Riisfeldt Neurology Education

This instalment brings another journal club episode, this time in the Parkinson’s disease and movement disorders series, focussing on the diagnostic accuracy of dopamine uptake scans (DAT SPECT; DaTscan) for Parkinson’s disease and the other primary extrapyramidal disorders/Parkinson’s plus syndromes (progressive supranuclear palsy, PSP; multiple system atrophy, MSA; corticobasal degeneration, CBD), and distinguishing these from other neurodegenerative conditions which may manifest with Parkinsonian features, and from other non-neurodegenerative conditions such as essential tremor, dystonic tremor, drug-induced Parkinsonism and vascular Parkinsonism. The episode also provides an example of critically evaluating a journal article and determining how it should...

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 cr...

Hope you’re ready for an important one! In this next instalment in the stroke & cerebrovascular diseases series we discuss how to effectively run a stroke call/code stroke, focussing on establishing the time last seen well (or midpoint of sleep), the baseline function (modified Rankin scale; mRS), stroke deficits (National Institutes of Health Stroke Scale; NIHSS), relevant comorbidities, & anticoagulants & antiplatelets. This then allows us to quickly and effectively make a diagnosis and a management decision in regard to whether the patient is eligible for thrombolysis &/or mechanical thrombectomy (endovascular clot retrieval; ECR). As always, the episode is presented in an...

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 eac...

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 i...

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 vertig...

We’ve got another surprise installed for you today… the first episode in the neuro-otology and vertigo series! (Again as an overlap with our ongoing clinical method series). This episode focuses on the HiNTs+ examination in distinguishing central from peripheral causes of an acute vestibular syndrome, in particular distinguishing a posterior circulation stroke (of the brainstem or the cerebellum and its connections) from vestibular neuritis. The episode then changes tack to discuss the Dix-Hallpike examination and then the horizontal head roll (log roll) tests to diagnose posterior canal and geotropic/ageotropic horizontal canal BPPV (benign paroxysmal positional vertigo), respectively, and...

This is the first episode in the neurological procedures series… drum roll please… you guessed it, it’s the lumbar puncture (LP)! This episode describes at length the many indications for lumbar punctures (a super helpful procedure!), the contraindications and how to evaluate these, how to consent the patient, what equipment is required and recommended, different options for ways to perform the procedure, and then of course a step-by-step how-to guide including invaluable tips and tricks, to hopefully improve all of your abilities in performing this essential procedure. The episode then concludes by providing a logical way of grouping and re...

Correction: 19:30 Visual threat testing is for testing visual fields when the patient isn't properly responding to your initial standard field testing (not for when there is already an established field deficit in a cooperative and responsive patient)

Correction: 21:31 Should say "retrochiasmal components" (not "upper motor neuron components", oops!)

Correction: 45:56 Same as for my initial correction

We’re very excited to present the first episode in the stroke and cerebrovascular diseases series! (As an overlap with our ongoing clinical method series). This episode focusses on how to perform a NIHSS hyperacute st...

This episode further continues our clinical method series by turning to the lower limb examination, focussing on tips and tricks to optimise your examination technique assessing inspection, tone, power, reflexes, sensation, coordination, stance and gait. The diagnostic utility of many of these examination components are critically discussed, and various pearls and pitfalls are highlighted, along with linking the examination to relevant clinical presentations in order to form mental connections and aid memorisation.

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This episode continues our clinical method series by turning to the upper limb examination, focussing on tips and tricks to optimise your examination technique assessing inspection, tone, power, reflexes, sensation and coordination. This episode also introduces some neurophysiological and anatomical principles, and ties these in with key patterns encountered in clinical neurology (such as distinguishing an upper from a lower motor neuron lesion), to assist with consolidation and memorisation.

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This episode is part 2 of the session taking a deep dive into the specific examination techniques for each cranial nerve, focussing on pearls and pitfalls for optimal testing, along with focussing on linking the examination to relevant neurological pathologies for contextualisation and to aid memorisation. This episode, part 2, focuses on cranial nerves V and VII-XII (the trigeminal, facial, vestibulocochlear/auditory, glossopharyngeal, vagus, spinal accessory and hypoglossal nerves), before concluding with a slightly condensed and more efficient way to examine the cranial nerves in routine day-to-day neurological practice.

