Welcome 2026! The first episode of the new year goes back to absolute fundamentals, discussing the foundations of diagnostic reasoning and how to generate a differential diagnosis in both medicine as a whole and in neurology, falling within our clinical methods series. We begin by discussing systems 1 vs. systems 2 thinking, along with examples provided for each and when each system is appropriate, before moving onto the details of systems 2 thinking, focusing on the aetiological/pathophysiological categories of disease, functional anatomy, and how to marry these together to generate comprehensive differential diagnoses. The episode includes very my coveted, patented (not really!), never-shared-publicly-before mnemonic for a very special surgical sieve. We then discuss how these are applied to medicine and specifically to neurology, focussing on each part of the neuraxis/central nervous system (CNS) and peripheral nervous system (PNS), along with focussing on anatomical patterns (e.g. unilateral vs. bilateral, symmetry, upper vs. lower limbs, motor vs. sensory vs. sensorimotor, whether any ocular, bulbar or pulmonary involvement) and consideration of single vs. multiple lesion patterns to answer the age-old “where is the lesion?” question, as well as considering the tempo of symptom onset (hyperacute, acute, subacute or chronic) to strongly hint answers at the “what is the lesion?” question, to arrive at a provisional diagnosis and sensible investigation and initial management plan. This episode is perfect for medical students and junior doctors, and more senior audience members should also derive value.#medicaleducation #meded #medicine #neurology #doctor #rneurologyeducation

This episode continues our run of journal club episodes, this time looking at whether SGLT2 inhibitors used for type 2 diabetes mellitus have any associated reduction in dementia (such as Alzheimer’s disease and vascular dementia) and Parkinson’s disease, therefore falling into these respective series as well. The content of this episode is best suited for more senior audience members (neurologists and neurology trainees), although all audience members (including medical students) will derive benefit from the way it teaches how to dissect a journal article, demonstrating the process involved in this critical evaluation and ultimately teaching how to decide in what ways a journal article applies to your daily clinical practice.#medicaleducation #diabetes #parkinsonsdisease #dementia #neurology #rneurologyeducation

We’re thrilled to present our first journal club episode, focusing on tenecteplase for ischaemic stroke in the 4.5-24 hour time window in patients with large vessel occlusions (LVOs) in whom mechanical thrombectomy is not an available option (the TRACE-III study, published in the New England Journal of Medicine; NEJM in 2024). This is a landmark study extending the thrombolysis timing window beyond 9 hours for the first time, although with a number of caveats as discussed in the episode. This episode, in addition to teaching you about the evolving landscape of hyperacute therapy options in stroke, teaches you how to critically evaluate a medical journal article, and how to then apply the journal article to your clinical practice, and determine in what ways (if any) that the article is practice changing. This is a more advanced episode, better suited to neurology trainees and neurologists, although more junior audience members will also find it valuable through its global significance in extending the thrombolysis window in places where mechanical thrombectomy is not available, and through its providing a step-by-step worked example in regard to how to critically evaluate a neurology article, an essential and highly transferable skill across clinical medicine as a whole.Correction: At various times when discussing the results section, I refer to the ‘placebo group’ (as a force of habit, apologies!) as opposed to correctly saying the ‘control group’ in this case, given that this was an open-label study at the time of randomisation (not placebo-controlled) and then later blinded at the time of outcome measurement and statistical analysis, as was discussed in the episode.

In this next episode in the movement disorders and Parkinson’s disease series, we begin with a brief overview of the mechanisms of action of the medications used to treat Parkinson’s disease, before focusing on five common and important ward dilemmas encountered in the management of patients with Parkinson’s disease: (1) the patient is unable to take their oral antiparkinsonian medications, (2) the patient is psychotic or delirious, (3) the patient has autonomic instability/dysregulation with orthostatic hypotension +/- supine nocturnal hypertension, (4) the patient is frozen/in an ‘off’ crisis, and (5) the much-feared Parkinson-hyperpyrexia syndrome. We discuss pragmatic ways to tackle each of these problems, coloured with analogies and detailed explanations to make the content understandable in a structured manner (and hopefully also memorable!). This episode is suitable for anyone caring for patients with Parkinson’s disease, although it should be especially useful for junior doctors covering the wards on evening/night and weekend shifts (and medical students also about to find themselves in this position)!

#medicaleducation #doctor #parkinsonsdisease #movementdisorders #rneurologyeducation

We’re thrilled to announce the first episode in our movement disorders & Parkinson’s disease series (also continuing our clinical method series), beginning with a discussion of how to perform an extrapyramidal examination, particularly in the context of suspected Parkinson’s disease, progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD; or corticobasal syndrome, CBS), dementia with Lewy bodies (DLB) and normal pressure hydrocephalus (NPH), as well as assessing treatment responses to levodopa and other Parkinsonian therapies to distinguish an excessively ‘on’ or dyskinetic state, from a ‘good on’ state, from an ‘off’ state including a frozen state. As always in Riisfeldt Neurology Education, we provide a clinical focus to help contextualise the information, peppered with tips and tricks to optimise your examination techniques, and hopefully providing a structure to your learning, along with helpful mnemonics in order to aid memorisation. This episode is appropriate for medical students, junior doctors, physician and neurology trainees, and general practitioners (family doctors) and emergency physicians and their respective trainees, and any other health professional assessing patients presenting with extrapyramidal symptoms and signs or with a pre-established diagnosis such as Parkinson’s disease.

#meded #doctor #parkinsonsdisease #clinicalskills #rneurologyeducation

The second episode in the neuro-otology and vertigo series takes a step back to review the clinical approach to the patient presenting with the notoriously misinterpreted symptom of ‘dizziness’, before reviewing the best way to classify common causes of vertigo into either acute persistent vertigo vs. episodic vertigo (which can in turn be triggered vs. non-triggered). It then discusses the diagnosis and management of vestibular neuritis, benign paroxysmal positional vertigo (BPPV, especially the posterior and geotropic/ageotropic horizontal canal variants), Meniere’s disease and migraine with vestibular features, before turning to a discussion of less commonly encountered causes of vertigo so as to provide an exhaustive list of the potential causes of vertigo, so that when you encounter them in clinical practice you are not then hearing about them for the first time. As always, the episode is packed to the rafters with useful tips, tricks and personal and practical insights so as to contextualise the content, in an attempt to aid structured understanding and memorisation. This episode is appropriate for medical students, junior doctors, physician and neurology trainees, neurologists, cardiologists/ general practitioners (family doctors)/emergency and intensive care physicians and their respective trainees, and any other health professional assessing patients presenting with dizziness (who may ultimately have a neurologic, cardiac or another cause for this presenting symptom).

#MedicalEducation #Doctor #Vertigo #Dizziness #RNeurologyEducation