Show Notes
Two highly unusual cases in this edition of Case Reports. The first case describes a 64-yo woman presenting to the emergency department with a five day history of bizarre behaviours (1:45). A BBC radio show prompts her, out of character, to reflect aloud about her childhood, and she experiences recurrent periods of unresponsiveness followed by intense agitation. She was kept in hospital for scans and discharged after two weeks, but returned soon after with a similar presentation - (link) A lifetime bodybuilder is the patient in the second case (21:12), with a practice of anabolic steroid injection over several decades. He presents with a three year history of unsteadiness when walking and tingling in his feet, as well as reduced dexterity. His symptoms are found to be brought on by a toxicity from an unexpected source - (link) The case reports discussion is hosted by Prof. Martin Turner (1), who is joined by Dr. Ruth Wood (2) and Dr. Xin You Tai (3) 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 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. Listen to the JNNP podcast, "Nutritional peripheral neuropathies, with Dr. Alexander Rossor" on Apple (https://apple.co/3WjTmrM), Spotify (https://spoti.fi/4bKOhNA), Web (https://bit.ly/4cYhx4m). 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.
More from Practical Neurology Podcast
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.