Fragmented sleep with delusions of theft, and falls after eye shingles - Case Reports April 2025

Two wide open cases from the latest issue of the journal. Starting with a case from Italy (1:18), of a 63-yo man having a history of behavioural and cognitive problems since retiring. His many changes included low mood, significant weight loss, and problems with sleep and temperature regulation. He had a background of type 2 diabetes. Initial treatment was on a suspicion of Alzheimer's, but there was no clinical improvement. https://pn.bmj.com/content/25/2/159  A case from the United States is next (17:36), featuring a 66-yo lady experiencing 10 days of generalised weakness, with episodes of forgetfulness and a series of falls. She had previously been treated for left-sided ophthalmic herpes zoster. Neurological examination showed mild right arm and leg weakness. https://pn.bmj.com/content/25/2/164    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 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 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. 

Immune checkpoint inhibitors can significantly improve cancer survival rates. But resulting immune-related toxicities are common, requiring multidisciplinary cooperation between oncology and neurology.  This episode, PN's podcast editor Dr. Amy Ross Russell speaks with a panel of experts on the balancing act required when treating cancer patients with these new drugs. Oncologist Dr. Heather Shaw is alongside neurologists Dr. Aisling Carr and Dr. Mark Willis, and they are amongst the authors of the editors' choice paper for the latest issue of Practical Neurology. Read the paper: Neurological complications of immune checkpoint inhibitors: a practical guide  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, Brian Kennedy, Amy Ross Russell and Brian O'Toole. Editing by Brian O'Toole. Thank you for listening. 

The latest guidelines on disease-modifying treatment in multiple sclerosis (MS) from the Association of British Neurologists is discussed in this intercontinental podcast with perspectives from the UK, the USA, and Australia.   Participants: Professor Alasdair Coles is Head of Department for Clinical Neuroscience and also Co-Director of the Cambridge Centre for Myelin Repair, UK. Dr. Tamara Kaplan is Assistant Professor of Neurology at Harvard Medical School, and is also affiliated with the Brigham and Women's Hospital, Boston, USA. Professor Michael Barnett is a consultant neurologist at Royal Prince Alfred Hospital Sydney, Central Clinical School, and Director of the RPAH MS Clinic and the MS Clinical Trials Unit at the Brain and Mind Centre, University of Sydney, Australia. Read the paper (https://pn.bmj.com/content/25/1/18) which is part of the February 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.     

It's a podcast of pairs this time, for the latest issue of the journal. There's two hosts, two halves of the brain, two sides to a clinical debate, and two themes to the episode itself. Leading off is a discussion on peripheral neurology, taking a look at the editors' choice paper on immune checkpoint inhibitors. That's followed by a paper on  secondary hypertension, and another on small fibre neuropathies. The second half covers elements of cognitive neurology, including a topic with increasing awareness - that of brain fog. There's the dramatically named STOP-BANG questionnaire, a notable appearance from a monkey, and a reflection on modern practices for cognitive assessment. Read the issue: https://pn.bmj.com/content/25/2/101 Listen to Dr. Laura McWhirter on the JNNP podcast: Brain fog demystified 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. 

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. 

Intermittent painful spasms, stiffness and rigidity of the proximal and truncal muscles are only a few symptoms of the relatively uncommon Stiff-person syndrome (SPS). In this podcast, we delve into the characteristics and diagnosis of this complex autoimmune condition. PN's podcast editor Dr. Amy Ross Russell interviews Professor Saiju Jacob (University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK). The paper is the Editor's Choice paper of the February issue of Practical Neurology. The episode is released to coincide with world Encephalitis day. For more information about World encephalitis day, or encephalitis international please follow this link: https://www.encephalitis.info/world-encephalitis-day/  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 practice of neurology is constantly changing, and the papers in this issue exemplify that trend. On this episode, journal editors Dr. Geraint Fuller and Prof. Philip Smith discuss their highlights from the latest issue of Practical Neurology, for February 2025. They begin with the editors' choice paper on stiff person syndrome, then speak about new guidance from the ABN on disease-modifying treatments for MS. There's also life-improving interventions for posterior cortical atrophy, changing attitudes towards stroke as a career option for neurologists, and management techniques for cryptococcal meningitis - including a resourceful substitute for India ink.  Read the issue: https://pn.bmj.com/content/25/1/1  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. 

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. 

The often challenging diagnosis of neuromuscular junction (NMJ) disorders can be explained by suspicious red flags for the key differential diagnoses (mimics) and atypical presentations (chameleons).  In the latest Editor's Choice paper podcast, PN's podcast editor Dr. Amy Ross Russell interviews Dr Stephen Reddel and Dr Shadi El-Wahsh, both from the Concord Hospital, New South Wales, Australia, and the authors of Neuromuscular junction disorders: mimics and chameleons. 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.