reduced consciousness, following 3 days of right-sided headache. His mother reports sudden behavioural changes with jerky movements and enlarged pupils. He is agitated, not obeying commands and not moving his left-side limbs. He had a history of autism and vascular Ehlers-Danlos syndrome and was on medication for stroke prevention. An MRI scan led to a differential diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES), but the final conclusion came post-discharge after a further review of his scans.  https://pn.bmj.com/content/25/6/549 The second report (19:37) describes two curious instances of functional neurological disorder (FND), both of which improved after the patients were in comatose states. The first patient is a 59-yo man who had developed muscle weakness shortly after at car crash at age 49, and had subsequently been reliant on a wheelchair for more than 8 years. Recently the patient had been infected simultaneously with severe cases of flu and COVID-19, during which he had been sedated and placed in an induced coma for several weeks. Awakening from the coma, the patient showed surprising signs of new mobility. In the second patient, a 40-yo woman presented with flaccid paralysis of her left arm, with loss of sensation up to the shoulder. She had a history of bipolar disorder and agoraphobia. She was diagnosed with FND and participated in physiotherapy and hypnotherapy with no improvement. Thirteen months later she was readmitted following an overdose on a mix of analgesics and sedatives, and was ventilated in the ITU for several hours. Upon waking the patient noticed that her previously paralyzed arm had completely recovered. https://pn.bmj.com/content/25/6/562  Further reading: Advances in functional Neurological disorder (BMJ Neurology Open)   The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the October 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening.

Neurology requires some detective work at times, and identifying the patterns of symptoms associated with drug misuse can be a tricky mystery indeed. For this episode, we're receiving a masterclass from Dr. Robin Howard¹ on the wide variety of drugs that bring patients into hospital, as well as the mechanisms they act on. His paper "Neurological aspects of drug misuse" is the Editors' Choice for the October 2025 issue, and he joins PN podcast editor Dr. Amy Ross Russell in the studio. From the new dangers of synthetic psychoactives to the profound consequences of chronic use, the discussion unveils critical clinical presentations every neurologist should recognize. We delve into fascinating phenomena including "punding," compulsive repetitive behaviors seen with stimulant abuse, and the rare but striking CHANTER syndrome, with its signs of disturbed consciousness and extensive cerebellar involvement. Hear too about the distinctive spongiform leukoencephalopathy associated with "chasing the dragon," a dangerous method of heroin inhalation, but which can also be caused by cocaine usage.   Read the paper: https://pn.bmj.com/content/25/5/411   (1) Guy's and St. Thomas’ NHS Foundation Trust, London, UK   Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Amy Ross Russell and Brian O'Toole and editing by Brian O'Toole. Thank you for listening. 

Delve into the conversation about the risks and nuances of medical imaging, especially with over 50 CT scans in one life. Discover new insights on selective MRI use for Parkinson's and how brutal scrutiny can improve healthcare resource management. Explore the intriguing world of masquerade syndromes and the potential connections between the gut microbiome and neurological disorders. Plus, enjoy some lighthearted festive fun with a book club update and a cryptic crossword!

Two new cases from the latest issue of the journal present the podcast team with some rare explanations, and a chance to test yourself on food trivia.   In the first case (1:18), from Malaysia, a 49-yo left-handed woman develops 10 days of recurrent left-sided focal facial seizures. These seizures progressed to epilepsia partialis continua, which is controlled with some difficulty by employing a broad range of six different anti-seizure medications. Further symptoms arose during monitoring, including emotional lability as well as dystonia, left arm dysfunction, dysphasia and dysarthria. EEG imaging showed focal slowing in the right hemisphere. https://pn.bmj.com/content/25/5/475 The second case (22:20) features a Northamptonshire chef in her 60s, who presents to the emergency department with a week-long history of nausea, vomiting, and abdominal pain. This progressed to dysphagia and dypsnoea, as well as a downshift in the pitch of her voice. Her conditioned worsened, with respiratory arrest requiring CPR to re-establish circulation. Neurological examination was initially done while sedated, showed fixed and dilated pupils.  https://pn.bmj.com/content/25/5/493 Overloaded with Greek terms today? Here are some definitions from BMJ Best Practice and NHS UK: Dystonia is a movement disorder characterised by sustained involuntary muscle contractions and abnormal postures of the trunk, neck, face, or extremities. Dysphasia, also known as aphasia, is an acquired impairment of language that affects comprehension and production of words, sentences, and/or discourse. Dysarthria is difficulty with speaking, caused by damage or weakness of the muscles needed for speech. Dysphagia is difficulty with the act of swallowing solids or liquids. Dyspnoea, also known as shortness of breath or breathlessness, is a subjective sensation of breathing discomfort. The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the October 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening.

