Unihemispheric atrophy, and a culinary culprit - Case Reports Oct 2025

Practical Neurology Podcast

Two new cases from the latest issue of the journal present the podcast team with some rare explanations, and a chance to test yourself on food trivia.  

In the first case (1:18), from Malaysia, a 49-yo left-handed woman develops 10 days of recurrent left-sided focal facial seizures. These seizures progressed to epilepsia partialis continua, which is controlled with some difficulty by employing a broad range of six different anti-seizure medications. Further symptoms arose during monitoring, including emotional lability as well as dystonia, left arm dysfunction, dysphasia and dysarthria. EEG imaging showed focal slowing in the right hemisphere.

https://pn.bmj.com/content/25/5/475

The second case (22:20) features a Northamptonshire chef in her 60s, who presents to the emergency department with a week-long history of nausea, vomiting, and abdominal pain. This progressed to dysphagia and dypsnoea, as well as a downshift in the pitch of her voice. Her conditioned worsened, with respiratory arrest requiring CPR to re-establish circulation. Neurological examination was initially done while sedated, showed fixed and dilated pupils.

https://pn.bmj.com/content/25/5/493

Overloaded with Greek terms today? Here are some definitions from BMJ Best Practice and NHS UK:

• Dystonia is a movement disorder characterised by sustained involuntary muscle contractions and abnormal postures of the trunk, neck, face, or extremities.
• Dysphasia, also known as aphasia, is an acquired impairment of language that affects comprehension and production of words, sentences, and/or discourse.
• Dysarthria is difficulty with speaking, caused by damage or weakness of the muscles needed for speech.
• Dysphagia is difficulty with the act of swallowing solids or liquids.
• Dyspnoea, also known as shortness of breath or breathlessness, is a subjective sensation of breathing discomfort.

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

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