Michael C Lowe, Gabriele Berman, Fernando Labella Álvarez, Pushkar Shah, Susan P Mollan
{"title":"How to diagnose papilloedema.","authors":"Michael C Lowe, Gabriele Berman, Fernando Labella Álvarez, Pushkar Shah, Susan P Mollan","doi":"10.1136/pn-2025-004784","DOIUrl":"10.1136/pn-2025-004784","url":null,"abstract":"<p><p>Papilloedema is optic disc swelling due to raised intracranial pressure (ICP). Typically, this occurs bilaterally, and visual function is usually relatively preserved unless the disease is moderately severe or chronic. The implications of a new finding of papilloedema are potentially serious; however, overdiagnosis of papilloedema can lead to iatrogenic harm from unnecessary investigation or treatment. It is important to consider the differential diagnosis for swollen optic disc appearances to ensure patients are investigated appropriately. We describe an approach to the clinical assessment of patients with suspected papilloedema, using history, examination and tools available in the eye clinic including perimetry and optical coherence tomography, as well as the pitfalls that may be encountered using these technologies. We also discuss a strategy for subsequent investigation of patients with probable papilloedema to identify causes of raised ICP, while highlighting potential pitfalls in this process.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"319-330"},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julia de Oliveira Xavier Ramos, Pedro Fraiman, Thiago Yoshinaga Tonholo Silva, Rubens Paulo Araújo Salomão, José Luiz Pedroso, Orlando G P Barsottini
{"title":"Neuroichthyosis: the interplay between brain and skin.","authors":"Julia de Oliveira Xavier Ramos, Pedro Fraiman, Thiago Yoshinaga Tonholo Silva, Rubens Paulo Araújo Salomão, José Luiz Pedroso, Orlando G P Barsottini","doi":"10.1136/pn-2025-004881","DOIUrl":"10.1136/pn-2025-004881","url":null,"abstract":"<p><p>The interplay between skin and neurological disorders is well recognised, given the shared embryological origin of both skin and nervous system cells from the ectoderm. Certain cutaneous manifestations may guide the neurological workup and contribute to a more accurate diagnosis. We report a 20-year-old man with drug-resistant epilepsy and developmental regression since childhood, who had characteristic skin findings compatible with ichthyosis. Despite the broad differential diagnosis for these neurological manifestations, recognising the skin involvement was important in guiding the genetic investigation, ultimately narrowing the diagnosis to the group of neuro-ichthyotic syndromes.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"376-378"},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sashini Mariathasan, Hadi Manji, Ali Alim-Marvasti
{"title":"A case of blurred vision.","authors":"Sashini Mariathasan, Hadi Manji, Ali Alim-Marvasti","doi":"10.1136/pn-2025-004849","DOIUrl":"10.1136/pn-2025-004849","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"400-403"},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yousef Hyder, Richard Irving, Satheesh Ramalingam, Benjamin R Wakerley
{"title":"Assessment and management of pulsatile tinnitus.","authors":"Yousef Hyder, Richard Irving, Satheesh Ramalingam, Benjamin R Wakerley","doi":"10.1136/pn-2025-004624","DOIUrl":"10.1136/pn-2025-004624","url":null,"abstract":"<p><p>Pulsatile tinnitus refers to the perception of intermittent, often rhythmical sounds, which are typically throbbing, beating or whooshing in nature, and may or may not be synchronised to the patient's pulse. It may also be classified as either objective, where the clinician can also hear the sound on auscultation, or subjective, where only the patient hears it, often due to heightened awareness of blood flow in the ear. It is important for neurologists to have an understanding of pulsatile tinnitus as, especially when combined with other symptoms and signs, it may suggest a specific neurological or neurovascular diagnosis.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"306-312"},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Antisynthetase syndrome causing progressive gait disturbance.","authors":"Orsolya Györfi, Danuta Szirmai, Gréta Benkő-Zaja, Zsolt Benkő, Mária Judit Molnár, Anita Kamondi","doi":"10.1136/pn-2025-004570","DOIUrl":"10.1136/pn-2025-004570","url":null,"abstract":"<p><p>Antisynthetase syndrome accounts for one-third of cases of idiopathic inflammatory myopathy. It is characterised by the presence of serum antibodies against aminoacyl-tRNA synthetase and most often manifests as interstitial lung disease, myositis and/or arthritis. We report a 67-year-old woman with gait disturbance and muscle weakness, which worsened over 7 years, especially during intermittent illnesses with fever. Extensive neurophysiological and immunological examination led to a diagnosis of antisynthetase syndrome. She improved with corticosteroids and methotrexate.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"362-365"},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Apoorva Anil Kumar, Victor Jia Wei Zhang, Carine J Moezinia, Sarah Levy, Fernanda Ruiz, Sebastian Brandner, Frederick Schon, Hamid Modarres, Alexander M Rossor