In this special international episode, we explore the 2025 update of the Association of British Neurologists’ guidelines on managing autoimmune myasthenia gravis. Ten years after the previous recommendations, significant changes have been introduced. We emphasise the importance of daily steroids, early thymectomy, rituximab, and emerging targeted therapies transforming patient care. We also examine how these updates influence frontline care in the UK, Australia, and the USA, and why a multidisciplinary approach remains vital in the management of MG.   Participants: Professor Alasdair Coles is Head of Department for Clinical Neuroscience and also Co-Director of the Cambridge Centre for Myelin Repair, UK. Associate Professor Katherine Buzzard, Clinical Lead, Eastern Health Multiple Sclerosis and Neuroimmunology Service, Melbourne, Australia. Dr. Christopher Doughty, MD is a board-certified neurologist, and affiliated with Brigham and Women's Hospital, in Boston, Massachusetts, USA. Read the paper (https://pn.bmj.com/content/25/5/422), which is part of the October issue of the Practical Neurology journal.   Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Letícia Amorim. Thank you for listening. 

Another packed episode for this month's issue of the journal. There's a special emphasis on case reports this time, showing their value as a way to understand the rarely encountered. For the more common conditions there are guidelines, and the editors give you an introduction to the new ABN guidelines on myasthenia gravis, as a preview to an upcoming full episode on the topic. There's a birder's take on the use of EEG for status epilepticus, a review of the benefits and challenges for digital health records, and some deliberation on ophthalmological pronunciation. Plus, an opportunity to test your knowledge on illicit drug slang: do you know your "jeff" from your "khat"? Read the highlights: https://pn.bmj.com/content/25/5/391   Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Brian Kennedy, Letícia Amorim. Editing by Brian O'Toole. Thank you for listening.

The wonders of the animal kingdom make an absorbing reappearance this episode, so grab your scuba mask before listening - or your chef’s hat. The first case this month is the kind that even an experienced neurologist would be nervous to encounter (1:35). A holidaymaker in his sixties presents to the emergency department with vomiting, dizziness, and an inability to walk, amongst several other symptoms. A suspicion of stroke was quickly replaced by a different hypothesis following discussions with the patient’s family members. https://pn.bmj.com/content/25/4/377   The second case follows a presentation over the span of multiple decades (18:44). A woman first presents in her thirties with extreme lethargy and occasional migraines. She was diagnosed with panhypopituitarism and treated with steroid replacement. Following breast cancer in her late forties, treated by surgery and radiotherapy, the migraines worsened, prompting further investigation. https://pn.bmj.com/content/25/4/359   The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the June 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Brian Kennedy, Letícia Amorim. Editing by Brian O'Toole. Thank you for listening.

"This is a disorder that you don't want to miss", says Prof. Jon Stone¹, describing the condition at the heart of this episode, alongside co-author Dr. Huw Green². Their paper "Health anxiety in a neurological setting" is the subject of the Editors' Choice podcast for the August 2025 issue, hosted by Dr. Amy Ross Russell. They cover the assumptions to avoid, the problematic pattern of patient reassurance and return, effective treatment methods, and even touch on a light bit of existentialism. Read the paper: https://pn.bmj.com/content/25/4/330 See also: https://neurosymptoms.org/ (1) Neuropsychology, Addenbrooke's Hospital, Cambridge, UK (2) Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Amy Ross Russell and Brian O'Toole, editing by Brian O'Toole. Thank you for listening. 

Simplification is everything - that's the message for the latest issue of the journal. Assisted by a cast of characters including Albert Einstein and deep sea sponges, your editors Phil Smith and Geraint Fuller take on topics from hyponatraemia to health anxiety. You'll also find bread and butter epileptology, somatosensory evoked potentials, creatine kinase, and a guide for exploring the hinterlands of essential tremor.   Read the issue: https://pn.bmj.com/content/25/4/297    Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening. 

In the latest bonus podcast, the practical use of intravenous immunoglobulin is discussed with perspectives from three continents. Participants: Professor Alasdair Coles is Head of Department for Clinical Neuroscience and also Co-Director of the Cambridge Centre for Myelin Repair, UK. Dr. Lynette Kiers is a Clinical Associate Professor at The University of Melbourne, and Director of Clinical Neurophysiology at the Royal Melbourne Hospital, Australia. Dr. Christopher Hahn is a Clinical Associate Professor of Neurology at the University of Calgary's Cumming School of Medicine, and the Medical Director of the Calgary Neuromuscular Program, Canada. Read the paper (https://pn.bmj.com/content/25/3/228) which is part of the June issue of the Practical Neurology journal.   Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Letícia Amorim. Thank you for listening.