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 UK 2. 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.

A rare sight on the podcast: a paper from the cutting edge of practice, with the novel use of CAR-T cells in treating neurological diseases. Editors Phil Smith and Geraint Fuller bring a selection of papers from the October 2026 issue of the journal to discuss. Returning to the more commonplace, they present a how-to on conversations around lower back pain. There's the editors' choice for the issue: a majestic paper on suspected encephalitis, as well as non-motor symptoms in Parkinson's, a review of the 2024 McDonald criteria for MS diagnosis, and pitfalls to avoid with oxygen desaturation.

Read the issue: https://pn.bmj.com/content/26/5/413

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.

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.