Practical Neurology Podcast

Encephalitis, at its simplest, is inflammation of the functional tissue of the brain. With a wide range of infectious and non-infectious causes, it can be difficult to differentiate from other forms of encephalopathy. Yet a growing evidence base suggests that the time to treatment is a key determinant in patient outcomes, making a rapid diagnosis of high importance. In this editors' choice podcast, PN podcast editor Dr. Amy Ross Russell interviews Dr. Yun Huang¹ ² and Prof. Benedict Michael¹ ², on the paper, "Suspected encephalitis in adults", published in the October 2026 edition of the journal. They highlight the importance of collateral history in encephalitis patients, and the strong influence of the patients immune status. Common treatments are discussed, including the risks and benefits of preemptive use of acyclovir, and the empirical application of steroids. Looking forward, testing methods such as metagenomics show promise in handling novel pathogens. Links: Autoimmune encephalitis: clinical spectrum and management Paraneoplastic neurological syndromes: a practical approach to diagnosis and management Management of suspected infectious and autoimmune encephalitis in adults – National Guidelines from the United Kingdom Joint Societies Encephalitis International 1. University of Liverpool, Liverpool UK2. The Walton Centre, Liverpool, 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 Amy Ross Russell, Marina Milsum, Letícia Amorim and Brian O'Toole. Editing by Brian O'Toole. Thank you for listening.

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: Whippits, nitrous oxide and the dangers of legal highs Beriberi following sleeve gastrectomy Functional vitamin B12 deficiency 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 August 2026 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) Clinical Lecturer in Neurology at the Institute of Cognitive Neuroscience, University College London, and an Honorary Neurology SpR at the National Hospital for Neurology and Neurosurgery.(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 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. Production and editing by Brian O'Toole. Thank you for listening.

In this special international episode, we explore the 2025 update of the Association of British Neurologists’ guidelines on managing autoimmune myasthenia gravis. Ten years after the previous recommendations, significant changes have been introduced. We emphasise the importance of daily steroids, early thymectomy, rituximab, and emerging targeted therapies transforming patient care. We also examine how these updates influence frontline care in the UK, Australia, and the USA, and why a multidisciplinary approach remains vital in the management of MG. Participants: Professor Alasdair Coles is Head of Department for Clinical Neuroscience and also Co-Director of the Cambridge Centre for Myelin Repair, UK. Associate Professor Katherine Buzzard, Clinical Lead, Eastern Health Multiple Sclerosis and Neuroimmunology Service, Melbourne, Australia. Dr. Christopher Doughty, MD is a board-certified neurologist, and affiliated with Brigham and Women's Hospital, in Boston, Massachusetts, USA. Read the paper (https://pn.bmj.com/content/25/5/422), which is part of the October 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.

The wonders of the animal kingdom make an absorbing reappearance this episode, so grab your scuba mask before listening - or your chef’s hat. The first case this month is the kind that even an experienced neurologist would be nervous to encounter (1:35). A holidaymaker in his sixties presents to the emergency department with vomiting, dizziness, and an inability to walk, amongst several other symptoms. A suspicion of stroke was quickly replaced by a different hypothesis following discussions with the patient’s family members. https://pn.bmj.com/content/25/4/377 The second case follows a presentation over the span of multiple decades (18:44). A woman first presents in her thirties with extreme lethargy and occasional migraines. She was diagnosed with panhypopituitarism and treated with steroid replacement. Following breast cancer in her late forties, treated by surgery and radiotherapy, the migraines worsened, prompting further investigation. https://pn.bmj.com/content/25/4/359 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 June 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 by Brian Kennedy, Letícia Amorim. Editing by Brian O'Toole. Thank you for listening.

Simplification is everything - that's the message for the latest issue of the journal. Assisted by a cast of characters including Albert Einstein and deep sea sponges, your editors Phil Smith and Geraint Fuller take on topics from hyponatraemia to health anxiety. You'll also find bread and butter epileptology, somatosensory evoked potentials, creatine kinase, and a guide for exploring the hinterlands of essential tremor. Read the issue: https://pn.bmj.com/content/25/4/297 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.