This month's cases both feature sudden onset neurological syndromes. The first case (1:23) is that of a 26-yo Brazilian man who awoke from sleep with weakness in all four limbs. The signs suggest a possibility of Guillain-Barré syndrome or polio. A normal cranial nerve examination follows, with no unusual findings - https://pn.bmj.com/content/24/4/342 

A 69-yo woman is the subject of the second case (14:33), after she presents with sudden onset unsteadiness and slurred speech when getting out of bed. A stroke was initially examined for by CT head scan, proving unremarkable, but a subsequent MRI scan showed an intense midbrain lesion. The patient subsequently improved, but then returned three months later with occurrences of the same symptoms multiple times throughout the day - https://pn.bmj.com/content/24/4/310

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 August 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. 

Genetic testing is a useful tool for any practising neurologist, but they must know how to interpret the results. This Editors' Choice podcast features two experts on the subject, Prof. Mary Reilly¹ and Dr. Christopher Record¹. They're in the studio to talk through their paper, covering the technology of genome sequencing itself, testing strategies, clinical use cases, and the constant changes in this developing field.

Read the paper:

Lessons and pitfalls of whole genome sequencing

1. Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, 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.

This episode was hosted by PN's podcast editor Dr. Amy Ross Russell. Production by Letícia Amorim, Brian O'Toole, and Amy Ross Russell. Editing by Brian O'Toole.

Journal editors Prof. Philip Smith and Dr. Geraint Fuller discuss the August 2024 issue of Practical Neurology, with room for mystery, history and practical advice. In particular, they cover topics like whole genome sequencing, foot surgery for Charcot-Marie-Tooth disease, safe prescribing in steroids, and fertility treatment for the epileptic. There are also good reasons for dusting off the old optokinetic nystagmus drum, and a touching story of neuro palliative care.

Read the Highlights - https://pn.bmj.com/content/24/4/261 - and the full issue - https://pn.bmj.com/content/24/4.

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.

The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening.

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. 

Neurodegenerative disease is the subject of this month's Editors' Choice podcast, with Dr. Patrick Cullinane¹ and Dr. Zane Jaunmuktane.¹ They join the podcast for an overview of brain examination, explaining the process of protein misfolding, the spread of pathology through the brain, and what new discoveries can tell us about old diseases.

Read the paper: Pathology of neurodegenerative disease for the general neurologist

1. Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, 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.

This episode was hosted by PN's podcast editor Dr. Amy Ross Russell. Production by Letícia Amorim, Brian O'Toole, and Amy Ross Russell. Editing by Brian O'Toole. Special thanks to The Podcast Studios Dublin for their assistance with the recording of this episode, and thank you for listening.

Journal editors Prof. Philip Smith and Dr. Geraint Fuller discuss the June 2024 issue of Practical Neurology, covering some of the interesting articles published this month. A number of difficult challenges and tradeoffs are featured, relating to recent men-only guidance for sodium valproate use, folic acid dosing for women with epilepsy, post-mortem brain donation, and sexual dysfunction caused by neurological medication. There is also some insight into the treatment of hepatic encephalopathy and congenital myasthenia.

Read the issue: https://pn.bmj.com/content/24/3

Further reading:

Cancer Risk in Children of Mothers With Epilepsy and High-Dose Folic Acid Use During Pregnancy. Vegrim HM, Dreier JW, Alvestad S, et al. JAMA Neurol. 2022;79(11):1130–1138.

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.

The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening.

The first of this episode's two case reports features a 62-yo man, referred from ophthalmology with a drooping eyelid, chronic coughing, and excess sweating in the face provoked by eating (1:21). An MR scan finds abnormal deposits in his brain - (link)

The second report describes two patients (17:05), firstly a 70-yo man presenting with abnormal facial movements and weight loss, and secondly a 90-yo woman with abnormal movements of her right arm and leg. Routine blood tests at presentation for both patients were normal at presentation - (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 April 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.

The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening. 

The first multidisciplinary consensus guideline for the diagnosis and treatment of spontaneous intracranial hypotension (SIH) has recently been published by the UK SIH Specialist Interest Group. Group members Prof. Manjit Matharu (1), Dr. Indran Davagnanam (2), and Mr. Parag Sayal (3) join Dr. Amy Ross Russell to explain their recommendations. They discuss the impact this condition has on patients, the possible presentations, and approaches for diagnosis and treatment.   Read the article: Spontaneous intracranial hypotension  

(1) Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
(2) Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
(3) Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, 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.

The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening.

Journal editors Prof. Philip Smith and Dr. Geraint Fuller discuss the April 2024 issue of Practical Neurology, covering some of the interesting articles published this month. Topics include inconsistencies observed in functional gait, the consequences of restrictive diets with reduced riboflavin, and a guideline to managing patients with spontaneous intracranial hypotension. In syndromic sightings there's a scattering of Ehlers-Danlos, Strachan and Alzheimer's to name but a few. Plus, some correspondence shedding light on the meaning behind an oversized comb - or was it an extreme brush?

Read the issue: https://pn.bmj.com/content/24/2

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.

The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening.

The first case for this issue's discussion is one of a young man with a history of involuntary jerks and photosensitivity (1:20). Several more seizures followed his initial presentation with a general tonic-clonic seizure. A number of examinations were done including an MR scan and EEG - (link)

Case two involves a 69-yo woman who developed non-convulsive status epilepticus, having been examined as a gastroenterology inpatient for abdominal pain (22:20). A positive PCR for Whipple’s disease in stools and saliva, but negative in the CSF, prompted further testing - (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 February 2024 issue of the journal.

Further reading:

Panegyres PK. Diagnosis and management of Whipple’s disease of the brain. Practical Neurology 2008;8:311-317.   Association of British Neurologists. Rare Diseases Ascertainment and Recruitment (RaDAR).

 

(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.

The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening. 

Neurophysiologists may "lock ourselves away in rooms looking at screens with wiggly lines on", but what are the applications in a clinical context for electroencephalography (EEG)?

In this deep-dive episode, podcast editor Dr. Amy Ross Russell is joined by Dr. Nick Kane (1), an author of the Editors' Choice for the Feb 2024 issue, "Electroencephalography in encephalopathy and encephalitis". They discuss the strategy of serial EEGs in epilepsy diagnosis, neuroinflammation in both autoimmune and COVID19 cases, prognostication for coma patients, and how automated AI systems may be integrated into ICU monitoring. 

Further reading:

Tveit J, Aurlien H, Plis S, et al. Automated Interpretation of Clinical Electroencephalograms Using Artificial Intelligence. JAMA Neurol. 2023;80(8):805–812.

L.J.W. Canham et al. Electroencephalographic (EEG) features of encephalopathy in the setting of Covid-19: a case series. Clin Neurophysiol Pract (2020)

 

(1) Grey Walter Dept of Clinical Neurophysiology, North Bristol NHS Trust, Westbury on Trym, 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.

The PN podcast is produced by Letícia Amorim and edited by Brian O'Toole. Thank you for listening.