PRACTICAL NEUROLOGY最新文献

A 34-year-old woman developed recurrent headaches with left-sided sensory and visual disturbances and was found to have multiple cystic brain lesions. This report documents the clinicopathological conference at the 45th Edinburgh Advanced Clinical Neurology course in 2025.

When persistent neurological symptoms and signs defy diagnostic explanation despite repeated rounds of investigation, how should the clinician proceed? We present a case of this type with an eventual and unusual diagnosis. As well as being an exercise in awareness raising, the case serves as a prelude to considering what practical management strategies might be adopted in the face of persistent diagnostic uncertainty with its consequent frustrations for patient, significant others and physicians. We consider these approaches first with respect to the specific finding of ophthalmoplegia, the principal feature in this case, and second with respect to any neurological diagnosis.

Ring-enhancing brain lesions present a common radiological conundrum, especially in immunocompetent hosts where there is a broad differential diagnosis. Toxoplasma gondii, an obligate intracellular protozoan, typically causes encephalitis in immunocompromised patients, especially those with HIV/AIDS. Toxoplasma cerebral lesions in apparently immunocompetent people pose a diagnostic dilemma. The clinical features may mimic neoplastic or fungal causes, particularly when there are atypical radiological and histological presentations. We report an immunocompetent patient with toxoplasma encephalitis causing multiple cerebral lesions, with persistent clinical deterioration, ambiguous radiological findings and delayed response to treatment. The case emphasises the importance of tissue diagnosis and multidisciplinary management in this condition.

Optimal nutrition is a fundamental determinant of a healthy life. Many non-motor symptoms in Parkinson's disease (PD) adversely affect nutritional status. Although current resources, including the 'Clinical nutrition in neurology guidelines' from the European Society for Clinical Nutrition and Metabolism, provide valuable recommendations, there is a need for updated, PD-specific dietary guidelines. This article aims to support neurologists by providing a concise and comprehensive overview of the most important nutritional considerations for PD: (1) body weight regulation; (2) guidance on micronutrient monitoring and supplementation; (3) strategies to ensure adequate protein intake while minimising nutrient-drug interactions; (4) dietary approaches for gastrointestinal issues and (5) promising dietary strategies for PD symptom management.

Functional seizures are one of the most common presentations of functional neurological disorder and frequently generate diagnostic uncertainty in emergency settings. We are experiencing increasing reports of oxygen desaturation during functional seizures, particularly with widespread use of consumer oximeters and wearable devices. We describe a case of recurrent functional seizures with documented desaturation that prompted cardiopulmonary investigations and repeat video-electroencephalogram evaluation. In a controlled setting, apparent desaturations were attributable to artefact and brief breath-holding, with saturations remaining within the expected physiological range. We review common artefactual causes of low oxyhaemoglobin saturation in functional seizures, including motion, excessive pressure due to clenched fingers, excessive ambient light, poor probe placement and low perfusion, as well as the potential role of posthyperventilation apnoea. Recognising these pitfalls is essential to avoid misinterpretation, unnecessary investigations and anxiety for patients and clinicians. Understanding oximetry waveform quality and artefact sources is key to distinguishing true hypoxia from misleading readings.

Linear scleroderma 'en coup de sabre' is a rare condition characterised by inflammation and fibrosis of the skin and underlying tissues; it rarely presents in adults. The adult-onset form seldom has extracutaneous manifestations, but those that occur are usually neurological. A 43-year-old woman with epilepsy had a scar-like lesion on her forehead. The MR brain scan showed focal cortical atrophy and white matter changes on the same side as the skin lesion. Skin biopsy identified hyaline sclerosis of the reticular dermis consistent with scleroderma. Her clinical condition stabilised on mycophenolate mofetil. Although uncommon in adults, it is important to consider this rare disease in adults with scalp lesions who have epileptic seizures.

Radiologically isolated syndrome (RIS) is the incidental finding of MRI evidence of demyelination suggesting multiple sclerosis in someone with no corresponding clinical signs or symptoms. RIS can be challenging for neurologists to manage. In this article, we discuss its diagnosis and misdiagnosis and how to approach and manage a suspected case, as well as potential therapies. We also discuss how the updated 2024 McDonald criteria have changed the diagnosis and management of some patients with RIS.