Practical Neurology Podcast

Unihemispheric atrophy, and a culinary culprit - Case Reports Oct 2025

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.

Rethinking Myasthenia Gravis: A global perspective on ABN's latest guidelines

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. 

The birdsong of the brain, cognitive flexibility, and a guideline update - Editors' Highlights October 2025

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.

Dangers from the deep, and prolonged pituitary inflammation - Case Reports August 2025

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.

Health anxiety: patient paradoxes and successful treatment

"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. 

Electrolyte abnormalities, unhelpful reassurance, and the essence of tremor - Editors' Highlights August 2025

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. 

An international approach to the use of immunoglobulin

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. 

The risks of "bariatric tourism", and photophobia with a pustular rash - Case Reports June 2025

Gastric sleeve surgery is the key feature of a pair of recent cases from the journal, which start this episode (1:17). Both cases feature 25-yo women with presentations in common: paraesthesia and limb weakness, along with disordered eye movement. Their symptoms arose soon after the gastrectomy operation. https://pn.bmj.com/content/25/3/268 
The second report is a "true grey case" (22:14), with a myriad of presenting symptoms in a 27-yo man: fevers, weight loss, lethargy, light sensitivity, and skin plaques around the nose and mouth. Steroid treatment was started with a suspicion of a  connective tissue disease, but was halted when his condition soon worsened. Some feathered friends of the podcast shine a light on the diagnosis.https://pn.bmj.com/content/25/3/253 
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 Amy Ross Russell and Brian O'Toole, editing by Brian O'Toole. Thank you for listening.

New, complicated and evolving: IgG4-related disease

A neuroinflammatory disorder with the potential to affect virtually any organ in the body, IgG4-related disease is a challenge on many fronts. The latest Editors' Choice paper in the June 2025 issue takes on this systemic disease, presenting a treatment algorithm for its management. This episode, PN's podcast editor Dr. Amy Ross Russell speaks with author Dr. Claire Rice. Hear an overview on the disease background, the signs in presentation, what to look for in the histology, and steroid treatment strategy. 
 
Read the paper: IgG4-related disease in the nervous system 
 
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. 

Nutritional perils, the immunoglobulin paradox, and a flickering candle - Editors' Highlights June 2025

This episode’s theme is new diseases, whether they are newly described, or old diseases back in a new form. We start off with IgG4-related disease, a chronic multisystem disorder that is still being understood. Then there is a genetics paper on repeat expansion disorders, a group of conditions often thought as disparate but with quite a few commonalities. Next along is a fascinating case following gastric sleeve bariatric surgery, highlighting the dangers of travelling for unsupervised surgeries, and raising the question, “Are you getting enough soil in your diet?” There’s also a discussion of what else Hoover’s sign might represent, and the evolution of immunoglobulin use. Closing the episode is a paper offering a masterclass on the assessment of best interests in  prolonged disorder of consciousness.
 
Read the issue: https://pn.bmj.com/content/25/3/199
 
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.