What unsuspecting dangers lie within a garden compost bin? The Case Reports team are back to uncover a new pair of neurological mysteries.

The first case this episode (1:24) comes from Edinburgh, centred on an 88-yo woman who presents with headache and eye-pain on her right side. She receives an early diagnosis of migraine, but returns a few weeks later with intermittent vomiting and subsequent progressive visual loss.

https://pn.bmj.com/content/26/1/83

The second case (19:51) from Wessex features a common presentation of tingling feet, with a 62-yo man who develops gait instability. More curious are a significant drop in his weight, as well as a scaly patch on his chest.

https://pn.bmj.com/content/26/1/63

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) 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 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://bit.ly/4aXF46i). We'd love to hear your feedback on social media - @PracticalNeurol.

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

Many patients will affirm seeing clouds shaped like animals or other similar phenomena, which is why confirming pareidolia (seeing meaningful images in meaningless visual stimuli) is such a tricky symptom in dementia with Lewy bodies (DLB). While it may not be exclusive to DLB, placing such symptoms in the context of "the company it keeps" is a key method to narrowing down the diagnosis. The Editors' Choice paper for the February 2026 issue of Practical Neurology is a practical guide to the clinical diagnosis and management of DLB. Authors Dr. Sarah Fullam¹ ² and Dr. Seán O'Dowd¹ ³ join PN podcast editor Dr. Amy Ross Russell to discuss their work. They describe the importance of the initial examination, from the patient's gait to difficulties in word retrieval. They also touch on challenges in the use of biomarkers, which drugs may be helpful, and how to advise patients and their carers.

Read the paper: Dementia with Lewy bodies: a practical guide to clinical diagnosis and management

Special thanks to The Podcast Studios Dublin for their assistance with the recording of this episode. (1) Tallaght Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland (2) Trinity College Dublin School of Medicine, Dublin, Ireland (3) Trinity College Dublin Academic Unit of Neurology, Dublin, Ireland

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

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.