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This episode begins with a description of the examinable components of each cranial nerve, and how they are best grouped together for an efficient and logical examination, before taking a deep dive into the specific examination techniques for each cranial nerve, focussing on pearls and pitfalls for optimal testing, along with focussing on linking the examination to relevant neurological pathologies for contextualisation and to aid memorisation. This episode, part 1, focusses on cranial nerves I-IV and VI (the olfactory, optic, oculomotor, trochlear and abducens nerves).

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This episode discusses how to semiologically distinguish nocturnal hypermotor (hyperkinetic) seizures typical of sleep-related hypermotor epilepsy (SHE, formerly nocturnal frontal lobe epilepsy, NFLE) from the two main differential diagnoses for paroxysmal sleep behaviours, namely exaggerated/confusional physiological arousals and various parasomnias (in both NREM and REM sleep, especially night terrors and REM sleep behaviour disorder). The semiological features that we focus on are the frequency, timing and duration of the events, whether the events are triggered and whether they have a discrete offset and result in complete arousal from sleep, whether there is subsequent coherent recall, whether the motor...

This short (and less serious!) episode explains the many hidden details in our intricate logo, with a few perhaps unexpected learning points discussed along the way, including a brief discussion of different ways of acquiring an electroencephalogram (EEG) recording, the four radiological locations for typical multiple sclerosis (MS) lesions, some of the clinical symptoms and signs of idiopathic Parkinson’s disease (iPD), one of the advanced therapy treatment options for migraine, the surface anatomy for performing routine motor nerve conduction studies (NCS) on the median nerve at the wrist in the context of carpal tunnel syndrome (CTS), the most co...

This episode discusses how to distinguish a bilateral tonic-clonic seizure (of generalised, focal or unknown onset) from a convulsive syncope and from a psychogenic non-epileptiform spell/seizure (PNES, as part of functional neurological disorder, FND).  To do so, we focus on key aspects of the semiology of the episode in addition to other relevant historical factors in the systems review, past medical history, epilepsy risk factors, family history and psychosocial history, along with important discriminatory examination and investigation findings.  The episode then discusses how to weigh all of this information together in order to formulate a provisional diagnosis, and th...

This episode first explores the clinical definition of epilepsy, why diagnosing epilepsy is important, and the fundamental steps required to make an accurate diagnosis.  It then discusses the relationship between seizure classifications and epilepsy classifications, and the core clinical and electrographic components that constitute an epilepsy syndrome.  It then provides a detailed overview of the specific epilepsy syndromes as defined by the International League Against Epilepsy (ILAE), divided into age of onset (neonates/infants, children, and juveniles/adults/variable age of onset), including a closer look at Lennox-Gastaut Syndrome (LGS) in particular.  It then addresses the relationship between the Gen...

This episode explores the ways in which seizures can be pathophysiologically, clinically and electrographically defined, and considers the various possible clinical manifestations of seizures, before scrutinising the current 2025 International League Against Epilepsy (ILAE) classification of seizures, encompassing focal, generalised and unknown-onset seizures, followed by a comparison of this current schema with their previous iterations.  The video then takes a deep dive into the distinction between unprovoked seizures vs. provoked/acute symptomatic seizures vs. reflex seizures, and by extension the distinction between precipitating, provoking and triggering factors for a seizure. The episode then concludes with a detailed discussion of the c...

This episode begins by reviewing the importance of optimal history taking in clinical neurology, along with associated history-taking pearls and pitfalls, before exploring the ordering and components of the history.  It then progresses to an in-depth discussion of the history of the presenting complaint, systems review, past medical history, family history, medications and allergies, and the psychosocialhistory, as they pertain to a range of general and subspecialty neurology presentations including epilepsy/seizures, stroke, headache/migraine, movement disorders/Parkinson's disease, neuroimmunology/multiple sclerosis, andneuromuscular conditions such as myopathies.

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Welcome to the inaugural episode of Riisfeldt Neurology Education (@rneurologyeducation), a not-for-profit, free open access and easily accessible project exploring all areas of clinical neurology! I’m your host, Dr Thomas D. Riisfeldt, an Australian neurologist, epileptologist, and neurophysiologist/neuromuscular specialist, and also a physician, philosopher and bioethicist. This podcast is aimed at medical students, neurologists/physicians and their trainees, and any other medical, nursing or allied health professionals involved in the care of patients with neurological conditions. Listen to this first episode if you'd like to find out about the project's rationale and aims, methods, and my own pr...