{"title":"Severe lupus vasculitic neuropathy.","authors":"Apoorva Anil Kumar, Victor Jia Wei Zhang, Carine J Moezinia, Sarah Levy, Fernanda Ruiz, Sebastian Brandner, Frederick Schon, Hamid Modarres, Alexander M Rossor","doi":"10.1136/pn-2025-004879","DOIUrl":"10.1136/pn-2025-004879","url":null,"abstract":"<p><p>A 31-year-old woman presented with generalised pain and weakness due to a severe axonal sensorimotor neuropathy, rapidly worsening over 2 weeks. For 6 months she had experienced transient joint symptoms, rash and hair loss. A vasculitic process was considered. Blood tests taken following intravenous immunoglobulin (IVIG) (given for suspected Guillain-Barré syndrome) noted strongly positive lupus and antiphospholipid antibody titres. She was diagnosed with severe multisystem lupus vasculitis involving the central and peripheral nervous system and started on cyclophosphamide and prednisolone, with notable improvement. We outline challenges faced in this patient's care, including making the diagnosis, interpreting autoantibody serology following IVIG treatment and identifying suitable immunosuppression regimens in a limited evidence base. It is important to be aware that peripheral neuropathy is an under-recognised presenting manifestation of neurological lupus.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"366-372"},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Relationship between cognitive impairment and chronic kidney disease.","authors":"Laila-Yasmin Mani, Robert John Unwin","doi":"10.1136/pn-2025-004837","DOIUrl":"https://doi.org/10.1136/pn-2025-004837","url":null,"abstract":"<p><p>Cognitive impairment is an under-recognised but clinically significant complication of chronic kidney disease (CKD). The global prevalence of CKD is approximately 10%, and it frequently affects neurological function, and particularly executive and language domains. This article encourages neurologists and neuropsychiatrists to consider CKD as a potential contributor to cognitive decline. By recognising the characteristic cognitive profile associated with CKD, and distinguishing it from coexisting neurodegenerative pathology, clinicians can implement early interventions that improve outcomes. We outline mechanisms that link CKD to cognitive dysfunction, present diagnostic approaches and offer multidisciplinary strategies for assessment and management.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":"26 4","pages":"313-318"},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Angelo Luigi Perez, Derek Debicki, Poul Espino, Teneille Gofton
{"title":"Subhairline EEG in neurocritical care: use and limitations through illustrative cases.","authors":"John Angelo Luigi Perez, Derek Debicki, Poul Espino, Teneille Gofton","doi":"10.1136/pn-2025-004859","DOIUrl":"10.1136/pn-2025-004859","url":null,"abstract":"<p><p>Subhairline electroencephalography (EEG) is a limited-montage EEG with applications in epilepsy and neurocritical care. It has potential advantages in resource-limited settings and may help in the early diagnosis and management of seizures and status epilepticus while providing real-time electrophysiological monitoring. It has several important technical limitations such as reduced spatial coverage, low sampling rate, inadequate bit depth and review software with limited features. Clinicians must carefully consider these limitations for proper interpretation and so avoid diagnoses based on false positives or false negatives. We present six cases using subhairline EEG and their corresponding 10-20 EEG recordings to help in pattern recognition and to highlight the usefulness and limitations of this technique.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"348-356"},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145821266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"PML in 2026: beyond recognition and towards treatment.","authors":"Shaza Almweisheer, Ronak K Kapadia","doi":"10.1136/pn-2026-005285","DOIUrl":"https://doi.org/10.1136/pn-2026-005285","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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