Practical Neurology Podcast

A puzzling pair of Case Reports from the most recent issue of the journal. First up (1:35) is a man in his mid-fifties, presenting with lumbar spine fractures, which then developed into confusion, vomiting, and abdominal pain. An x-ray showed  dilated intestinal loops and his blood sodium levels were low. https://pn.bmj.com/content/25/1/87 The second case (23:06) involves a 21-yo woman, who presented  at 18 weeks pregnant with  multiple episodes of right upper limb tonic extension, and subsequently developed new-onset refractory status epilepticus (NORSE). https://pn.bmj.com/content/25/1/56    The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Xin You Tai³ 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 February 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 Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  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 and Brian O'Toole. Thank you for listening. 

In this discussion, Professor Saiju Jacob, a leading consultant neurologist specializing in neuroimmunology, explores Stiff-Person Syndrome (SPS), a complex autoimmune disorder. He highlights the diagnostic dilemmas faced, particularly its prevalence in women and the role of specific antibody tests. The conversation delves into associated ocular symptoms and the importance of clinical history in accurate diagnosis. Professor Jacob also discusses treatment strategies, emphasizing the need for early intervention and the potential improvements in mental health with effective management.

Delve into the complexities of Stiff Person Syndrome and emerging treatments for multiple sclerosis. Discover innovative rehabilitation strategies for posterior cortical atrophy, a lesser-known variant of Alzheimer's. Explore the evolving landscape of neurology, including new guidelines for MS and insights into stroke as a career option for neurologists. Plus, learn about effective management techniques for cryptococcal meningitis and a surprising substitute for traditional diagnostic methods.

Two more fascinating Case Reports from the latest issue of the journal. The first case (1:15) is of a 57-yo woman, with an intermittent posterior headache, which had an associated bilateral pressure-like sensation. Her symptoms had begun on a recent trip to Sri Lanka. https://pn.bmj.com/content/24/6/526  Following on is the second case (22:18), which features a 54-yo man experiencing deterioration in his speech and mobility. He had a background of chronic HIV infection with ongoing treatment. https://pn.bmj.com/content/24/6/507   The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Xin You Tai³ 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 December 2024 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 Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  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 and Brian O'Toole. Thank you for listening. 

It’s the Christmas Special for 2024! Joining Amy in the studio is Dr. Steven Lewis. Current secretary general of the World Federation of Neurology, Steven is based in the United States, where he works as a general neurologist. Their conversation builds on a recent article by Dr. Bas Bloem, "Islands and bridges in healthcare: the importance of general neurology”. Listen in for insights on the differences in training and practice in the US and UK, the value of developing a network as a neurologist, and the enduring need for general neurology’s broad diagnostic approach. Related links: "Welcome to the mainland: general neurology’s role in rescue from the islands of subspecialisation", the editorial by Dr. Steven Lewis "In defence of general neurology", an editorial by Dr. Neil Anderson 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, Amy Ross Russell, and Brian O'Toole. Thank you for listening. 

Joining the discussion are Shadi El-Wahsh, an early career neurologist and clinical neurophysiologist from Sydney, and Stephen Reddel, a neurologist specializing in neuroimmunology. They dive into the complexities of diagnosing neuromuscular junction disorders, emphasizing the red flags and atypical presentations that can lead to misdiagnosis. Their insights include the significance of antibody testing and distinguishing between true junction disorders and mimics, particularly in relation to symptoms like ptosis and visual disturbances.

Neuromuscular junction disorders can present in a variety of challenging ways, with the potential to mislead neurologists. Journal editors Prof. Philip Smith and Dr. Geraint Fuller begin with this subject as they talk through the latest issue of Practical Neurology, for December 2024. The conversation moves to neck flexion and brain zaps, reflects on the undiminished importance of "general" neurology, and also touches on maternal epilepsy risks, frailty's impact on stroke patients, timely recognition of glaucoma, and sustainable practices for green physicians. To finish, there's the now-traditional recital of eponymous syndromes. Read the issue: https://pn.bmj.com/content/24/6  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 Letícia Amorim and Brian O'Toole. Editing by Brian O'Toole. Thank you for listening. 

The immune system is a recurring feature in the cases discussed in this edition of the Case Reports podcast. The first paper details the cases of two young women, sisters, presenting with overlapping conditions but resulting in tragically different outcomes (1:16). Both were in their twenties, had given birth recently, and developed limb weakness along with several other neurological symptoms. https://pn.bmj.com/content/24/5/422 Our second case is a 72-yo woman with a range of symptoms including diplopia, ptosis, myalgia, and worsening shortness of breath (21:27). She had had surgical resection of a malignant melanoma, and was receiving immunotherapy treatment. Her presentation resembled myasthenia gravis, but initial treatment did not yield a response. https://pn.bmj.com/content/24/5/428  The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Xin You Tai³ 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 2024 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 Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  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. This episode was produced and edited by Brian O'Toole. Thank you for listening. 

Frederick Vonberg, a postdoctoral clinical researcher specializing in neurotoxicology, discusses the crucial role of toxins in neurological conditions. He sheds light on the global crisis of lead poisoning and its insidious symptoms that often emerge late. The conversation navigates through botulism and organophosphate poisoning, emphasizing their complex clinical features. Vonberg also highlights the origins of Mad Hatter syndrome and the importance of recognizing neurotoxic exposures in both occupational and recreational settings. This insightful talk underscores the pressing need for accurate diagnosis in neurotoxicity.

Prof. Philip Smith, a prominent journal editor in neurology, teams up with Dr. Geraint Fuller, who delves into diagnostic tools and unresolved cases. They dissect oligoclonal bands as crucial for diagnosing conditions like multiple sclerosis. The discussion also covers neurotoxicology, exploring the complexities of methotrexate's use in treatment. Additionally, they highlight the evolving role of podcasts in neurology, providing a fresh avenue for self-directed learning and challenging traditional academic resources.