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Nocturnal behaviours, stridor and recurrent respiratory failure in anti-IgLON5 disease

Practical Neurology - Online First Published 29 Sep 2026 Relevancy: 93%

Anti-IgLON5 disease is a rare autoimmune encephalopathy with concurrent tauopathy, characterised by sleep dysfunction and brainstem involvement. A 77-year-old woman developed obstructive sleep apnoea and recurrent hypercapnic respiratory failure requiring repeated intubation, initially misdiagnosed as epilepsy. Video recordings captured elaborate nocturnal behaviours, including praying and offering alms during sleep, alongside inspiratory stridor and sleep attacks during eating. Serial polysomnography documented progressive loss of sleep spindles and undifferentiated non-rapid eye movement sleep. Brain imaging showed only mild cortical, cerebellar and brainstem atrophy. She had anti-IgLON5 antibodies in serum and cerebrospinal fluid. Her condition partially improved after intravenous methylprednisolone and then rituximab, and she remains under follow-up. Patients with treatment-resistant sleep-disordered breathing, laryngeal dysfunction and nocturnal motor behaviours should be tested for anti-IgLON5 disease.

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Our brains, our selves by Masud Husain

Practical Neurology - Online First Published 26 Sep 2026 Relevancy: 23%

The Cardiff Neurology Book Club met to discuss Our Brains, Our Selves by Masud Husain, Professor of Neurology and cognitive neuroscientist at the University of Oxford. In the book, Husain uses a series of clinical case studies—interwoven with reflections from his own life—to explore how disorders of the brain can reshape and even dissolve the sense of self. The book was approached with the familiar ambivalence reserved for neurologists who venture into literary territory. Comparisons with Oliver Sacks, author of The Man Who Mistook His Wife For A Hat , were unavoidable, and discussion quickly turned to the broader genre of clinical storytelling. Sacks himself divided the group: some praised him as a pioneer who restored dignity to patients by seeing the world through their eyes, while others placed him in a more voyeuristic tradition, echoing Charcot’s theatrical demonstrations of neurological illness for public fascination. Likewise, some saw Husain as continuing a...

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Studying Peripheral Neuropathy and Associated Neuropathic Pain in HIV-1 Transgenic Rats: Evaluation of the Therapeutic Effect of Cannabidiol and Beta-Caryophyllene

PubMed - small fiber neuropathy Published 26 Sep 2026 Relevancy: 32%

Background/Objectives: Peripheral neuropathy affects up to 50% of people living with HIV (PLWH). Currently, no small translational rodent model accurately replicates the peripheral neuropathy observed in PLWH. The primary objectives of this study are to assess whether HIV transgenic (HIV-tg) rats develop peripheral neuropathy with pathological and pain-like behaviors similar to those observed in PLWH and to evaluate the analgesic effects of the non-psychoactive cannabis compounds cannabidiol...

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Focal neuropathies: a neuroanatomical approach to diagnosis and management

Practical Neurology - Online First Published 25 Sep 2026 Relevancy: 82%

We provide a framework for clinically evaluating and managing focal neuropathies, emphasising the value of functional neuroanatomy in their diagnosis. Rather than relying solely on electrophysiology, we advocate an approach that aligns specific symptoms with known anatomical pathways to improve clinical diagnostic accuracy. We structure the paper around common clinical presentations of various mononeuropathies involving the upper and lower limbs. By categorising disorders based on their typical motor and sensory manifestations, we offer a practical approach to identifying nerve entrapments and injuries. We also explore how traditional bedside assessment can be used alongside advanced imaging to inform diagnosis and management.

