Neurotoxicology’s top offenders

Diet continues to be a growing presence in the neurological diagnoses cropping up for the Case Reports team, returning again after its previous appearance with gastric sleeves. The first case (1:25), from UCLH in London, is that of a 49-yo woman, presenting with a history of worsening intermittent headaches and blurred vision. Metabolic testing identified high values for homocysteine and methyl malonic acid. Further probing of the patient's history revealed a previous eating disorder and recent dietary restriction after a bereavement, with subsequent weight loss. She was treated with a course of vitamin supplementation for B2, B6, B9 (folate), and B12, but re-presented again with persistent symptoms. https://pn.bmj.com/content/26/4/400 The second case (22:19) comes from Cork, Ireland. A 19-yo woman presents with gradual onset headache, vomiting and unsteadiness. Her temperature is read at 38.4 ℃, prompting consideration of brain stem infections such as Lyme disease, tuberculosis and listeria. The MRI brain scan returned some unusual findings. https://pn.bmj.com/content/26/4/395 This episode is the last appearance on the podcast for our dear discussant Dr. Ruth Wood, who - by now an able seaman - is disembarking for new shores. The paper on aquatic neurology may be the high water mark of her years on the podcast, but each episode was a pearl in its own right. Best wishes, Ruth!Further reading:

Space, the final frontier. A new domain for the podcast opens, as we learn how astronauts are preparing for Mars transit by lying in bed. But first - the ophthalmology department refers a patient with a swollen optic disc. When is it papilloedema, and when is it not? And what does that have to do with Martian vistas? In this editors' choice podcast, PN podcast editor Dr. Amy Ross Russell interviews Prof. Susan Mollan¹ ², last author of the paper, "How to diagnose papilloedema", published in the August 2026 edition of the journal. From crashing visual loss to pulsatile tinnitus, they discuss the signs in a patient history which can build a picture of their condition. There's a practical walkthrough of the key elements of the eye exam, as well as discussion of the modern tools that are available to assist. Sometimes backup is needed, and Prof. Mollan explains when it's the right time to call the ophthalmologists back, and how to buy yourself extra time on a late Friday shift. Links:

The latest highlights from the journal will deliver confidence when managing complex everyday presentations. In this podcast for the August 2026 issue of Practical Neurology, co-editors Phil Smith and Geraint Fuller present the key highlights from a cracking 100-page edition spanning the full spectrum of neurological care. They examine how to accurately diagnose papilloedema and distinguish swollen optic discs from pseudo-swelling or other mimics. Next, they discuss a comprehensive guide to the Parkinson's disease follow-up consultation, focusing on non-motor symptoms, lifestyle advice, and long-term management. The editors also explore a structured approach to assessing neurogenic bladder, bowel, and sexual dysfunction, before covering the key clinical clues and investigations for evaluating pulsatile tinnitus. They also review the intricate link between chronic kidney disease and cognitive impairment, and finish with a critical look at the practical uses and limitations of subhairline EEG monitoring in neurocritical care. Read the issue: https://pn.bmj.com/content/26/4 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, Nick Currey and Letícia Amorim. Thank you for listening.

In this special episode coming live from the Association of British Neurologists (ABN) annual meeting in Birmingham, Practical Neurology co-editors Phil Smith and Geraint Fuller join hosts Ruth Wood and Babak Soleimani to discuss the perennial clinical and educational value of case reports in which, in a rare event, the patients are actually referred to directly by their first names. The team discusses two compelling, patient-centered narratives. They look at a complex case of refractory focal epilepsy from 2024 where the patient actively partnered in the high-stakes decision to balance seizure freedom against a predicted post-surgical motor deficit. A review of a poignant "Me and My Neurological Illness" piece written in 2016 by a prominent epileptologist is a reflection on his subtle subacute presentation of autoimmune encephalitis, how a doctor's baseline cognitive reserve can mask complex focal seizures, and the unique clinical and personal challenges faced when dealing with medical colleagues who lack diagnostic insight into their own condition. Archive papers discussed in this episode: Case Report 1: Complicated epilepsy surgery: importance of balancing benefit and deficit. https://pn.bmj.com/content/24/5/393 Case Report 2: Me and my neurological illness. Autoimmune limbic encephalitis due to VGKC-Ab. Thanks for the memory. Leo Robin (Title of song, 1937). https://pn.bmj.com/content/16/2/162

What's the real difference between a night owl and a morning lark? The Editors' Choice paper for the June 2026 issue of Practical Neurology is a review of all the ways sleep intersects with neurological practice. Last author Prof. Guy Leschziner¹ joins PN podcast editor Dr. Amy Ross Russell to the wide variety of sleep-related disorders: insomnia, hypersomnolence, and sleep-related movement disorders. Each category contains pitfalls to be avoided when treating, like overlooking critical signs or reaching for drugs too eagerly. You'll also learn about "sleep reactivity", teenage sleep patterns in the animal kingdom, and diagnostic insight that can be gained from partners. Sleep neurology: pearls and pitfalls 1. Sleep Disorders Centre, Guy's and St Thomas’ Hospitals NHS Trust, London, England, UK Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest episodes. 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.