Unusual emboli, and software versus hardware - Case Reports December 2025

Another set of intriguing cases from the latest issue of the journal, pored over by the Case Reports team. 

In the first case, a 24-yo man presents acutely with reduced consciousness, following 3 days of right-sided headache. His mother reports sudden behavioural changes with jerky movements and enlarged pupils. He is agitated, not obeying commands and not moving his left-side limbs. He had a history of autism and vascular Ehlers-Danlos syndrome and was on medication for stroke prevention. An MRI scan led to a differential diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES), but the final conclusion came post-discharge after a further review of his scans. 

https://pn.bmj.com/content/25/6/549

The second report (19:37) describes two curious instances of functional neurological disorder (FND), both of which improved after the patients were in comatose states. The first patient is a 59-yo man who had developed muscle weakness shortly after at car crash at age 49, and had subsequently been reliant on a wheelchair for more than 8 years. Recently the patient had been infected simultaneously with severe cases of flu and COVID-19, during which he had been sedated and placed in an induced coma for several weeks. Awakening from the coma, the patient showed surprising signs of new mobility. In the second patient, a 40-yo woman presented with flaccid paralysis of her left arm, with loss of sensation up to the shoulder. She had a history of bipolar disorder and agoraphobia. She was diagnosed with FND and participated in physiotherapy and hypnotherapy with no improvement. Thirteen months later she was readmitted following an overdose on a mix of analgesics and sedatives, and was ventilated in the ITU for several hours. Upon waking the patient noticed that her previously paralyzed arm had completely recovered.

https://pn.bmj.com/content/25/6/562 

Further reading:

Advances in functional Neurological disorder (BMJ Neurology Open)

 

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 October 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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