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Stroke recurrence after primary intracerebral haemorrhage: a population-based study of clinical and MRI factors associated with recurrence

Journal of Neurology, Neurosurgery & Psychiatry - Online First Published 25 Sep 2026 Relevancy: 43%

Background Survivors of primary intracerebral haemorrhage (ICH) face competing risks of recurrent ICH and ischaemic stroke. We quantified ischaemic stroke recurrence (ISR) and haemorrhagic stroke recurrence (HSR) and examined associated imaging factors. Methods We analysed 30-day survivors of primary ICH in the Brest Stroke Registry (2008–2020). Cumulative incidence was estimated with death as a competing event. Cause-specific Cox models were fitted in the cohort and MRI subgroup. Results Among 806 survivors, 118 experienced recurrence: 437 died without recurrence. The overall incidence rate was 3.2 per 100 person-years (95% CI 2.7 to 3.9). At 8 years, cumulative incidence was 15.4% (95% CI 12.1% to 19.5%). HSR was higher after lobar than non-lobar ICH (10.1% vs 5.1%), whereas ISR was higher after non-lobar than lobar ICH (10.3% vs 4.8%). ISR was associated with systolic blood pressure, CT leukoaraiosis and atrial fibrillation/flutter. Among 416 participants with MRI, probable cerebral amyloid angiopathy (CAA) was associated with HSR (HR 4.54, 95% CI 1.78 to 11.62). In an exploratory model adjusted for systolic blood pressure and atrial fibrillation/flutter, centrum semiovale perivascular spaces (HR 3.94, 95% CI 1.11 to 13.98) and cortical superficial siderosis (HR 2.96, 95% CI 1.05 to 8.36) were associated with HSR. Brainstem leukoaraiosis was associated with ISR (HR 2.18, 95% CI 1.10 to 4.31). Conclusions Recurrence patterns differed by index ICH location. CAA-related MRI markers were associated with HSR, whereas ISR was associated with vascular risk and brainstem small-vessel disease. These findings identify candidate predictors for the development of recurrence prediction models, with potential utility in supporting clinical decision.

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Corneal nerve imaging in systemic neuropathy: A minireview of experimental and precision medicine applications

PubMed - small fiber neuropathy Published 24 Sep 2026 Relevancy: 73%

Small-fiber neuropathy is a common complication of metabolic, neurodegenerative, and treatment-related disorders. Early detection can be challenging because established diagnostic approaches may be invasive, resource-intensive, or relatively insensitive to early small-fiber injury. Corneal confocal microscopy (CCM) is a rapid, noninvasive imaging technique that enables quantitative assessment of the corneal subbasal nerve plexus and has been proposed as a biomarker of peripheral small-fiber...

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Nomograms for the lower normal limits of epidermal nerve fibers number and their morphological alterations according to age and sex

PubMed - small fiber neuropathy Published 23 Sep 2026 Relevancy: 69%

CONCLUSION: Using restricted methods, our single-center study results propose a nomogram for the lower normal limits of IENFD according to age and sex for first time including children > 10 years old as complement to the already published multicenter study values. Part of the above have already been applied successfully to evaluate SFN of different etiology in patients. Additionally, for the first time we propose nomogram for the epidermal nerve fibers with small swellings according to the age...

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Extraosseous Ewing sarcoma of the common fibular nerve

BMJ Practical Neurology - Current Issue Published 21 Sep 2026 Relevancy: 72%

Ewing sarcoma is a highly aggressive malignancy predominantly affecting bones and soft tissues, which typically occurs in young people. Its occurrence in peripheral nerves is exceptionally rare, posing significant diagnostic and therapeutic challenges. We describe a 64-year-old woman with progressive weakness of the left foot, who had an intraneural extraosseous Ewing sarcoma of the common fibular nerve. We describe the complexities of diagnosing this rare malignancy and emphasise the role of a multidisciplinary approach to management.

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Bilateral facial palsy due to Melkersson-Rosenthal syndrome

BMJ Practical Neurology - Current Issue Published 21 Sep 2026 Relevancy: 73%

A 29-year-old woman developed bilateral facial nerve palsy for which no cause could be identified despite neuroimaging, lumbar puncture, viral serology and blood testing. Neuroinflammatory and dermatology input was sought. The patient later presented with a new manifestation of upper lip swelling, leading to a clinical diagnosis of Melkersson–Rosenthal syndrome. The diagnosis of this neuromucocutaneous disorder is challenging, with the classical triad of signs—facial nerve palsy, orofacial oedema, lingua plicata—often not presenting together. Suspecting the condition in oligosymptomatic presentations could reduce the delay in diagnosis, thereby facilitating earlier consideration for corticosteroid or immunosuppressive treatment and involvement of dermatology as appropriate.

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