The wonders of the animal kingdom make an absorbing reappearance this episode, so grab your scuba mask before listening - or your chef’s hat.

The first case this month is the kind that even an experienced neurologist would be nervous to encounter (1:35 ). A holidaymaker in his sixties presents to the emergency department with vomiting, dizziness, and an inability to walk, amongst several other symptoms. A suspicion of stroke was quickly replaced by a different hypothesis following discussions with the patient’s family members.

https://pn.bmj.com/content/25/4/377

The second case follows a presentation over the span of multiple decades (18:44 ). A woman first presents in her thirties with extreme lethargy and occasional migraines. She was diagnosed with panhypopituitarism and treated with steroid replacement. Following breast cancer in her late forties, treated by surgery and radiotherapy, the migraines worsened, prompting further investigation.

https://pn.bmj.com/content/25/4/359

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 June 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) Neurology Registrar, University Hospitals Sussex.

(3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford

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Production by Brian Kennedy, Letícia Amorim. Editing by Brian O'Toole. Thank you for listening.