Practical Neurology Podcast

When a patient says, "I biffed the car," how should that be translated? Puzzles like this represent the gap between description and diagnosis, and are a critical part of neurological practice. In this podcast for the February 2026 issue of Practical Neurology, editors Phil Smith and Geraint Fuller take turns decoding some of the mysteries of everyday neurology. They cover dementia with Lewy bodies, osteoporosis and fracture risk, and anxiety and depression in epilepsy patients, as a sample of some of the published work in the latest journal. There's also a guide to the latest stroke rehabilitation guidelines, freezing of gait, and a farewell to a 'nom de plume'.

Read the issue: https://pn.bmj.com/content/26/1/1

 

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 and editing by Brian O'Toole. Thank you for listening.

Eye pain can be a source of serious concern for patients, bringing worries about their eyesight. While uveitis is far from the only source of ocular pain, in many presentations of the condition it is a feature. In this Editors' Choice podcast, ophthalmic surgeon Mr. Harry Petrushkin¹ ² and neurologist Dr. Ruth Dubson³ join forces to explain a comprehensive approach to uveitis treatment. Host Dr. Amy Ross Russell leads the way through a refresher on eye anatomy and the spectrum of uveitis patients neurologists are likely to encounter. These are often the more serious of patients, requiring good working relationships across disciplines. They also speak of the overlap with neuroinflammatory presentations, and the eye manifestations seen in conditions like multiple sclerosis and sarcoidosis.

Read the paper: Uveitis for Neurologists

(1) Uveitis and Scleritis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
(2) Rheumatology Service, Great Ormond Street Hospital NHS Trust, London, UK
(3) Blizard Institute, Queen Mary University London, 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.

Production by Amy Ross Russell and Brian O'Toole. Editing by Brian O'Toole. Thank you for listening.

Another set of intriguing cases from the latest issue of the journal, pored over by the Case Reports team. 

In the first case, a 24-yo man presents acutely with reduced consciousness, following 3 days of right-sided headache. His mother reports sudden behavioural changes with jerky movements and enlarged pupils. He is agitated, not obeying commands and not moving his left-side limbs. He had a history of autism and vascular Ehlers-Danlos syndrome and was on medication for stroke prevention. An MRI scan led to a differential diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES), but the final conclusion came post-discharge after a further review of his scans. 

https://pn.bmj.com/content/25/6/549

The second report (19:37) describes two curious instances of functional neurological disorder (FND), both of which improved after the patients were in comatose states. The first patient is a 59-yo man who had developed muscle weakness shortly after at car crash at age 49, and had subsequently been reliant on a wheelchair for more than 8 years. Recently the patient had been infected simultaneously with severe cases of flu and COVID-19, during which he had been sedated and placed in an induced coma for several weeks. Awakening from the coma, the patient showed surprising signs of new mobility. In the second patient, a 40-yo woman presented with flaccid paralysis of her left arm, with loss of sensation up to the shoulder. She had a history of bipolar disorder and agoraphobia. She was diagnosed with FND and participated in physiotherapy and hypnotherapy with no improvement. Thirteen months later she was readmitted following an overdose on a mix of analgesics and sedatives, and was ventilated in the ITU for several hours. Upon waking the patient noticed that her previously paralyzed arm had completely recovered.

https://pn.bmj.com/content/25/6/562 

Further reading:

Advances in functional Neurological disorder (BMJ Neurology Open)

 

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.

Neurology requires some detective work at times, and identifying the patterns of symptoms associated with drug misuse can be a tricky mystery indeed. For this episode, we're receiving a masterclass from Dr. Robin Howard¹ on the wide variety of drugs that bring patients into hospital, as well as the mechanisms they act on. His paper "Neurological aspects of drug misuse" is the Editors' Choice for the October 2025 issue, and he joins PN podcast editor Dr. Amy Ross Russell in the studio. From the new dangers of synthetic psychoactives to the profound consequences of chronic use, the discussion unveils critical clinical presentations every neurologist should recognize. We delve into fascinating phenomena including "punding," compulsive repetitive behaviors seen with stimulant abuse, and the rare but striking CHANTER syndrome, with its signs of disturbed consciousness and extensive cerebellar involvement. Hear too about the distinctive spongiform leukoencephalopathy associated with "chasing the dragon," a dangerous method of heroin inhalation, but which can also be caused by cocaine usage.

 

Read the paper: https://pn.bmj.com/content/25/5/411

 

(1) Guy's and St. Thomas’ NHS Foundation Trust, 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.

Production by Amy Ross Russell and Brian O'Toole and editing by Brian O'Toole. Thank you for listening.

Who do we need to scan? Behind the constant considerations of irradiation risk and resource usage, there is nuance to be found. Parkinson's disease - being a clinical diagnosis - doesn't suggest a need for imaging, yet one case in this issue argues that should not be an absolute rule. Another paper brings in the context of a specific patient: does one man really need 50 CT scans in his life? There's also an unboxing of uveitis, diagnosis of Alexander disease in adults, and an exploration of connections between the microbiome and neurology. This being the fifth(!) Christmas podcast for editors Phil Smith and Geraint Fuller, they finish with the annual crossword and book club update, featuring hot cross buns and hummingbirds.

Read the issue: https://pn.bmj.com/content/25/6/501

 

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.